Dr Dror Paley (Florida, USA) Paley Advanced Limb Lengthening Institute

Here are the response from Dr Paley Limb Lengthening Institute, based in West Palm Beach, Florida.

1) How many patients have you operated for cosmetic Limb Lengthening so far and How many patients do you operate yearly?

Safety is my number one concern. All of my patients have ended up with normal function after this treatment. I do between 800-900 lengthening surgeries a year of which about 50 are for cosmetic.

2) What is the estimated total cost, including post-op treatments, stay, medications, physiotherapy? Are unscheduled surgeries covered and How much does a consultation cost?
 
The cost of surgery with physical therapy is $80,000 (Precice1) and $83,000 (Precice2) for bilateral femoral lengthening and $95,000 for bilateral tibial lengthening (Precice 1&2). For individuals who undergo femoral lengthening followed by tibial lengthening we offer a package price of $170,000 (Precice 1&2). 

3) What kind of physical therapy is assigned to the patient?

Daily PT in our department for the entire distraction phase.

4) What maximum amount of lengthening do you recommend per segment, regarding patient safety? What is the daily rate of lengthening?

8cms femur and 6-7 cms tibia

1 mm daily femur and .75 tibias

5)  What are your opinions regarding the weightbearing of the patients?

WB is allowed to the level of tolerance of the device to make sure it does not break.

6)  How often will you follow up with patients during lengthening?

Every two weeks.

7) How fast can patients return to normal life (walking without support)? What is the time required to lengthen 5 cm and 7.5-8 cm ?

Femurs usually 4 months walking 5 months running and six months sports.    The distraction phase length for femur lengthening is one day for each mm of planned lengthening. E.g. 65mms = 65 days.   We don't start lengthening for 5 days.

Therefore 70 days for 65mms (Precice1) and 85 days for 80mms (Precice2). For tibia lengthening the distraction phase for 65mm is 130 days plus 5 days before we start lengthening (Precice1) and 112days for 80mms (Precice2). Tibia lengthening is ¾mm per day compared to 1mm/day for femur lengthening

Dr Dror Paley
Paley Advanced Limb Lengthening Institute (St. Mary’s Medical Center)
901 45th Street
Kimmel Building
West Palm Beach, FL  33407
Toll Free (888) 888-3873
Email: [email protected],  [email protected]
Website: http://www.paleyinstitute.org, http://www.limblengtheningdoc.org

I would also like to add that there's a nail removal cost of $15,000, so add that to the expenses. Dr. Paley is an excellent surgeon, so if you can afford him, the additional expense shouldn't be much of a problem. Safety doesn't have a price.

I sent an inquiry to Dr. Paley about cosmetic arm lengthening and he responded with this:

"Yes we provide it. The cost depends on which method is done.

The costs for surgery are: If done by external fixation then the cost is $48,000. If done by the internal Precice method the cost is $65,000."

From Cat29

"I'm going to get right to the point here and get to my Q&A with Dr. Paley about the Precice-2 and the most important questions. Thank you to Captain America and Stadiometer for all the information they have already written about Dr. Paley. Even the not so flattering information from Captain America was helpful. Dr. Paley come off to me as a very caring and a no BS kind of guy. I get the impression he does his best to give the reality of lengthening without sugar coating anything and uses the word safety in almost every single sentence.

Q. How much weight bearing does the Precice-2 allow?
A. Each nail allows 75lbs of weight bearing so a patient lengthening both femurs or tibias can put 150lbs of weight on the nails. The welds of the nail have been removed so the risk of breaking the nail from early or too much weight bearing is much lower. That was a weak point in the Precice-1

Q. Can patients walk with crutches during lengthening?
A. Yes, they have to be very careful and follow our exact instructions. We take the time to teach all our patients how to walk safely

Q. Can patients drive during lengthening?
A. Yes, as long as you are not taking pain medicine before you drive

Q. Do patients who have surgery with the Precice nail heal faster than patients who have surgery with other internal nails? Why?
A. Yes, there are many reasons why. First, Precice does not require a torque or twisting motion to activate the lengthening mechanism. Secondly, the Precice offers perfect rate control. Third, I use what's called an osteotome and make drill holes to break the bone.  First, the twisting motion causes patients more pain and discomfort and often leads to delays in bone healing by causing trauma to the bone gap.

