Would you have your legs broken to be taller?

0:00Ruth Michaelson:This is The Guardian.

0:10Today, would you have your legs broken to make yourself taller?

0:24Ruth Michaelson:My name is Ezekiel. I am from Barcelona, from Spain. I am 41 years old. And right now I am in Turkey because I am doing the leg lengthening. Ezekiel is halfway through this grueling process, in which he would have spent three months living in a hotel in Istanbul to complete a procedure that will break and then lengthen his legs. I had my surgery on 3rd July. Right now I have length almost 5 centimetres. I want to achieve eight centimetres. He was excited before the surgery. He'd done his research, he'd saved the money, and now, finally, the moment was here. You wake up, and when you wake up, believe me, the pain is so, so extreme.

1:17Ruth Michaelson:You feel that your bones, everything is like, it's an explosion of pain inside you. The first three days, you regret. You start to realise that I had my bones break and you are in a foreign country and I can't even move. I can do nothing. This isn't for the faint-hearted. After his femur bones, that's the ones in his thighs, after they were broken in two, the surgeon inserted metal rods and added fixators. You stay five days in the hospital, but the hardest part of the process is when you're back to the hotel and you have to do the things by your own. To go to the toilet is the worst part, really.

2:07The risks are high, and patients have to be trusted to administer their own strict regime of care in order for the whole ordeal to even work.

2:16Ruth Michaelson:They give you painkillers, antibiotics, blood thinner, protector for the stomach. And you have to turn the screw 90 degrees. So every day you length one millimetre. And you have to do that four times per day. You cannot forget.

2:37This screw, a key, is inserted into a metal bracket on the side of Ezekiel's thigh. When he turns it, it forces apart the rods that have been inserted into his femurs. New bone then grows into the gap in his thigh bones, one agonising millimetre at a time.

2:57Ruth Michaelson:I'm sure you feel alone and you are thinking about, oh my God, I wonder that all this process just ends, ends, ends. It's extreme. It's eye water really expensive. And it may only buy you a few inches. But despite all this, leg lengthening has gone from a niche field of orthopaedics to a multi-billion pound growth industry. From The Guardian, I'm Nashi Anikbal. Today in Focus, leg lengthening surgery. Why? How?

3:34Ezekiel, you're in Istanbul halfway through the leg lengthening process. It's obviously a really big decision. Could you tell us about what brought you to this moment? When did your height become a problem for you?

3:47Ruth Michaelson:It started to become a problem when I was about 20 years old. When I was 13, 14, I was one of the tallest guys of my class. But I just stopped to grow. For me, it started to be a problem. 21, 22. But when I moved to Poland, in Poland, the people, you know, it's taller. So there, yes, it started to be a bigger problem for me. How did you feel that? Were there experiences that made you feel judged or that had a direct correlation to your height? No, to be honest, no. I didn't have problems with dating, with people, no. It was only a problem for me. My understanding is that when you began this process, you were 173 centimetres, which is 5 foot 8 inches.

4:37The average height of a man in Spain is only a tiny bit taller at 175 centimetres, just under 5 '9". And so I was curious about your family. How tall are they?

4:48Ruth Michaelson:My mother was 62, but my father was almost 6 feet. My grandpa also was really tall. So, you know, yeah, the men, yeah, very tall. And this feeling that you've described, that you've held on to for 20 years, did it ever ebb and flow? Did you ever think, actually, this isn't that bad, I've got other things going on? Or did it just seem to swell inside you? Well, you know, at the beginning I was just sad, worried, yeah. And, you know, it evolves a lot with the years. When I'm back from Poland to Spain, that was definitely a problem. because I am a Spanish teacher and I teach Polish people. I organize many events, many meetings.

5:37Ruth Michaelson:Many people know who I am through internet, in Facebook. And when they meet me at Real, most of them just say to me, oh, I thought that you are taller. Because you have a big personality. Exactly. It's bigger than me physically. For me, I was like, wow, my God. Yeah, I should be taller. And I have this topic all the time in my mind. When I was making the shopping, you know, just compare yourself with the other people. This is height dysphoria. And just overthink about the height all the time, all the day. So it's intrusive. You cannot live your life at 100%. You are with your girlfriend and you cannot enjoy it.

