Aesthetic lower limb lengthening techniques: a systematic review of efficacy, complications, and patient satisfaction

Background: Aesthetic limb lengthening (ALL) is a cosmetic procedure aimed at enhancing body symmetry and improving self-esteem through the gradual elongation of bones. Unlike functional limb lengthening, which addresses limb length discrepancies, ALL focuses on increasing limb length for aesthetic purposes. While functional limb lengthening has been extensively studied, a comprehensive analysis of ALL outcomes is needed. This systematic review evaluates the efficacy, complications, and patient satisfaction associated with different ALL techniques, including distraction osteogenesis and various external and internal fixation systems. Methods: A systematic search of PubMed, Embase, and Scopus was conducted up to July 2024 to identify relevant studies in English. Eligible studies included case series, cohort studies, and randomized controlled trials with at least 12 months of follow-up. Studies focusing on adult populations undergoing aesthetic limb lengthening were included. Data on limb lengthening achieved, bone healing rates, complications, and patient satisfaction were extracted and synthesized through narrative analysis. The methodological quality of studies was assessed using the MINORS criteria for non-randomized studies. Results: A total of 12 studies involving 760 patients were included. Most patients were male (67%), with an average age of 24.75 years. Techniques employed included the Ilizarov method, motorized internal lengthening nails (MILN), and combined methods like Lengthening And Then Nailing (LATN). The lengthening achieved ranged from 62 mm to 87 mm, with an average of 67 mm. Patient satisfaction rates ranged from 88.8 to 98%. Psychological outcomes showed improvements in body image and self-esteem. Functionally, most patients resumed normal activities with minimal joint limitations. However, common complications included infections, bone healing issues, joint deformities, and material-related complications. Conclusion: ALL offers high patient satisfaction and psychological benefits, with patients reporting improved body image and self-esteem. Despite these positive outcomes, complications such as infections and bone healing issues remain significant. Further research with rigorous study designs is needed to improve the safety and efficacy of ALL procedures.