At 8'1", Sultan Kosen is the tallest man in the world (Dan Kitwood/Getty Images)

February 27, 2024   6 mins

When Ryan* arrived in Istanbul he was 5’7” — but when he returned to the UK he was 5’10”. By having his legs surgically broken and then extended at the glacial rate of 1mm per day, he had achieved his target height. Immobilised in an Istanbul hotel room, Ryan existed in a post-surgical limbo for three months to allow a fissure of new bone to form a bridge over the gradually growing gap. His stay was punctuated by regular physical therapy sessions with 20 fellow patients in one of the hotel’s co-opted conference rooms. “Some of them were screaming in agony,” he recalls.

Ryan acknowledges that his decision to pay ÂŁ25,000 for a surgery that was pioneered to help soldiers recover from battlefield injuries might seem irrational. Now in his late 20s, he worked extra shifts as a waiter and freelance writer to help finance the operation. “A normal person would think you were crazy,” he says. “But I was at breaking point. If you lived in my head for the last five years, you’d understand.”

Despite having an outwardly confident exterior, Ryan’s height-related insecurity began at around the age of 16 while he was still at college and started to notice that younger friends were outgrowing him. “I remember feeling significantly smaller than my classmates, as if I was underdeveloped. There was a sense that I didn’t matter as much as the others and that there was that something missing.”

Although he was never bullied, Ryan found the long-term cumulative effect of occasional height-related digs corrosive enough to lead from low self-esteem to anxiety and depression. “You realise that there’s something about you that’s outside the standard deviation of people that you’d meet — and then you realise you can’t do anything to fix it. It was definitely a contributing factor to a lot of the mental-health difficulties I had during my late teens and early 20s. It sort of consumes you.” Even close friends had little sense of the extent of his despair.

Ryan remembers reading that cosmetic limb-lengthening surgery had been pioneered in the United States. But at a prohibitive cost of around £125,000, it was too remote a prospect to ever entertain seriously. And then he became aware that, by outsourcing post-operative care and physical therapy to a non-clinical setting in hotels, providers in Turkey were offering several versions of the same procedure at more affordable rates.

At around ÂŁ45,000, the most expensive package there replicates the higher-tech version of operation available in the States. By implanting an extendable nail in the bone cavity, and then using magnetic sensors to lengthen it by remote control, it does away with the need for a bulky metal external fixator while also speeding up recovery and reducing the likelihood of infection, nerve damage, blood clots or the possibility of the bones not properly fusing.

However, younger patients on more limited budgets like Ryan, tend to opt for the lower-tech Lengthening Over Nail (LON) method that costs between £25,000 and £33,000 Unfortunately, LON does requires require the bulky external fixator, which is wrapped around the leg externally and attached to the bone through the skin with pins, making scarring and infections more likely. What’s more, LON patients are required to lengthen their limbs themselves, by manually twisting a key in the metal fixator on four excruciating occasions throughout the day.

By the time Ryan was ready to outline what the LON procedure would entail to his girlfriend, he had sunk further into his depression. Although she was initially horrified at the idea, she came around when she realised that the risks of doing nothing outweighed those from the surgery itself. Therapy had been repeatedly tried and had failed to remove Ryan’s crippling insecurity.

“She could see that I was at breaking point and that I’d already made my mind up, so she supported me throughout the process,” he says. After undergoing surgery 18 months ago, Ryan remained in hospital for five days on a cocktail of strong painkillers, morphine, antibiotics and blood thinners before being transferred to the hotel.

Today, Ryan claims he was one of the lucky ones because he always found the pain manageable; he remembers mind-numbing boredom being the biggest challenge. Robert, also from the UK, is there now and has not been so fortunate. When I spoke to him, he was halfway through the three-month lengthening process and still in very obvious discomfort. On the rare occasions that the pain subsides, Robert, an IT developer in his late 30s, can work remotely. “The pain is constantly there so I’m using painkillers. It stops you from doing anything like reading or watching films, but I sometimes manage to do some work on the laptop.”

Relentlessly, every six hours without fail, Robert turns the key in the external fixator that lengthens the legs by 0.25 mm. Invariably, the pain intensifies 10 minutes later as the muscles, and nerves stretch to accommodate the adjustment. ‘’It’s a serious procedure and being trapped in a hotel with such limited movement is obviously a very unusual situation.”