6:19Ruth Michaelson:The same with your friends, with your family. And this is what I want to feel at the end of the process. Just don't think about that. You say it is a psychological issue. And if that's the case, I wondered if you had considered psychological treatment. I have considered, yes. And I did my research in internet. And as far as I know, it's not possible to fix it with a psycholog. Right. The only possible to fix it, the only way, is with the surgery. I'm not sure most psychologists would agree. You can search in Google, yeah, and there is a center where they make this surgery and they even check it with more psychologists if it's possible to fix it only by psychology and there's no way.

7:08When you started reading about it and looking it up online, and obviously, you know, there's forums, threads, social media dedicated to the subject. How much do you think that drove your obsession?

7:22Ruth Michaelson:To be honest, I didn't check it in the social media because I don't like so much the social media. But when I started the process, I created my TikTok account. And then, yes, I check it. and I must say that the social media is sick. You know, if you have some problem, you know, with yourself about insecurity, better don't check social media because the people is sick. I think that the social media for sure doesn't help. Ezekiel, how much has all this cost you? The surgery plus two days in the hotel before the surgery plus the five days in the hospital with the medicines, with everything. It's 22 ,000 euros.

8:09Ruth Michaelson:Then if you want to stay here, the hotel is about 3 ,000 euros per month. And for me, how I managed, I have sold my car, my motorbike. I was saving money for about one year for this. But I think that is going to be the best investment of my life. Obviously, you were very aware of the risks. and I just wonder, were you scared and did that fear ever threaten to overtake taking this decision? I must say that I'm a little bit crazy, you know. Is that how your friends would describe you? Would they generally describe you as a little bit crazy? No, I like to joke a lot, sorry. You know, I know that there are a lot of risks, yeah.

8:57Ruth Michaelson:But, you know, I prefer the pain of the surgery. than live all my life with this topic in my mind. You know, for me, it's more painful to live my life like I was living it than just being here three months, suffering, having pain. Yeah, it's painful. But, you know, this is less painful than my past life. So you feel mentally liberated. Exactly. And now I am 178. You know, I feel so much better now. What did your friends and family say when you told them you were going to Turkey to do this? Well, at the beginning, they said that I am crazy, yeah. But I was explaining all the procedure to my family.

9:43Ruth Michaelson:And they told me, OK, we will support you. We are with you. So, you know, I love my family, yeah. I feel very, very lucky. Has everyone in your life been supportive? or has anyone reacted badly? What's been the response of friends? You mean about my height? About your problem with your height. I never explained this. Even to my family, I never explained it. Really? So you never actually verbalized this out loud? No, never. This constant anxiety that you felt? Never, never. Once you explained it and you talked about the treatment, after they got over their initial shock, everyone's kind of okay, we're with you not everyone, no for instance I have my supposed best friend he didn't understand yeah you know it's just like that and now we are not friends anymore maybe that's painful yeah, that's painful yeah

10:57Ruth Michelson, you're a journalist based in Istanbul and you've written a piece for Saturday Magazine for The Guardian on the industry of leg lengthening. We've just spoken to Ezekiel. You spent time in the hotel that he's recuperating in, talking to other leg lengthening patients like him. What's it like? The hotel on the outskirts of Istanbul, where people spend the bulk of the recovery from the surgery, it's pretty unassuming. I think that there are probably some tourists hanging out in there, not realizing who else is in the hotel. But, you know, this hotel you walk in, there's fake gold leaf and some fake marble in the lobby.

11:42And then if you go downstairs into the basement, there's just this big physiotherapy room where a procession of different men, certainly and most of the time in my reporting experience, it was men, are coming in to have physiotherapy and then spending the remaining hours on this regimen of painkillers and blood thinners and all the work that goes into the recovery from this very, very intense surgery. And is there any commonality between the men that you spoke to? I met a man who was in his early 40s who is of Turkish heritage. There were young men who had flown in from Japan, from China, and there is this camaraderie about this between them.

