As a teenager, Lewis hit 5ft 5in (165cm) and stopped growing. He would be almost 4in (10cm) shorter than the average British man; in fact, nine out of 10 men would be taller than him. When he plucked up the courage to go out, he wore stacked heels. He resented the way dating apps encouraged height discrimination. “You’re a great guy – you deserve to be taller,” one woman said. At one point he went on antidepressants.

I speak to Lewis the day after Rishi Sunak, who is reported to be 5ft 6in, becomes prime minister. He’s seen all the usual jokes on Twitter and elsewhere. “I believe it’s one of the last prejudices that is seen as acceptable,” Lewis says. “It’s interesting that people fixate on something you can’t change … Well, at least I thought you couldn’t.”

A couple of years ago, Lewis paid a surgeon tens of thousands of pounds to break his legs and make them longer. He knew it would be a risky, painful procedure. But he also knew that, all being well, he would come out of it about three inches (7.6cm) taller. “The day before the surgery I started to get really nervous,” says Lewis, who is British and prefers not to share his real name or any details of his surgery, including its exact cost. “But this is what I really wanted.”

Demand for cosmetic leg lengthening, also known as stature lengthening, is on the rise, particularly among young men. Thanks to technological advances, changing attitudes to cosmetic procedures, and a growing entrepreneurialism among orthopaedic surgeons, clinics all over the world are competing for patients. Yet there is also concern about this growth industry. What does it say about a society that potentially vulnerable people are lining up for major surgery? And what is motivating the surgeons who offer it?

“What’s driving it, sadly, is cash,” says Dr Dror Paley, a pioneering orthopaedic surgeon in Florida and one of world’s most experienced limb-lengthening specialists. He now gets half a dozen inquiries from new patients every day, up from one a day only five years ago. “For the first time, orthopaedic surgeons have a piece of the plastic surgery business, but that doesn’t mean it’s being done well,” he says. “In fact, patients are being preyed upon and are coming to me with horrible complications.”

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The operation is a remarkable feat of medical engineering – and not for the squeamish. Techniques and devices vary. Paley’s version uses nails or rods similar to those that have long been employed to stabilise bad fractures. But when he drills out the marrow cavity and drives in the nail, he also intentionally breaks the bone in half.

The clever bit comes after the operation itself. A handheld device positioned against the leg at home creates a magnetic field. This activates a magnetic screwing mechanism inside the nail, which is telescopic. At a typical rate of a millimetre per day, spread across three or four activations of a few minutes each, the nail pulls the two sections of bone apart. The body makes new bone tissue to bridge the growing gap.

This extension process lasts several weeks and involves a period of relative immobility, sometimes necessitating time in a wheelchair, and months of physiotherapy to help the muscles adapt. Once the lengthening is complete, the nail can be removed.

Patients typically extend both femurs (thigh bones) by up to 8cm (3.1in). The pain apparently comes not from the magnetic activation, but from the overall effects of surgery and a double leg fracture. It is also possible to extend the tibias, or shin bones, by up to 5cm (2in).

Paley, who operates on around a dozen UK patients per year, charges $95,500 (£83,000) for both femurs, and up to $275,000 (£240,000) for a two-year package that extends all four leg bones for a height gain of up to 16cm (6.2in). A handful of UK surgeons offer leg-lengthening procedures, charging between £50,000 and £70,000 for both femurs. Prices can drop to around half that, depending on the device used, in “cosmetic tourism” hotspots such as Turkey and India.

A 32-year-old American, who prefers not to share his name, wanted to extend all four leg bones to go from 5ft 8in to 6ft. He tells me he paid around $50,000 at the Wanna Be Taller clinic in Istanbul – a quarter of the price he had been quoted in the US. “I worked 80-hour weeks and took out loans to pay for it,” he says.