When I ask him why he’s putting himself through this, Robert cites a lack of confidence and a general sense of never quite being able to live life to the full. “Being taller has always been at the back of my mind — a sort of secret wish. You do feel as if you’ve missed out on certain things. And of course women desire taller men compared to themselves.”

“Women desire taller men compared to themselves.”

By the time he returns to the UK in around six weeks, Robert is hoping for 8cm of growth (from 167cm to 175cm). While he still needs a wheelchair to get around, by then he should be able to manage on crutches — although a full recovery will probably take nine months. He has no plans to broadcast where he’s been, but if close friends expressly ask him where he’s been or notice the change in his appearance, he plans to confide in them if they promise to be discreet.

Back in Istanbul, Makbulijana Haruni, the patient welfare coordinator at the Iwannabetaller clinic, remains inundated with dozens of enquiries about limb-lengthening each week. She explains that most requests are rooted in the desire to project more confidence, power and status at work. “We see a lot of businessmen who say I’m in a senior position and need to lead teams of people but with this height I’m not able to do this,” she says. People believe that if they are taller, they will be heard more or more likely to be considered for promotions because they’re taken more seriously.”

As a patient welfare coordinator, Haruni comes as part of the package. The clinic has the capacity to operate on 80 patients each year and Haruni works with her team to screen out patients with body dysmorphia — a serious mental-health condition where sufferers obsess over flaws in their appearance. She acknowledges that patients with body dysmorphia can be treated more effectively by therapy and antidepressants; surgery would be futile. Patients have to pass a pre-surgical psychological assessment to be eligible for the operation.

However, according to Haruni, not all of their competitors are quite so scrupulous. You only have to type limb-lengthening surgery into a search engine to see the proliferation of the procedure with clinics popping up in health tourist hotspots Mexico, India and even Iran. It’s an entirely unregulated global market where orthopaedic surgeons promise simple surgical solutions to complex problems with far too much gusto and entrepreneurial flair.

“Around the world, orthopaedic surgeons have clearly realised that they can make a lot of money in this way,” Haruni says, before adding that the hype is clearly fuelling unrealistic expectations. She increasingly has to reason with patients demanding growth of more than 6-8cm from the procedure, even though that escalates the risks of potentially life-changing complications.

But what is driving such international demand? When the American sociologist Saul Feldman popularised the term “heightism” in the Seventies, he identified an insidious unconscious bias that’s hiding in plain sight. “American society is a society with a heightism premise: to be tall is to be good and to be short is to be stigmatised,” he wrote. And to combat the last socially acceptable form of discrimination, he called for a “sociology of stature”. Over the past half century, researchers have been amassing an imposing body of research, with international studies showing that being tall correlates not just with enhanced educational outcomes, social mobility, romantic success, and acquisition of leadership positions, but a better quality of life in general.

Elsewhere, anthropological studies across cultures consistently show that taller stature is linked to increased social status. Although the reason why is unclear, there is a lot of evidence to support the interpersonal dominance theory — that we’re more likely to defer to the judgement of taller people because they are more likely to win a physical confrontation. When, for instance, the journalist Malcolm Gladwell was researching how we unconsciously form erroneous first impressions for his book Blink, he found that 58% of the CEOs of Fortune 500 companies were above 6 feet even though only 14% of men in the general population were that tall.

Does this mean that heightism is hardwired into our consciousness as an insidious prejudice? Taken in the aggregate, the evidence for the existence of the so-called “height premium” is certainly compelling, to the extent that limb-lengthening surgery starts to seem like the extreme end of the cosmetic-procedure continuum: how different is it to transhumanist endeavours such anti-ageing biotech or biohacking?

Viewed in this way, Turkey’s nascent limb-lengthening industry feels like an unnerving glimpse into that biomedical brave new world where status itself is a marketable commodity. A tummy tuck or nose job might give you confidence and change the way you feel about yourself, but it can’t re-engineer the invisible power dynamics in every room that have been crafted by millions of years of evolution in the way a “height transplant” can.

Eighteen months on from his surgery, and three inches taller, Ryan has transitioned from just below average height to just above, and is perhaps uniquely placed to comment on these new power dynamics. “I just feel that I’m a default person now with my own attributes who can no longer be as easily dismissed,” he says. “It forces people to engage with me for who I really am.”

Sean T. Smith is a journalist and author.