This guide covers LL basics and answers your most common questions upfront.
Once you're clear on the fundamentals, head to LL forums for surgeon picks, cost breakdowns, and specifics.
\
BASICS
Leg Lengthening Overview
Leg lengthening is a surgical procedure aimed at increasing the length of the leg bones, the femur (thigh bone) and tibia (shin bone). The surgery begins with an osteotomy, where the bone is carefully cut. A specialized device is then used to slowly pull the bone segments apart over time, stimulating the body to create new bone in the gap. This gradual process is known as distraction osteogenesis and typically allows lengthening of up to about 5 cm (2 inches) per bone in a single round. Larger gains can be achieved through staged procedures.
Distraction Speed
A critical component of successful leg lengthening is the distraction speed, commonly set at approximately 1 millimeter per day (often divided into four adjustments of 0.25 mm every 6 hours). This rate is considered optimal because it allows new bone tissue and the surrounding blood vessels, nerves, muscles, and skin to keep pace with the lengthening process without causing premature bone consolidation or damaging soft tissues. Distraction faster than 1 mm/day risks poor bone regeneration, while slower rates may lead to premature healing and insufficient lengthening.
Age Factor
This 1 mm/day distraction rate is generally applied to patients from children through young adults up to around 30 years old who have good bone healing capacity, this age group heals the same. For older patients, especially those of advanced age, distraction is usually done more slowly eg. 0.6mm/ day to accommodate slower bone regeneration and reduce complications.
This is how it’s performed
▶ Watch the video here
Rod Removal
It’s not 100% necessary but recommended to avoid future complications, it can be removed after the consolidation phase but usually delayed till full healing. Don’t need to go to the same surgeon who put it in, it’s relatively easy & 1 day procedure. The external device is removed right after lengthening — here I mean the internal device.
TYPES OF DEVICES
Fully Internal Nails (Precice, STRYDE, Fitbone)
How it works: A telescopic rod inside the bone lengthens with an external remote (magnetic or motorized).
Pros:
- No external pins → lower infection risk.
- Better comfort and mobility during distraction.
- Easier to hide socially.
Cons:
- expensive.
Best for: Those willing to pay for comfort, aesthetics, and lower day-to-day hassle.
LON (Lengthening Over Nail)
How it works: External fixator starts the lengthening, but there’s an internal nail from the start. Once length is achieved, frame is removed, nail supports healing.
Pros:
- Cheaper than full internal.
- Frame removal happens earlier than pure external methods.
- Also minimal scarring.
Cons:
- Pin site infections are common. This is what raped that Looksmaxxing Channel guy with Sean o’ pry pfp.
- Frame phase still awkward for walking and sleeping.
- Can’t do quadrilateral with this — will need to use internal for 2 limbs minimum.
Externals
Not worth consideration, jestermaxxed af.
Will rape you with so many scars.
Everybody gonna know you did LL & think you’re retarded.
You’ll look disgusting.
Phases of LL
The treatment process usually involves:
Latency phase – 5–7 days after surgery before lengthening starts. They wait a week after cutting your legs & inserting rod before they start lengthening.
Distraction / lengthening phase – ~80 days. Daily small adjustments at about 1 mm per day (for typical patients) until the desired length is achieved, monitoring for bone healing and soft tissue adaptation.
Consolidation phase – ~12 weeks. Bone hardens and strengthens around the new length.
Full treatment often spans several months, with intensive physical therapy required to maintain flexibility, prevent stiffness, and rebuild muscle strength.
Risk & Complications
*(With a good clinic, most of these are rare and easily prevented)*
Fat Embolism (FES)
• What – Fat from bone marrow enters bloodstream; severe cases can affect lungs.
• Likelihood – Microscopic fat enters blood in all cases, but symptomatic FES is ≈ 1% with modern precautions; severe ICU-level cases are ~0.06%.
• Prevention – Slow & careful reaming, venting the bone, IV albumin, strict no-nicotine for 3+ months.
• If it happens – Usually mild & treated with oxygen; severe cases get ICU care (full recovery likely with early treatment).
Pulmonary Embolism (PE)
• What – Blood clot travels to lungs.
• Likelihood – Almost zero now at Paley’s center; past spike (6–7%) was during peak COVID clotting.