What concerns Paley is not growing international competition, but the fact that generalist orthopaedists are increasingly marketing themselves as specialists without the right experience, infrastructure or awareness of complications. These can include infections, blood clots, joint dislocation and a sometimes fatal condition in which fat expelled by the rod ends up in the lungs. “You have the potential to handicap a patient – it has to be taken extremely seriously,” Paley says. He points out that China outlawed stature lengthening in 2006 after a reported spate of botched operations.

Hamish Simpson, a surgeon and professor of orthopaedics and trauma at the University of Edinburgh, does not offer cosmetic lengthening, but increasingly gets inquiries from shorter men. “I nearly always try to talk them out of it,” he says. He estimates that, even in the best hands, the risk of complications are twice that of, for example, a knee replacement.

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Limb lengthening was never intended as a cosmetic fix. Modern techniques emerged in the early 1950s when a Soviet physician called Gavriil Ilizarov invented an external fixator system for injured soldiers. Extendable, halo-like frames supported pins fixed straight through the leg. Ilizarov achieved national fame in 1967 after treating the champion Soviet high jumper Valeriy Brumel, but he was isolated behind the iron curtain until an Italian surgeon discovered his work.

In 1983, Paley, who was then an ambitious young registrar in his native Canada, heard about the method. “This was a brand new orthopaedic field that was being ignored,” he says. He studied the technique in Italy and Russia, and began practising in Canada in 1987, later moving to the US. The apparatus, which was first used in the UK in 1989, was unwieldy, unsightly, painful – and revolutionary. Bone lost in accidents or to infection could be grown back as if by magic, saving limbs from amputation. Children born with deformities or leg-length discrepancies could escape a life of stigma and pain.

People with height insecurity also showed an early interest. “My first cosmetic patient was in 1988,” Paley says. “The market always existed.” But it stayed small. Paley, who values the transformation his cosmetic patients report in their confidence and wellbeing, performed around 10 stature lengthenings per year for the following two decades. The first telescopic nails arrived in the 1990s. They worked mechanically: patients twisted the limb to activate a ratcheting mechanism in the nail.

The big change came in 2011 with the launch of the magnetic Precice nail, which Paley helped develop, and which is now owned by NuVasive, a US medical tech firm. In 2018, NuVasive launched the Precice Stryde nail, which allowed patients to bear weight on their still-elongating legs soon after surgery. With each new development, leg lengthening looked more like a futuristic body hack than medieval torture.

Even a recall of the Precice Stryde nail in 2021 due to “biocompatibility” issues – which Nuvasive tells me are still being investigated – has failed to reduce demand. Paley now uses the Precice 2.2 nail, which is still available in the US, and is also developing a new, smartphone-linked device. All types of Precice nail remain unavailable in the UK. While the pandemic shut down clinics and tourism for months, surgeons tell me it only created pent-up demand, as people had more time to contemplate their perceived imperfections. Paley says inquiries for stature lengthening have gone from one a month in 2013 to 40 a month in 2017 – and 200 a month today. He now performs 100 cosmetic procedures a year, and 84% of his patients are men.

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As surgeons market themselves via social media and Google search results, shorter people are discovering a brave new world – and a minefield. Victor Egonu, a health clinic manager in Baltimore, has emerged as a lightning rod for their questions. The amateur bodybuilder had a leg lengthened in 2012 to correct a two-inch discrepancy caused by a childhood rollerskating crash. Since early 2020, he has interviewed dozens of surgeons and patients for his Cyborg 4 Life YouTube channel, which has had more than a million views. He now gets up to 30 messages a day from prospective patients, almost all young men.

While nobody counts the total number of procedures performed worldwide, Egonu estimates it is in the thousands every year, and rising fast. He says men account for 95% of his views, and that women who get the surgery start proportionally smaller – he recently had a message from a woman in her 20s who is 4ft 7in (140cm) and fed up of being treated like a child.