12:27Comparing notes, comparing stats, how tall were you before? You know, how are you adapting to the challenges of what's happening? By and large, they tended to sort of fall into two categories, which was either there was a kind of shame about the surgery, not about how they felt about their own height, but they didn't want people to know that they'd had this surgery. But then on the other side, there is this world almost of influences. There's men who are over six foot tall showing up at this clinic or close to six foot. No way. So it's not necessarily the case that all of these men are under average height or anything like that.

13:10You can certainly see some of these sort of like height influences online, where they've had multiple surgeries in order to become taller. and there is a sense that it's almost addictive or it's something that once they've started chasing an idea of what their own body can look like through surgical enhancement, that it's something that they didn't feel able to stop.

13:44Ruth, you've reported before on the massive rise of medical tourism in Turkey, a large part of which is cosmetic treatments. Why has the country become such a major destination for people looking for boob jobs, butt lifts, new teeth, more hair? I mean, first of all, you see it. You walk through the Istanbul airport. There's people walking around ready to fly out with bloody scalps from a hair transplant or bandages from a nose job and things like that. And you can see that these things are on the rise. A lot of people, instead of deciding that they will spend a lot of money on private dental care in the UK, would rather fly to Turkey and have what's called turkey teeth, where you file down all of your teeth and then replace them with veneers.

14:36This is the electric white beam that you see plastered on football managers and influencers. Yes, the visual signature is pretty clear. Plus the idea that you're going somewhere sunny and allegedly it's something of a holiday. Right. And the reality can be quite different. People are recovering from sometimes very intense medical procedures alone in a hotel room far away from home. There is a growing number of British tourists who have suffered complications or who have even died. And the other thing is that even if you have complications, you then end up having to have corrective procedures in the UK.

15:18So it's not the quick and easy, cheaper solution that you've been sold in the first place.

15:36leg lengthening wouldn't be high on a lot of people's lists and yet it is and excuse me it is a growth industry it's even a plot point in the new film materialists ruth what do we know about how big it is and why? It's built on a form of medical treatment that has existed for decades. And the clinic whose work I was looking at, they say that they have treated something like 700 patients in about the past decade. And they also claim to be the first leg lengthening clinic in Turkey, and there are now others. This is a procedure that has been popular elsewhere in the world, but has also been banned elsewhere in the world.

16:23China previously banned cosmetic leg lengthening surgery because it had become this unregulated industry where people were getting hurt. But it is considered to be an increasingly popular procedure. Is there any kind of screening process for these patients? And is it a physical one, a psychological one, or both? So my understanding is that Wannabe Taller consults with patients before about their expectations, about what's possible. The clinic that I spoke to, they at least said, you know, we do have these kind of consulting period with a patient beforehand to try and set expectations. What I was wondering is whether there's any kind of psychological therapeutic counselling or interrogation as to why would you like to have this done?

17:21And are you mentally well enough to have it done? I think it's much more a discussion about whether the patient's body can withstand what they're doing and whether the patient in question is prepared to undergo such an intense procedure rather than the utility of the surgery in the first place, because that's the clinic's MO. They want to say that they're solving problems and they're making people feel better through offering this surgery. It's worth saying that listeners will be spared the images that accompany this piece. And it does look like a torturous process. It looks medieval and barbaric.

18:01And yet people are choosing to go and pay lots of money. In fact, Ruth, how much money are people paying on average for this treatment? The person that I interviewed spent about£32 ,000 on this. Yes, the down payment for their mortgage, most of that went on this. The cost is not just the procedure itself. It's the months in the hotel afterwards. The aftercare. Daily physiotherapy. And then also the additional medical fees of any complications. Frank, the man that I followed through this process, he got a pulmonary embolism, a blood clot that travels to the lung. He could have died. So it's high risk.