• Prevention – Daily blood thinners, early walking, extra monitoring for high-risk patients.
• If it happens – Treated with anticoagulants until clot dissolves.
Muscle Contracture
• What – Tight muscles limit joint movement during lengthening.
• Likelihood – Common if patient skips stretching; very low if compliant.
• Prevention – Aggressive daily stretching & splints; pause lengthening if range drops too much.
• If it happens – PT usually restores range; surgery very rarely needed.
Delayed Union / Non-Union
• What – Bone heals slower than expected.
• Likelihood – 0% complete non-union in Paley’s stature patients to date.
• Prevention – Correct distraction speed, small-incision bone cut, keep vitamin D high.
• If it happens – Adjust speed, use bone stimulators, rare bone graft.
Premature Consolidation
• What – Bone heals too quickly before target length is reached.
• Likelihood – Rare in adults.
• Prevention – Maintain exact distraction speed; check device often.
• If it happens – Re-break bone or adjust device.
Peroneal Nerve Compression
• What – Nerve at knee gets compressed → foot drop risk.
• Likelihood – Pain fairly common, actual weakness rare.
• Prevention – Preventive decompression in high-risk patients.
• If it happens – Immediate decompression (near 100% recovery if early).
Malalignment
• What – Bone drifts out of correct angle.
• Likelihood – Almost zero with proper blocking screws.
• Prevention – Correct starting point & nail placement.
• If it happens – Corrective surgery.
IT Band Tightness
• What – Tight fascia affects gait.
• Likelihood – Common without release; rare with it.
• Prevention – IT band release during femur surgery if needed.
• If it happens – Fascia loosens naturally during recovery.
Pre Surgery Preparations
Exercise – Build Strength Before
After surgery, stability drops instantly and muscles start shrinking fast.
The stronger you are going in, the easier LL will be. (Yes, gear can shortcut this — but a good base still helps.)
Key muscle groups to train:
• Quads, Hamstrings, Glutes
• Hip Abductors — especially the glute medius. Weakness/tightness here is what causes this Jester Penguin
walk
Watch example here
Stretching is Cope Pre-Surgery
No, you can’t “bank” flexibility. Muscles & tendons don’t store it for later.
Pre-surgery stretching won’t save you from post-op stiffness — it’s just Jestermaxxing.
Quit Vaping
Damaged lungs can’t filter fat emboli well during surgery.
Nicotine needs to be avoided at-least 3-months before surgery.
If you’ve vaped in the last 3 months, you’re not ready. Simple as.
Stop Smoking
Smoking crushes bone blood supply, slows healing, and weakens lungs right when you need them most.
Quit months ahead — or don’t even bother booking the surgery.
Medical Clearance
Make sure you’re screened for:
• Clotting disorders
• Heart issues
• Lung conditions
(Your surgeon will want these cleared before they operate.)
Max Safe Length & Limitations
Everyone wants max height for the pain they’re about to go through. But there are hard limits set by your own anatomy, not just by the bone. You’re not just stretching bone, you’re stretching every single piece of soft tissue that runs alongside it. Nerves are what determine max length the most & no peptide can dramatically speed up their adaptation.
Safe Length Guidelines
Femurs: Around 8 cm in one surgery is the accepted safe limit for most people.
Tibias: Around 6 cm in one surgery is the accepted safe limit.
These aren’t arbitrary, they come from decades of data on when complication rates spike sharply.
These are max lengths. If complication occurs, lengthening needs to be stopped immediately, doesn’t matter whether you did 7 cm or 2 cm.
Why These Limits Exist
When you lengthen, every soft tissue structure crossing that bone has to elongate:
• Muscles – quadriceps, hamstrings, gastrocnemius, soleus, tibialis anterior, etc.
• Tendons – patellar tendon, Achilles tendon.
• Fascia – iliotibial band, crural fascia.
• Nerves – sciatic, peroneal, tibial nerve.
• Blood vessels – femoral artery/vein, popliteal vessels.
These tissues can only adapt so fast before something gives. Go past tolerance, and you risk:
• Permanent joint contractures.
• Nerve palsy (foot drop, numbness).
• Chronic pain and gait issues.
You can’t really get extra length with roids/peptides either.
You can make it easier to quickly walk properly — but more length is not highly achievable mainly because of nerves not being sped up dramatically with roids.