Second, the perfect rate control is something that was a major problem in the ISKD and was also a problem with the Albizzia nail (Betzbone, Guichet. This is me typing that so there is no confusion) leading to many patients reporting that their rotation counts did not match the lengthening measured in the nail which made it very difficult to achieve the correct lengthening amount per day.

Having the ability to lengthen exactly the correct and safe amount per day with the Precice is a huge advantage and excellent safety feature for patients. Third, surgeons in Europe mostly use an internal saw to break the bone instead of an osteotome and drill holes. Using an internal saw has higher complication rates including delayed healing and non union.

Q. Does the femur bone heal faster than the tibia bone? How much faster are patients able to walk without crutches?
A. Yes, the femur bone heals faster than the tibia but only a little faster. Usually patients who lengthen their femurs are walking without crutches about 30 days after they finish lengthening. Patients who lengthen their tibias are usually walking without crutches about 45 days after they finish lengthening.

The most important part to remember is it's safer to lengthen the femur. The femur has lower complications rates and there is only one bone to break and lengthen compared to the tibia where you have to break two bones and make sure they lengthen equally. I always recommend patients lengthen their femurs first and then come back if they want more height by lengthening their tibias, but we will lengthen their tibias first if that is what they request.

Q. How much does lengthening cost?
A. Answer was the same as what Stadiometer has already posted so nothing new. $70,000 for both femurs and $80,000 for both tibias if you lengthen at home

Q. Can patients fully recover back to their previous athletic ability after lengthening? Does the amount of lengthening make a difference like going over 5cm?
A. Yes, patients can fully recover but it requires a tremendous amount of work and dedication by the patient in daily physical therapy. Lengthening amount can make a difference but it's not that straight forward. You want to choose a surgeon who is experienced and puts safety first and does not allow you to lengthen beyond what is safe for your body. The surgeon should be constantly assessing your bodies response to the lengthening. Complications can develop quickly and need to be addressed quickly. So you can see it's not as simple as just lengthen 5cm an you're safe."
 
"Dr. Paley said most patients will not achieve the full 8cm in their tibias with the Precice-2 and their soft tissue will most likely prevent them from lengthening anything more than 6.5cm. So nothing different there.  "

Quote from: Carter on December 13, 2013, 04:43:25 PM"Dr. Paley said most patients will not achieve the full 8cm in their tibias with the Precice-2 and their soft tissue will most likely prevent them from lengthening anything more than 6.5cm. So nothing different there.  "

I saw that Cat29 posted this as well. "Dr. Paley said 8cm in the femurs and 6.5cm in the tibias will likely be the maximum for most patients soft tissues." 

It just shows how insane Apotheosis is for doing 10cm on both the femurs and tibias.  What the hell is Dr. Betz thinking allowing patients to lengthen that much!? 

Quote from: handy on December 13, 2013, 06:06:25 PMI saw that Cat29 posted this as well. "Dr. Paley said 8cm in the femurs and 6.5cm in the tibias will likely be the maximum for most patients soft tissues." 

It just shows how insane Apotheosis is for doing 10cm on both the femurs and tibias.  What the hell is Dr. Betz thinking allowing patients to lengthen that much!? 

Didn't he do 11cm in his tibs and 9cm in his femurs? 11cm in your tibs is really fúcking stupid, it takes for all eternity for it to consolidate and to regain your pre-op level of fitness and flexibility. I want 3 inches for my tibiae because it will probably a very long time before I can do my femurs, but I don't want to end up limping or not being able to run because I lengthened too much.

I think I'll take a similar approach to Sweden's lengthening journey by working my legs in the best physical condition I've ever been in, but I'll lengthen at a slower rate and fight ballerina harder.

does dr paley only do precice or does he have lower cost options (lon / latn) as well?

Quote from: inquisitivemind on January 29, 2014, 05:12:05 AMdoes dr paley only do precice or does he have lower cost options (lon / latn) as well?

He will also do external only or LON/LATN. He encourages using Precise over all the other options though.

do you know approximately how much difference the cost would be?



also, the way I see it, he could recommend precice but money isn't easy - i would still consider paying more to do the other methods just to do it with him though. He's still an amazing surgeon and would be in the states, yes?

Quote from: inquisitivemind on January 29, 2014, 05:22:54 AMdo you know approximately how much difference the cost would be?



also, the way I see it, he could recommend precice but money isn't easy - i would still consider paying more to do the other methods with him than go all the way to china . He's still an amazing surgeon and would be in the states, yes?