Costs & Financial Considerations

Cosmetic surgery of any kind is not covered by medical insurance. Therefore, cost is probably the number one limiting factor for most individuals seeking cosmetic stature lengthening. The Paley Institute provides detailed cost estimates that cover most aspects of treatment.

The cost of surgery with physical therapy using the PRECICE 2 is $90,000 for bilateral femoral lengthening and $100,000 for bilateral tibial lengthening. For individuals who undergo femoral lengthening followed by tibial lengthening, we offer a package price of $180,000 (PRECICE 2) if the two lengthenings are performed six or more months apart. If the two lengthenings are staggered two to three weeks apart such that their physical therapy overlaps, there is further cost savings with a total price of $175,000. In some select individuals we will consider simultaneous femur and tibia lengthening at one surgery for a total cost of $165,000. Please note that there is a higher risk for fat embolism which can lead to death if both femur and tibia devices are inserted at one time. Although we have never had this complication, it remains a serious theoretical risk. It remains safer to do the two lengthening surgeries on separate dates separated by at least two to three weeks apart.

Cost Estimate

The price for PRECICE lengthening covers the following costs in addition to the surgery itself:

  • Hospital stay for up to 4 days; there is a surcharge for patients staying longer than this.
  • All hospital charges relating to the operating room and recovery room.
  • Surgeon fees.
  • Anesthesiologist fees.
  • Surgery assistant fees.
  • Hospitalist fees (internal medicine doctor available during the entire hospital stay).
  • Radiologist fees.
  • All x-rays. Up to 11 weeks for femurs and 13 weeks for tibias. There is a surcharge for additional x-rays.
  • All office visits. Up to 11 weeks for femurs and 13 weeks for tibias. There is a surcharge for any additional office visits.
  • Wheelchair, walker, crutches, and bedside commode as needed for post-surgery rehabilitation; provided as part of discharge from the hospital.
  • Physical therapy daily, 5 days per week, at the Paley Institute’s outpatient rehabilitation department. Up to 11 weeks for femurs (55 visits) and 13 weeks for tibias (65 visits). Physical therapy may be available on weekends for a surcharge. There is a surcharge for any additional visits beyond the allotted amount (55 for femoral lengthening and 65 for tibial lengthening).
  • Transportation to and from the Paley Institute and the extended stay hotels on the approved list. Transportation is available daily for physical therapy appointments as well as office visits.

The following is not covered in the cost estimate:

  • Medications and pharmaceuticals (pain medicine and anticoagulants).
  • Accommodations in West Palm Beach.
  • Travel to and from West Palm Beach.
  • Travel to the hospital on weekends (although the hotel shuttles will usually provide this for free).
  • Food and other supplies during your stay in West Palm Beach.
  • Entertainment and/or Internet costs.
  • Home health aides (nurses, homemakers, etc.).

Potential Additional Costs

The pricing for the femur and tibia lengthening includes all additional ancillary procedures, such as iliotibial band release and biceps tendon lengthening for femur lengthening and gastro-soleus recession (if needed) for tibial lengthening. These are done to prevent complications. The need for this is determined at the first consultation. Dr. Paley performs three muscle length tests (Ober test, Popliteal Angle measurement, and Ely test) to determine if the iliotibial band-fascia lata, hamstrings, and rectus femoris muscles are too tight. It is not possible to advise a patient of this without seeing them first. The greater the amount of lengthening the more likely is the need for such soft tissue releases. For example, every patient with an 8 cm lengthening requires an iliotibial band release while only 50% require this if less than 5 cm is carried out. For tibial lengthening, a Silverskiold test (physical examination) will assess the Achilles tendon. If the Achilles tendon is too tight, then a gastro-soleus recession is required prior to lengthening.

If these structures are tight before surgery and not prophylactially lengthened then muscle / joint contractures may develop and require later, more expensive surgery (these are commonly referred to as duck ass deformity for tight iliotibial band and fascia lata, and ballerina feet for tight Achilles tendon). Prophylactic anterior compartment release may be done at the time of tibial lengthening. This is done to prevent compartment syndrome. The normal cost of these releases is built into the global fee for the lengthening surgery.

Fortunately, complications that require additional surgery are uncommon. We had two patients in the past 50 that experienced unexpected complications that required additional unplanned surgery to fix. This lead to additional costs of about $30,000 each to fix the complication. This risk is about 4%. It is therefore our recommendation to keep about $30,000 in reserve.

Insurance Coverage

Cosmetic surgery of any kind is not covered by medical insurance. Therefore, cost is probably the number one limiting factor for most individuals seeking cosmetic stature lengthening. Not only will insurance not pay for the surgery, but if a complication arises that requires additional surgery, insurance will not pay for the costs associated with treating the complications.