Does that mean 14 cm, That’s All I Can Get?
Good news — NO, you can gain 20cm or more
If you’re patient, you can push it up to 20 cm total safely.
You just need to respect how long it takes your soft tissue to adapt before going in for round two.
The realistic way to hit 20 cm:
First surgery: 8 cm femur + 6 cm tibia = 14 cm
Wait ~1 year (let your muscles, tendons, fascia, and nerves fully adapt)
Second surgery: Another 6 cm on the tibia
tho it will depend on you initial proportions, not everyone can gain 20cm
Why not double surgery on femur?
look up last chapter, "Proportion & Biomechanics"
Quadrilateral Lengthening
Lengthening both Femur & Tibia at the same time
Quadrilateral vs Staged Femur/Tibia Lengthening
Factors to consider:
Total Timeline
• Quadrilateral – Shortest possible — both segments lengthened & consolidated together; walking normal in ~8 months.
• Staged – 2× longer — must complete first segment before starting second.
Cost
• Quadrilateral – Cheaper overall (fewer surgeries, hospital stays, anesthesia). Most clinics offer 10–20% discount.
• Staged – More expensive (double surgeries, hospital stays, rehab phases).
Soft Tissue Strain
• Quadrilateral – Highest — knee joint structures (hamstrings, gastroc, capsule, PCL) stretched from both ends.
• Staged – Moderate — only one segment stretches shared structures at a time.
Max Safe Length (No Enhancement)
• Quadrilateral – ~10–14 cm total.
• Staged – ~14 cm total possible.
Max Safe Length (With GH + Peptides)
• Quadrilateral – ~12–14 cm total.
• Staged – ~14 cm total possible (over two surgeries).
Fat Embolism Risk
• Quadrilateral – Higher — double intramedullary work in one surgery, but if delayed ~1 week it’s same as staged (cost increases slightly).
• Staged – Lower — spread over two surgeries.
Surgeon Willingness
• Quadrilateral – Also widely available but some avoid or put heavy restrictions — Paley avoids it; Donghoon & others do it.
• Staged – Widely offered by most LL surgeons.
Rehab Difficulty
• Quadrilateral – Harder — more tissues adapting at once, same pain per mm lengthened.
• Staged – Easier — fewer tissues adapting at the same time.
Pain
• Quadrilateral – Same total pain as staged.
• Staged – Same total pain as quads, but spread across two surgeries = more prolonged torture.
Recovery After Surgery
How fast you get off support and start walking again depends a lot on the device you use.
If you’ve got a weight-bearing nail or frame, you can put some load on your legs even during distraction. That means you can take a few unassisted steps at home ,like walking from your bed to grab a bottle, but don’t think that means you can just stroll around.
Walking without support before completing consolidation is asking for trouble. You can start walking without assistance after that.
If we’re talking about real “normal walking” (no limp, no penguinmaxxed jester walking), you’re not getting that at least until consolidation is done and your soft tissues have caught up.
For most people, that’s anywhere from around 9 months to around an year.
You can cut that time down to 7 months if you’ve done your homework, pre-surgery strength, proper rehab, and running the right stack (roids, HGH, peptides).
Why the delay?
• Bone heals faster than everything else.
• Muscles can regain strength quickly, but tendons, fascia, and nerves are slow.
• Until they adapt to the new length, you’ll feel tight, awkward, and off-balance, even if the bone looks perfect on X-ray.
Full strength usually comes back around 18 months to 2 years after surgery in natural recovery, but most people can return to basic sports & start walking properly after the 12–18 month mark.
With a proper enhancement protocol, you can bring that 12 months down to 8–10 months, and hit or beat your old performance in 1 year.
Roids HGH & Peptides for LL Recovery
1. HGH + BPC-157 + GHK-Cu → Soft-Tissue Regeneration (Amplified)
Why:
• HGH / IGF pathways → ↑ collagen synthesis, ↑ tissue turnover.
• BPC-157 → accelerates tendon, ligament, and peripheral nerve healing; boosts angiogenesis; reduces inflammation (animal + preliminary human data).
• GHK-Cu → improves collagen remodeling, angiogenesis, and microcirculation.
Synergy: Creates a highly pro-repair environment for connective tissue.
