Short stature or bow legs can cause a significant psychological suffer. The number of the patients who wants to improve the shape or length of their legs has been increasing recently.  However, not everyone decides to do surgery due to lack of information or financial difficulties. Regarding possibilities of contemporary aesthetic surgery of legs NEWS.am.Medicine took an interview from Professor Arshak Mirzoyan, MD. 

Dr Mirzoyan, you are performing surgery to lengthen legs : who are your patients, men or women? Mostly the youth or people above 40?

Mostly, our patients are people from 20 to 40. Our oldest patient was from Georgia, at the time of operation he was 47. He lengthened his legs by 6 cm, then we knew, that he got married, for the first time.

Who apply to you more often, women or men? Who are more concerned of the beauty of their legs?

Approximately it is the same. Women are most worried about the shape of their legs; men are concerned about their length.

What technologies are used for aesthetic leg surgery? Do you use any implants?

No, implants are not used. This is the Ilizarov method. Under certain mechanical conditions, all tissues have ability to grow. Ilizarov method is one of the most significant discoveries in orthopedics in the 20th century, and it is very well known worldwide as one of the most powerful method for solving various orthopedic problems. But if it is possible to lengthen the limb for orthopedic reason, then why not to do it also in aesthetic surgery? 

No foreign materials are remained after our treatment in limb. These are their own newly grown tissues and newly grown bone.

How much time is required for lengthening legs and how long is the rehabilitation period?

Duration of procedure directly depends on how many centimeters you want to lengthen your legs: for example, 3 or 13. Bone grows 1 to 2 mm per day. Approximately 20 days are required for each centimeter of lengthening, so as the newly grown bone gets weight bearing capacity, and then only after clinical test frame is removed. In the process of lengthening and fixation the patient walks and does medical exercises under the guide of physical therapist.

How long should the patient be under medical care after the surgery? What kind of post operational procedures are required?

We have a well-coordinated team, and everyone knows what to do. The patient always remains under care of our staff (physicians, nurses, physical therapist). The first steps patients do on the next day of the surgery. In 3-7 days, they are able to walk enough to be discharged from hospital and to continue treatment in outdoor condition. Foreign patients continue their treatment in the apartment that we provide, but they are under permanent medical care. Periodically, we call patients to the clinic for control X-ray examination to determine how the bone increases. The rest of necessary procedure (re-adjustment of apparatus, bandaging etc.) we perform at home.

How soon patients can return to normal activities, work, run etc.?

After frame removal usually about up to one month, we recommend to be careful, because the newly grown bones need some time, to be completely rebuilt and to obtain the necessary mechanical characteristics. 3 months from frame removal, there are no limitations: you can do sports, even jump with parachute if you wish. It takes about two months to fully restore joints range of motion, completely restore the gait, and the patient returns to normal full life.

How developed is this sphere in Armenia, what are the perspectives of development? In your opinion what are the problems? Perhaps, new technologies are required?

I think this field in Armenia is developed enough; otherwise, patients from developed countries didn’t come to us for treatment. Of course, many fields in medicine including aesthetic surgery keep developing. We participate in all major international forums as frequently possible, trying to share our experience and bring these innovations into our country. Probably soon we would implement new technique of leg lengthening with self-extending intramedullary nails. Today it is a relatively expensive operation performed in a few centers in Europe and USA. But as a rule, new methods at first are expensive and less available, but then the society gets used to the prices, operations themselves become cheaper. When local patients will be able to afford it, we will provide these technologies as well.

Now we have come to the most exciting issue for potential patient: how much is such an operation? They tell it is rather expensive...

The price depends on amount of lengthening. I can only say that it is not a cheap procedure, because the whole process is long-lasting and laborious. From the beginning to the end, the whole staff works with the patient. It is not cheap, but the price is reasonable. We had patients from various countries including Russia, Georgia, Japan, USA, Middle East, Australia… Because the ratio of our price/quality is one of the most competitive in the world.

For example, in Russia the same operation costs from $5000 to $10000. Is that a reasonable price?

It is not too much for such a surgery and procedure in general. our price is  approximately the same.

Is it possible to study your specialization at Yerevan State Medical University or is it necessary to study it abroad?

In Armenia study and application of Ilizarov method is relatively good but it is implemented mostly in trauma and orthopedic cases. As far as I know, this method in aesthetic surgery is not taught because it is a rather narrow specialization, and there is not much demand for such specialists yet.

Do you inform your patients about the details of the upcoming operation?

Sure. The patients should be well informed about the details of upcoming treatment: moderate pain after the surgery, duration of the process, level of discomfort when doing physical therapy and other possible details. We prefer and often we contact new patients with ex-patients, who have experienced lengthening and/or correction of leg shape. As a rule, it has a great psychotherapeutic effect and stimulates patients’ motivation.

The operation is performed under general anesthesia? What type of anesthesia is used?

Mostly it is an epidural/spinal anesthesia. But the final decision is made by anesthesiologist after examination of the patient.

Are there any age limitation?

Operation can be performed only after complete physiological zone arrest. Sometimes due to late development, growth continues up to 20 years, but that is a very rare case. There is no upper level limit for such an operation.

Besides leg lengthening do you correct bowlegs?

Of course. There are numerous articles, witnessing how the shape and length of legs can cause significant psychological discomfort.  Our modest experience certainly proves it. It isn’t new that beautiful legs are always attractive. You don’t have to be a doctor to agree with that. Beside that recent studies testify that patients with «О»-type curve have increased chance of knee arthritis in future, due to not proper distribution of biomechanical bearing between medial and lateral condyles. Following that this surgery not only brings peace of mind but also prevents knee arthritis in future.

Just one very recent example: a girl from Russian Black Sea corrected her bowlegs. She left happy home and keep her contact with our office manager. Once to her answer to how are you? She answered bad, but why? Because she got sunburnt at the beach. Our manager asked why she had spent so much time under the sun. The answer was, “You don’t understand, the sea was always nearby, but because of my bowlegs didn’t let me enjoy it.”

As it was mentioned besides local patients, we have patients from various countries, who stay in Armenia relatively a long time, spend money on living, though this is not big money, but it is still income. This can be called medical tourism, which exist in many countries with developed medicine.

What are the limitations? Who is not allowed to do such an operation? Whom will you send back home as a doctor?

The patient should be a somatically healthy adult. It is important to know the motivation of the patient: how the shape or length of his legs affects his self-estimation. Sometimes there are visited by people with normal legs who think that they are ugly and unattractive. In such cases we direct them to psychotherapist.

Do you practice charity? There are people, who need your help, but do not have enough money.

We practice charity only in orthopedic cases. We find money ourselves for patients from vulnerable families and treat them charge free, but aesthetic surgery is not included in this sphere.

The cognitive conversation ended on positive notes. To our question whether there are talented young men in Armenia, whom he could entrust such operation, Dr Mirzoyan answered, that there are such young men, and now they work with him. Nevertheless, one of the main issues is the credibility of the doctor; patients more trust experienced doctors with good name. However, technically, all the doctors do the same on a very high level. Doctor is very sure of his followers and trusts his trainees, who can operate as good as he can.

Interviewed Ani Liparityan

“Look: from the buttocks to the shoulder, from the buttocks to the knees, from the knees down shin with the foot, it makes isosceles triangle. We have achieved this after treatment. If the knee does not reach the level of the shoulder, according to certain standards it is considered a disproportionate ratio of the length of the body and lower extremities, which is not rare. This girl we brought to such a standard by lengthening her tibias and femurs by 11 cm. I think, it is beautiful.”