18:47It's a high risk surgery. You know, there are two patients that have had pulmonary embolisms at want to be taller. One of them was Frank. And another patient was a man from Saudi Arabia, who last year flew into the clinic, had the surgery and died afterwards. and when I spoke to the clinic about this they said they very much say that if there are complications afterwards that that is the fault of the patient for not following a proper aftercare regimen you know you have to take the blood thinners on a very specific schedule and in Frank's case he was doing that but it turned out that he was allergic to one of the blood thinners right and as your piece shows it's not straightforward in the immediate aftermath people need crutches or walkers for months their legs may not work properly for a year or more after surgery you need the bones to fuse properly which is which is a risk and and then there's also the potential for for a myriad of other complications in some cases your hamstrings might not stretch in the way that they need to to accommodate this you can get something called ballerina syndrome if that happens, where the foot is in a constant high arch and you can't walk properly.

20:03Like Barbie? Essentially, yeah. Well then let's talk about regulation because you think that would be the first port of safety for patients. I mean, what does it look like for cosmetic procedures in Istanbul? Is there any regulation for a treatment like leg lengthening? There is regulation in Turkey and I don't want to present the idea that all cosmetic surgery in Turkey is is the Wild West, because that's not true. This is regulated by the government, it's regulated by the health ministry, but at the same time, in some cases, there are practitioners that are slipping through the net.

20:42Coming up, what's really driving the rise in leg lengthening surgery?

20:57Ruth, what did you learn about the pressures that are driving these men, and sometimes women, to essentially break their legs in order to gain a few inches? It can be mystifying for those of us that wouldn't consider doing something like this. In the words of one man I spoke to was a short man, you're always treated worse. He had examples from his dating life, from people singling him out, even in some cases, like physical violence. And he felt that this is all due to his height. Frank sort of said to me, like, for me, it's not about that. I just want to be average. I want to be average height and therefore unremarkable.

21:34But I think that when we're talking about this, we're talking about masculinity, we're talking about power and who visually gets to be seen as powerful. You know, when somebody just looks at a stranger in the street? Do you see them as imposing? Do you see them as someone that you could attack? Really, it's about how men feel about their own sense of power in the world and how that is reflected in their height. I was reading about how there's a growing popularity of jaw enhancement procedures among men in Washington. Looks maxing, right? Isn't that the whole self-optimization? Exactly. Taught by influencers online and the bro heroes.

22:16And that's inherently political. So I think on one hand, it's all about this idea that if you have the money and you're willing to work for it, you can change your body and it can be, you know, more stereotypically masculine. And therefore, you're just going to get ahead in life a lot easier. Women are telling me that I need to be taller in order for them to date me. And I think in the end, it comes down to masculinity. no matter what the data says. How did working on this story leave you feeling about the culture of where we are in terms of either vanity, insecurity, and where does it leave you feeling?

22:53I do understand that on some level, this is about bodily autonomy, but it left me in a pretty confusing place. Because if you have an insecurity, there is now a market in place that will say, if okay if you've got the money you can make those changes to your body and you can be happier but I think where things get difficult is I think people then feel additional pressure more than they may have done in the past to opt in because it's like well I could make this change to myself I could spend this money so why aren't I doing it and I think that's a much harder conversation to have with yourself about why not have this surgery even if you want it

23:45Ezekiel, if I've got the maths right, you'll be coming to the end of this stage of the process in Turkey sometime in September.

23:53Ruth Michaelson:Yeah, 26, 27. And ideally you'll have reached a goal height of 181 centimetres, which is 5 '11". Yeah. How do you think you'll feel about yourself? I think that I will feel great. I think, you know. But I already know because my physiotherapist, He was taller than me. Now he's not, you know. And when I am now near to him, yeah, we are more or less the same height. I don't think about the height, you know, and I start to feel more like a real man. It's interesting you say that. So how much of all this for you is tied up with this idea of masculinity? It depends what you understand with masculinity, yeah.

24:36Ruth Michaelson:Because if I was expecting to be a more masculine guy, no, I wasn't. I wasn't. But I am feeling it. I must recognize it. Yeah, I am feeling it. But for me, masculinity is another thing. For me, masculinity is a guy, no matter how tall is him, he's able to have his wife very happy, to take care about his children. This is a real man for me. for me yeah this is a real guy who really knows how to make the people who is you know around him make them happy so rationally you know that being a real man isn't necessarily tied to one's height it's tied to being there for their loved ones how does that then tie in i guess with this idea for you that you can't be a real man until you reach a certain height no no i i wasn't thinking like that.