2. Test E + Tren → Muscle Maintenance / Anti-Atrophy
Why:
• Testosterone → preserves muscle mass & strength, counteracts disuse atrophy.
• GH → preserves lean mass & complements connective tissue repair.
Cautions:
• Test → ↑ hematocrit, transient ↑ VTE risk (esp. within first 6 months).
• GH → fluid retention, potential insulin resistance.
3. BPC-157 Solo → Tendon & Nerve MVP
Why:
• In animal models: speeds sciatic nerve regeneration, enhances tendon outgrowth, boosts angiogenesis, reduces inflammation.
• Rare peptide with direct peripheral nerve repair data.
Note: Human data sparse but promising.
I recommend,
Start with the Distraction phase, few weeks after the surgery.
Don’t be soy about "muh VTE & muscle–tendon, strength balance, fluid retention"
unless you’re genetic trash or a fossil fuel, this shouldn’t be a problem, inform your surgeon, they have tools to check for these problems.
These will increase soft tissue repair by multiple folds.
Tho, nerve adaptation is not sped up that dramatically & it will be the main factor why you aren’t able to reduce the recovery time to below 7 months.
But your strength & function will be way better than if you don’t use these compounds, both during & after LL.
If you are already on roids, you just need to lower dose few weeks before surgery, donate blood & take blood thinners.
Proportion & Biomechanics
Femur-to-Torso : the most important one to consider
The reasons why you shouldn’t do 16 cm femur is because it can push it to 1.7+ —
it matters for squatting, skiing, and some other movements & can mess you up severely.
It will also ruin your aesthetics in motion.
Average femur-to-torso ratio = 1.3
+8 cm femur pushes it to 1.5+.
Functionally: 1.3 is ideal.
Aesthetically: longer femur is preferred, 1.4 is ideal.
1.5 isn’t bad-looking, it’s actually good aesthetically and makes you look taller.
It’s not terrible functionally either.
However: If you already have a high femur-to-body ratio and you add femur length on top,
it’s bad for some sports (squatting, skiing).
1.5 isn’t very bad for most things other than those sports.
If you’re already 1.4+, either reduce femur lengthening or skip it altogether and do tibia-only.
Interlimb (Femur to Tibia)
If you only lengthen one segment (either femur or tibia), you’re fine.
It doesn’t matter much unless you already have very odd proportions & make them worse with LL.
Wingspan-to-Height
Broke copecels & low IQ subhumans keep crying about this ratio, it’s pure cope and overhyped trash.
Go look at any roster of MMA fighters with short wingspans, still look normal af.
The only ones who look bad are those with a bad "Arm to Torso" Ratio, not "Wingspan to Height Ratio"
You won't spot a single person with short wingspan
Humerus Lengthening & Forearm Lengthening
Arm lengthening is a straight up meme surgery unless your wingspan is so pathetic you are like a -4 ape index subhuman and you’re going for 20cm LL on top of that.
If you’re in that clown-tier category, then +4 - 5cm humerus in one surgery = +10cm wingspan.
Do it twice and no one will notice your humerus to forearm ratio.
you end up with 20cm wingspan addition.
Forearms? Forget it. Cosmetic lengthening is purely retarded— the complication rate will obliterate you. you might end up with unusable hand.
no decent surgeon would do this for cosmetic reason.
Leg-to-Full-Body Ratio
Average person: 0.52
Aesthetically ideal: 0.55–0.62
LL will almost always make it better.
Why Post-LL Transformations Look “Bad”
It’s not the bones , it’s just that these jesters went through LL without roids
Bones are lengthened + they’ve been on bed rest & experienced muscle atrophy.
Muscle didn’t fill out the legs, so they look chicken.
After complete recovery, muscles fill your legs up & it’s actually looks more aesthetic than before.
Surgeon Selection
You want someone with specific experience in limb lengthening surgery. Experience is the most important factor. Functional LL experience matters just as much as cosmetic LL experience.
Surgeon's Experience matters the most, they will be the one's handling complications.
Overall Look for:
Don’t just rely on clinic marketing
browse LL forums for real patient reviews, diaries, and complication reports before committing.
Once you're clear on the fundamentals, head to LL forums for surgeon picks, cost breakdowns, and specifics.