Egonu wants patients to be better informed. He also wants to tackle a secondary stigma that confronts people trying to escape height prejudice. “People say breaking your legs to get taller is barbaric and you should never do it,” he says. “But when you hear about the unhappiness patients wake up with every day, you understand.”

I speak to one father, who does not want to be named, whose teenage son is convinced that he needs the surgery. “He says that nobody takes you seriously if you’re small, and that girls don’t like you,” the father says. He blames social media and the cult of the body beautiful. “Kids want chiselled chins, no spots, awesome hair and to be 6ft 1in,” he says. “But it’s the height thing that really seems to be big for him and his friends. When they’re chatting online to girls, the first question they get after being asked for a photo is: ‘How tall are you?’”

“Just look at Love Island,” Lewis says. “It’s all so body-focused.” In 2020, Love Island contestant Nas (5ft 7in) was mocked in and outside the villa. In the same month, former islander Amy Hart made a joke in an interview about her “dating deal-breakers”: “What do you call a man under 5ft 10?” she asked. “A friend.”

When we speak, the father is hoping that X-rays will show his son still has growth plates – the areas of bone tissue in children that indicate growth is still to come. “I literally hope he grows out of the whole idea,” he says. “But I guarantee there are many families going through exactly the same thing.”

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Surgeons themselves are navigating the ethics of limb lengthening. When I contact Ian Bacarese-Hamilton, the UK’s best-known limb-lengthening specialist (he trained with Paley), the surgeon initially agrees to talk before cancelling and referring me to the Schoen Clinic, where he works, near Harley Street in London. The clinic tells me it has never carried out cosmetic limb lengthening, despite having previously marketed it, and has even stopped lengthening for medical reasons while the Stryde nail is unavailable. Neither the surgeon nor the clinic respond when I ask why they appear to be distancing themselves from stature lengthening.

Matija Krkovic, a consultant orthopaedic surgeon and limb-reconstruction specialist in Cambridge, tells me he always had “severe reservations” about the practice. “The risks, while low in frequency, can be substantial,” he says. But that hasn’t stopped a flood of recent inquiries – and a change of heart. “I realised that people will do this, and that I’m well suited to it because I know how to deal with complications.”

Krkovic is now waiting for a handful of prospective patients to have a psychological assessment before carrying out his first cosmetic leg-lengthening operations. He’s ready to disappoint people if he thinks surgery won’t solve their problems. Dimitrios Giotikas, a Greek surgeon and specialist operating in Athens and Cambridge, tells me he says “no” to about one in 15 patients if assessment reveals body dysmorphia, a psychological condition that can be treated with therapy and antidepressants. “I make sure that I’m doing the right thing for the right person,” he says.

Lewis has had therapy, but he doesn’t think he had body dysmorphia. “I think I had valid concerns,” he says. His own surgeon agreed. After a couple of months of lengthening, Lewis was 3in taller – and not far off the average height for a UK man (5ft 9in, or 175cm). “It’s almost a good social experiment in that everything else about me is the same, but the way people treat me is so different,” he says. “And it’s hard to disentangle the confidence I’ve also gained, but I do think people make first impressions in seconds.” He is now walking normally, without any ill effects.

When Lewis saw people who knew him before the operation, he watched their confusion, but wasn’t asked to explain his transformation. Dating suddenly got a lot easier, although on one occasion a woman unwittingly mocked shorter people in front of him. Lewis bit his tongue, but later told her about his surgery. “She said, ‘Oh, you didn’t need to do that!’ And I said, ‘You literally just said we wouldn’t be here now if I’d been who I was.’” The relationship didn’t last.

If Lewis has any regrets, it is that society made him feel this way. As good as he now feels, he would rather not have spent a small fortune on risky surgery. “This has such an effect on people,” he says. “I get sad looking back at how worthless I was made to feel. I just wish people were, you know, a bit kinder.”

• This article was amended on 9 November 2022 to remove an image of an X-ray showing an outdated leg-lengthening procedure.