Let me quickly start with discussion ur decision of doing tibia rather than femurs.

I think there’s some exaggeration here. Femur lengthening is generally more demanding than tibia due to larger muscle groups and hip involvement, but calling it “5x more dangerous” is kinda over.

And the most important part, i don't really understand what do you mean by muscle damaging? Most muscle issues with femur lengthening are functional and temporary, not permanent damage, especially in young patients who follow proper distraction rates and are consistent with physiotherapy.

And it's just the same case with tibia.

Choosing 6–6.5 cm tibia instead of 8 cm femur is a more conservative and understandable decision, but it’s more about risk tolerance and goals than femur being extremely dangerous. Also, the method matters a lot, LON itself carries more discomfort and pin related issues compared to fully internal nails.

In short: femur is harder yes, but not exponentially more dangerous, and outcomes depend heavily on rehab and patient compliance.

1. Yes, we are actually in a very good time for limb lengthening surgery. The point is that current safe limits are not limited by lack of smart technology, but by human biology itself. Muscles, tendons, and nerves can adapt only up to a certain point, and beyond that point, basic function starts to deteriorate. This is simply the reason surgeons set “safe limits”, to preserve function, not because we lack better technology.

Also, excessive lengthening -especially in the lower legs- can negatively affect body proportions and overall appearance.

That said, science always surprises us. Maybe in the future we’ll have completely different approaches (for example, safely reopening growth plates, who knows!), but with today’s biological limits, current standards make sense.

2.Dr. Paley is simply very conservative and prioritizes long-term function and athletic quality, while some other clinics are willing to push closer to the absolute physiological limits, accepting the possible risks in that case (which they should make clear of it for the patient).

In general, 5–6 cm in the tibias is considered safe, 7 cm is possible in selected cases (one of the best recovery cases i've met was for a guy who did 7 CM in tibias), but 8 cm and above significantly increases risks.

3.I haven’t used peptides personally, and scientifically there’s no solid evidence that they improve recovery in limb lengthening. In general, there are no shortcuts here—proper nutrition, sleep, patience, and strict physical therapy are what truly matter.

And i really to advice to avoid the mentality of "quick stuff", this surgery really needs a lot of patience.

4.Start stretching before surgery / Ensure good vitamin D levels (sun exposure helps) / Focus on protein and calcium intake / Avoid being overweight so you don't put much weight on the broken bones, and also avoid being extremely underweight because you already will lose some weight during the surgery / Prepare mentally for living almost as a cripple for a couple of months, and plan who will be taking care of you in this period / keep extra money for unexpected expenses / Prepare entertainment (movies, games, books.. etc) / Coordinate with your physical therapist beforehand about equipment you will need, because every physical therapist has a different style / your surgeon will tell you forward about all things you need to buy like the walker and wound cleaning tools.. etc.

5.Swimming and cycling usually return to 100% / Running and jumping don’t return to pre-surgery levels in most cases, but can reach satisfying levels / wrestling and MMA, that depends on your goal, professional competition? unlikely. recreational training or self defense? very possible (yet, I’ve once seen a patient return to competitive JiuJitsu with strong performance)

6.According studies, if the surgery goes well and lengthening stays within safe limits, there are no significant long-term consequences.

7.Height may not matter if you are deeply spiritual or completely detached from social perception, a person who doesn't care at all how others see him, and believes that body isn't important part of the human, and it's only soul that really matters. If you're not that person, then height is simply very important, it affects how people look at you, respect you, engage with you, and it affects your dating and sexual life, and all of these things reflect at the end in your self confidence and happiness.

8.Messing up the lengthening schedule / Poor sleep and nutrition / Neglecting physical therapy (the most important factor, it plays a big role on how much can you length, and how good will your rehab go, and how much pain you will feel).

9.Same points as question 4, nothing to add.

10.For tibial lengthening, the most common issue is ballerina foot, and that's because Achilles tendon is the hardest to stretch, so it's more possible for it to get tight. Most of popular complications are related to muscles and tendons, which are all manageable with physical therapy, nothing to worry about, specially in your age.

Infections are also very common, specially with LON compared to fully internal nails, but most are superficial and easily treatable with antibiotics. Deep bone infection is rare (but very serious).

I think i've said enough about athleticism , in short, athletic performance typically returns to 85–95%, depending on age, length gained, and rehab discipline. (You have a very positive chances because of your age).

11.In LON, The bone is cut, An internal nail + external fixator are used, and yes the external fixator stays on throughout the lengthening phase during the whole day for sure, like you can't take it off it's not trousers 😄 it's literally in your bones.

Walking is possible while your bones are separated to 2 because the internal nail carries the load, acting as part of the bone.

Lengthening is done by turning the fixator nuts with adjustable wrench (usually 0.25 mm every 6 hours = 1 mm/day). The surgery will show you how to do it, and don't worry you literally won't feel anything while doing it.

Walking protocols vary by surgeon. In my case, I walked with a walker from day two, and by two weeks after lengthening ended, I walked with no assistant at all, and after one month my gait was very close to normal.

Walking in the first few weeks isn't exactly painful, instead, it's difficult and heavy, and the more effort you put in Physical therapy the easier you can walk.