\
BASICS
Leg Lengthening Overview
Leg lengthening is a surgical procedure aimed at increasing the length of the leg bones, the femur (thigh bone) and tibia (shin bone). The surgery begins with an osteotomy, where the bone is carefully cut. A specialized device is then used to slowly pull the bone segments apart over time, stimulating the body to create new bone in the gap. This gradual process is known as distraction osteogenesis and typically allows lengthening of up to about 5 cm (2 inches) per bone in a single round. Larger gains can be achieved through staged procedures.
Distraction Speed
A critical component of successful leg lengthening is the distraction speed, commonly set at approximately 1 millimeter per day (often divided into four adjustments of 0.25 mm every 6 hours). This rate is considered optimal because it allows new bone tissue and the surrounding blood vessels, nerves, muscles, and skin to keep pace with the lengthening process without causing premature bone consolidation or damaging soft tissues. Distraction faster than 1 mm/day risks poor bone regeneration, while slower rates may lead to premature healing and insufficient lengthening.
Age Factor
This 1 mm/day distraction rate is generally applied to patients from children through young adults up to around 30 years old who have good bone healing capacity, this age group heals the same. For older patients, especially those of advanced age, distraction is usually done more slowly eg. 0.6mm/ day to accommodate slower bone regeneration and reduce complications.
This is how it’s performed
▶ Watch the video here
Rod Removal
It’s not 100% necessary but recommended to avoid future complications, it can be removed after the consolidation phase but usually delayed till full healing. Don’t need to go to the same surgeon who put it in, it’s relatively easy & 1 day procedure. The external device is removed right after lengthening — here I mean the internal device.
TYPES OF DEVICES
Fully Internal Nails (Precice, STRYDE, Fitbone)
How it works: A telescopic rod inside the bone lengthens with an external remote (magnetic or motorized).
Pros:
- No external pins → lower infection risk.
- Better comfort and mobility during distraction.
- Easier to hide socially.
Cons:
- expensive.
Best for: Those willing to pay for comfort, aesthetics, and lower day-to-day hassle.
LON (Lengthening Over Nail)
How it works: External fixator starts the lengthening, but there’s an internal nail from the start. Once length is achieved, frame is removed, nail supports healing.
Pros:
- Cheaper than full internal.
- Frame removal happens earlier than pure external methods.
- Also minimal scarring.
Cons:
- Pin site infections are common. This is what raped that Looksmaxxing Channel guy with Sean o’ pry pfp.
- Frame phase still awkward for walking and sleeping.
- Can’t do quadrilateral with this — will need to use internal for 2 limbs minimum.
Externals
Not worth consideration, jestermaxxed af.
Will rape you with so many scars.
Everybody gonna know you did LL & think you’re retarded.
You’ll look disgusting.
Phases of LL
The treatment process usually involves:
Latency phase – 5–7 days after surgery before lengthening starts. They wait a week after cutting your legs & inserting rod before they start lengthening.
Distraction / lengthening phase – ~80 days. Daily small adjustments at about 1 mm per day (for typical patients) until the desired length is achieved, monitoring for bone healing and soft tissue adaptation.
Consolidation phase – ~12 weeks. Bone hardens and strengthens around the new length.
Full treatment often spans several months, with intensive physical therapy required to maintain flexibility, prevent stiffness, and rebuild muscle strength.
Risk & Complications
*(With a good clinic, most of these are rare and easily prevented)*
Fat Embolism (FES)
• What – Fat from bone marrow enters bloodstream; severe cases can affect lungs.
• Likelihood – Microscopic fat enters blood in all cases, but symptomatic FES is ≈ 1% with modern precautions; severe ICU-level cases are ~0.06%.
• Prevention – Slow & careful reaming, venting the bone, IV albumin, strict no-nicotine for 3+ months.
• If it happens – Usually mild & treated with oxygen; severe cases get ICU care (full recovery likely with early treatment).
Pulmonary Embolism (PE)
• What – Blood clot travels to lungs.
• Likelihood – Almost zero now at Paley’s center; past spike (6–7%) was during peak COVID clotting.
• Prevention – Daily blood thinners, early walking, extra monitoring for high-risk patients.
• If it happens – Treated with anticoagulants until clot dissolves.
Muscle Contracture
• What – Tight muscles limit joint movement during lengthening.