Can I get the surgery cheaper in other countries and is it safe?

The Paley Institute is the safest place in the world to have this surgery.

Costs vary by country, center, surgeon, and technique. The cost of the device contributes a lot to the cost of the procedure. External fixators, while expensive when new, can be reused. Therefore, the cost of external fixators can be quite cheap. Undergoing lengthening with external fixators can be very unpleasant, with bulky external fixators, complications such as pin site infections, joint stiffness, and scars. The experience does not compare to having it done with the newest, safest technology with few scars and minimal pain (PRECICE).

Many patients choose to go overseas for treatment only because of cost. There are many centers where you put yourself at risk of disaster and permanent disability. Dr. Paley has had to fix the complications of surgery of many of these patients who had lengthening performed overseas. Since this surgery is very lucrative, it is open to abuse all over the world, including the United States. It can be very difficult for the consumer to discern where to go. All limb lengthening surgeons and centers are not the same. Just because it is cheaper does not mean the patient will get the desired result. In short, you get what you pay for. While the cost in the United States is higher, the safety factor is proportionally higher. In the past 5 years, Dr. Paley has seen and operated upon 20 American and foreign patients to correct complications they received when they went to have cosmetic stature lengthening at less expensive centers overseas. The cost to reconstruct and rescue their limbs was as high as or higher than the cost to undergo the procedure at the Paley Institute in the first place. The final result, while improved, did not compare to the final result had the patient come to the Paley Institute initially. Finally, the PRECICE is the most advanced and safest method available for cosmetic lengthening, with less pain and lower complications.

Payment Schedule

Full payment is due two weeks before surgery or the surgery will be cancelled. Payment can be made by wire transfer or certified check but not by credit card. A non-refundable deposit of $10,000 is due at least two months before surgery. The deposit can be made by credit card on the phone or by wire transfer. We will not hold a surgery date for more than 3 days without a deposit. Cancellation or change of surgery date by the patient or their family with less than two months’ notice results in loss of the deposit. The deposit is fully refundable if changes or cancellation of surgery are more than six weeks before the booked surgery date. The deposit money is part of the total fee and will be credited to the total amount due if it is not lost due to late cancellation or changes. In the case of late cancellation, rebooking of surgery will require another deposit.

Complications

Complications, although infrequent, can occur and may require surgery to treat and to prevent a negative outcome. An example is premature consolidation of the bone which requires re-breaking the bone. Another is nerve entrapment which requires nerve decompression surgery. Another is muscle contracture which requires lengthening of muscles, tendons, or fascia. Finally, there can be failure of bone healing after the end of the distraction phase requiring repair of nonunion. The cost to treat most of these complications ranges from $12–$35,000. It is important to keep this money in reserve in the rare case of a complication. As long as you follow all medical directions and precautions, the likelihood of developing a complication that requires additional surgery is less than 5%.    

For more information on the potential complications of stature lengthening, see Complications.

Package Prices

Many patients ask if they can lengthen the femur and tibia at the same time to save time and expense and to get more length and better proportions. Lengthening both bones is much more involved and more expensive than lengthening only one pair of bones.

Options Cost Maximum Length Gain Risk

Do the femur and tibia lengthening surgery at the same time in one surgery

$165,000 5 cm + 5 cm = 10 cm total Highest risk for fat embolism and death
Do the femur and tibia lengthening surgery three weeks apart in two surgeries $175,000 5 cm + 5 cm = 10 cm total More pain
Do the femur and tibia lengthening surgery a year apart in two surgeries $180,000  8 cm + 6.5 cm = 14.5 cm total

Smallest risk and greatest length gain

 

Option 1 is the highest risk and we do not recommend it since there is a much higher risk of fat embolism, which can lead to death. I have only performed this option in one patient. Fortunately, he did not have any complications.

Option 2 is the safer way of achieving 10 cm lengthening at one time by overlapping the two surgeries. The treatment time is a little longer than Option 1 by about three weeks. The cost is reduced compared to Option 3 since the physical therapy is done at the same time.

Option 3 is the safest way and allows getting the most lengthening since the femur and tibia lengthenings are done at different times. It requires more physical therapy and more time. We give a discount on the second lengthening of $10,000 so the total is lower than the normal femur plus tibia costs.

Although femur and tibia lengthening can be done at the same time we prefer not to insert the femur and tibia rods in the same surgery due to the theoretical increased risk of fat embolism syndrome from reaming the medullary canal of more than two bones at a time. To insert 4 rods at the same surgery would increase the chance of fat embolism and death. We have done this successfully without complication but do not recommend it.

Next Page: Complications