• Likelihood – Common if patient skips stretching; very low if compliant.
• Prevention – Aggressive daily stretching & splints; pause lengthening if range drops too much.
• If it happens – PT usually restores range; surgery very rarely needed.
Delayed Union / Non-Union
• What – Bone heals slower than expected.
• Likelihood – 0% complete non-union in Paley’s stature patients to date.
• Prevention – Correct distraction speed, small-incision bone cut, keep vitamin D high.
• If it happens – Adjust speed, use bone stimulators, rare bone graft.
Premature Consolidation
• What – Bone heals too quickly before target length is reached.
• Likelihood – Rare in adults.
• Prevention – Maintain exact distraction speed; check device often.
• If it happens – Re-break bone or adjust device.
Peroneal Nerve Compression
• What – Nerve at knee gets compressed → foot drop risk.
• Likelihood – Pain fairly common, actual weakness rare.
• Prevention – Preventive decompression in high-risk patients.
• If it happens – Immediate decompression (near 100% recovery if early).
Malalignment
• What – Bone drifts out of correct angle.
• Likelihood – Almost zero with proper blocking screws.
• Prevention – Correct starting point & nail placement.
• If it happens – Corrective surgery.
IT Band Tightness
• What – Tight fascia affects gait.
• Likelihood – Common without release; rare with it.
• Prevention – IT band release during femur surgery if needed.
• If it happens – Fascia loosens naturally during recovery.
Pre Surgery Preparations
Exercise – Build Strength Before
After surgery, stability drops instantly and muscles start shrinking fast.
The stronger you are going in, the easier LL will be. (Yes, gear can shortcut this — but a good base still helps.)
Key muscle groups to train:
• Quads, Hamstrings, Glutes
• Hip Abductors — especially the glute medius. Weakness/tightness here is what causes this Jester Penguin
Watch example here
Stretching is Cope Pre-Surgery
No, you can’t “bank” flexibility. Muscles & tendons don’t store it for later.
Pre-surgery stretching won’t save you from post-op stiffness — it’s just Jestermaxxing.
Quit Vaping
Damaged lungs can’t filter fat emboli well during surgery.
Nicotine needs to be avoided at-least 3-months before surgery.
If you’ve vaped in the last 3 months, you’re not ready. Simple as.
Stop Smoking
Smoking crushes bone blood supply, slows healing, and weakens lungs right when you need them most.
Quit months ahead — or don’t even bother booking the surgery.
Medical Clearance
Make sure you’re screened for:
• Clotting disorders
• Heart issues
• Lung conditions
(Your surgeon will want these cleared before they operate.)
Max Safe Length & Limitations
Everyone wants max height for the pain they’re about to go through. But there are hard limits set by your own anatomy, not just by the bone. You’re not just stretching bone, you’re stretching every single piece of soft tissue that runs alongside it. Nerves are what determine max length the most & no peptide can dramatically speed up their adaptation.
Safe Length Guidelines
Femurs: Around 8 cm in one surgery is the accepted safe limit for most people.
Tibias: Around 6 cm in one surgery is the accepted safe limit.
These aren’t arbitrary, they come from decades of data on when complication rates spike sharply.
These are max lengths. If complication occurs, lengthening needs to be stopped immediately, doesn’t matter whether you did 7 cm or 2 cm.
Why These Limits Exist
When you lengthen, every soft tissue structure crossing that bone has to elongate:
• Muscles – quadriceps, hamstrings, gastrocnemius, soleus, tibialis anterior, etc.
• Tendons – patellar tendon, Achilles tendon.
• Fascia – iliotibial band, crural fascia.
• Nerves – sciatic, peroneal, tibial nerve.
• Blood vessels – femoral artery/vein, popliteal vessels.
These tissues can only adapt so fast before something gives. Go past tolerance, and you risk:
• Permanent joint contractures.
• Nerve palsy (foot drop, numbness).
• Chronic pain and gait issues.
You can’t really get extra length with roids/peptides either.
You can make it easier to quickly walk properly — but more length is not highly achievable mainly because of nerves not being sped up dramatically with roids.
Does that mean 14 cm, That’s All I Can Get?
Good news — NO, you can gain 20cm or more
If you’re patient, you can push it up to 20 cm total safely.
You just need to respect how long it takes your soft tissue to adapt before going in for round two.
The realistic way to hit 20 cm:
First surgery: 8 cm femur + 6 cm tibia = 14 cm
Wait ~1 year (let your muscles, tendons, fascia, and nerves fully adapt)
Second surgery: Another 6 cm on the tibia
tho it will depend on you initial proportions, not everyone can gain 20cm
Why not double surgery on femur?
look up last chapter, "Proportion & Biomechanics"
Quadrilateral Lengthening
Lengthening both Femur & Tibia at the same time
Quadrilateral vs Staged Femur/Tibia Lengthening
Factors to consider:
Total Timeline
• Quadrilateral – Shortest possible — both segments lengthened & consolidated together; walking normal in ~8 months.
• Staged – 2× longer — must complete first segment before starting second.
Cost
• Quadrilateral – Cheaper overall (fewer surgeries, hospital stays, anesthesia). Most clinics offer 10–20% discount.
• Staged – More expensive (double surgeries, hospital stays, rehab phases).
Soft Tissue Strain
• Quadrilateral – Highest — knee joint structures (hamstrings, gastroc, capsule, PCL) stretched from both ends.
• Staged – Moderate — only one segment stretches shared structures at a time.
Max Safe Length (No Enhancement)
• Quadrilateral – ~10–14 cm total.
• Staged – ~14 cm total possible.
Max Safe Length (With GH + Peptides)
• Quadrilateral – ~12–14 cm total.
• Staged – ~14 cm total possible (over two surgeries).
Fat Embolism Risk
• Quadrilateral – Higher — double intramedullary work in one surgery, but if delayed ~1 week it’s same as staged (cost increases slightly).
• Staged – Lower — spread over two surgeries.
Surgeon Willingness
• Quadrilateral – Also widely available but some avoid or put heavy restrictions — Paley avoids it; Donghoon & others do it.
• Staged – Widely offered by most LL surgeons.
Rehab Difficulty
• Quadrilateral – Harder — more tissues adapting at once, same pain per mm lengthened.
• Staged – Easier — fewer tissues adapting at the same time.
Pain
• Quadrilateral – Same total pain as staged.
• Staged – Same total pain as quads, but spread across two surgeries = more prolonged torture.
Recovery After Surgery
How fast you get off support and start walking again depends a lot on the device you use.
If you’ve got a weight-bearing nail or frame, you can put some load on your legs even during distraction. That means you can take a few unassisted steps at home ,like walking from your bed to grab a bottle, but don’t think that means you can just stroll around.
Walking without support before completing consolidation is asking for trouble. You can start walking without assistance after that.
If we’re talking about real “normal walking” (no limp, no penguinmaxxed jester walking), you’re not getting that at least until consolidation is done and your soft tissues have caught up.
For most people, that’s anywhere from around 9 months to around an year.
You can cut that time down to 7 months if you’ve done your homework, pre-surgery strength, proper rehab, and running the right stack (roids, HGH, peptides).
Why the delay?
• Bone heals faster than everything else.
• Muscles can regain strength quickly, but tendons, fascia, and nerves are slow.
• Until they adapt to the new length, you’ll feel tight, awkward, and off-balance, even if the bone looks perfect on X-ray.
Full strength usually comes back around 18 months to 2 years after surgery in natural recovery, but most people can return to basic sports & start walking properly after the 12–18 month mark.
With a proper enhancement protocol, you can bring that 12 months down to 8–10 months, and hit or beat your old performance in 1 year.
Roids HGH & Peptides for LL Recovery
1. HGH + BPC-157 + GHK-Cu → Soft-Tissue Regeneration (Amplified)
Why:
• HGH / IGF pathways → ↑ collagen synthesis, ↑ tissue turnover.
• BPC-157 → accelerates tendon, ligament, and peripheral nerve healing; boosts angiogenesis; reduces inflammation (animal + preliminary human data).
• GHK-Cu → improves collagen remodeling, angiogenesis, and microcirculation.
Synergy: Creates a highly pro-repair environment for connective tissue.
2. Test E + Tren → Muscle Maintenance / Anti-Atrophy
Why:
• Testosterone → preserves muscle mass & strength, counteracts disuse atrophy.
• GH → preserves lean mass & complements connective tissue repair.
Cautions:
• Test → ↑ hematocrit, transient ↑ VTE risk (esp. within first 6 months).
• GH → fluid retention, potential insulin resistance.
3. BPC-157 Solo → Tendon & Nerve MVP
Why:
• In animal models: speeds sciatic nerve regeneration, enhances tendon outgrowth, boosts angiogenesis, reduces inflammation.
• Rare peptide with direct peripheral nerve repair data.
Note: Human data sparse but promising.
I recommend,
- HGH → 6 IU/day, is about as high as most tolerate without side effects.
- BPC-157 → 1,000–2,000 mcg/day split.
- GHK-Cu → 500 mcg/day split.
- Testosterone → 100mg-500 mg/week.
- Tren→ ~100mg/week.
Start with the Distraction phase, few weeks after the surgery.
Don’t be soy about "muh VTE & muscle–tendon, strength balance, fluid retention"
unless you’re genetic trash or a fossil fuel, this shouldn’t be a problem, inform your surgeon, they have tools to check for these problems.
These will increase soft tissue repair by multiple folds.
Tho, nerve adaptation is not sped up that dramatically & it will be the main factor why you aren’t able to reduce the recovery time to below 7 months.
But your strength & function will be way better than if you don’t use these compounds, both during & after LL.
If you are already on roids, you just need to lower dose few weeks before surgery, donate blood & take blood thinners.
Proportion & Biomechanics
Femur-to-Torso : the most important one to consider
The reasons why you shouldn’t do 16 cm femur is because it can push it to 1.7+ —
it matters for squatting, skiing, and some other movements & can mess you up severely.
It will also ruin your aesthetics in motion.
Average femur-to-torso ratio = 1.3
+8 cm femur pushes it to 1.5+.
Functionally: 1.3 is ideal.
Aesthetically: longer femur is preferred, 1.4 is ideal.
1.5 isn’t bad-looking, it’s actually good aesthetically and makes you look taller.
It’s not terrible functionally either.
However: If you already have a high femur-to-body ratio and you add femur length on top,
it’s bad for some sports (squatting, skiing).
1.5 isn’t very bad for most things other than those sports.
If you’re already 1.4+, either reduce femur lengthening or skip it altogether and do tibia-only.
Interlimb (Femur to Tibia)
If you only lengthen one segment (either femur or tibia), you’re fine.
It doesn’t matter much unless you already have very odd proportions & make them worse with LL.
Wingspan-to-Height
Broke copecels & low IQ subhumans keep crying about this ratio, it’s pure cope and overhyped trash.
Go look at any roster of MMA fighters with short wingspans, still look normal af.
The only ones who look bad are those with a bad "Arm to Torso" Ratio, not "Wingspan to Height Ratio"
You won't spot a single person with short wingspan
Humerus Lengthening & Forearm Lengthening
Arm lengthening is a straight up meme surgery unless your wingspan is so pathetic you are like a -4 ape index subhuman and you’re going for 20cm LL on top of that.
If you’re in that clown-tier category, then +4 - 5cm humerus in one surgery = +10cm wingspan.
Do it twice and no one will notice your humerus to forearm ratio.
you end up with 20cm wingspan addition.
Forearms? Forget it. Cosmetic lengthening is purely retarded— the complication rate will obliterate you. you might end up with unusable hand.
no decent surgeon would do this for cosmetic reason.
Leg-to-Full-Body Ratio
Average person: 0.52
Aesthetically ideal: 0.55–0.62
LL will almost always make it better.
Why Post-LL Transformations Look “Bad”
It’s not the bones , it’s just that these jesters went through LL without roids
Bones are lengthened + they’ve been on bed rest & experienced muscle atrophy.
Muscle didn’t fill out the legs, so they look chicken.
After complete recovery, muscles fill your legs up & it’s actually looks more aesthetic than before.
Surgeon Selection
You want someone with specific experience in limb lengthening surgery. Experience is the most important factor. Functional LL experience matters just as much as cosmetic LL experience.
Surgeon's Experience matters the most, they will be the one's handling complications.
Overall Look for:
- Proven track record with multiple LL cases.
- Good post-op care facilities and dedicated recovery support.
- Transparent communication about risks, costs, and timelines.
Don’t just rely on clinic marketing
browse LL forums for real patient reviews, diaries, and complication reports before committing.
