SINGAPORE – It was initially devised as a method of leg lengthening for those with congenital growth abnormalities or trauma to the lower limbs. However, since it was introduced in 2001, Fitbone surgery (http://www.singaporemedicine.com/leadingmedhub/leadingmedhub1.asp) has without much fanfare, slipped into the realm of cosmetics.

Professor Sarbjit Singh, a Senior Consultant Orthopedic Surgeon at Singapore's renowned Mount Elizabeth Hospital, part of ParkwayHealth (http://www.singaporemedicine.com/hcp/hcp1.asp), was the first surgeon in Asia to carry out the high-tech procedure in 2001.

He maintains, "This procedure was meant to be an improvement over the older method of treating the limbs of polio or accident patients. However, seeing that it is much safer and more efficient, with less down-time and low risk of infection, it was inevitable that the good results would attract other uses."

The older Ilizarov method involves fitting the patient's leg within a circular frame using pins and wires pierced into the skin, muscles and bone. Screws attached to the bone are turned 1mm daily. After the growth gap is closed, patients then have to wear the frame until the new bone solidifies. However, since this involves placement of an external device into the skin, there is a high risk of infection at the point of entry.

Fitbone is essentially an advancement over this. Developed by German surgeons, Augustin Betz and Rainer Baumgart, the minimally-invasive surgery requires the bone of the leg to be cut before remote-controlled motorized nails are implanted. Through radio signals from an external transmitter, the nail expands about 1mm a day and allows bone tissue to grow around a rod inserted insider the hollow interior of the bone (marrow).

After being lengthened, the bone is then allowed to solidify. The surgery takes three to four hours with a week-long hospital stay and another nine months before the patient can walk again. The rod is removed after two years.

Prof Sarbjit asserts, "Besides being less traumatic, Fitbone spares the patient the inconvenience of any external scaffolding. Moreover, infection and scarring is minimal and risk of misalignment due to movement of the frame is eliminated."

Although originally intended for medical use, it has now become increasingly popular in cosmetic leg lengthening (http://www.singaporemedicine.com/healthcaredest/healthcaredest1.asp). Prof Sarbjit reports that 60 per cent of the Fitbone surgeries he has carried out were on individuals wanting to be taller or professional models who desire the added height to capture lucrative runway assignments.

Whether it is for medical or cosmetic reasons, Prof Sarbjit would only perform Fitbone surgery after making sure that his patients fully understand the risks involved. For cosmetic limb lengthening, he recommends it for those with constitutional short stature; meaning 165cm or below for males, and 155cm or below for females.

"It's important in these cases, not to over-lengthen the limbs. It must be aesthetically acceptable. The maximum I have increased a person's leg length is by 11 cm, using four rods, above and below the knee. My shortest patient was a 152 cm tall male," shares Prof Sarbjit, who has done over 60 such surgeries.

He says, "I expect this to really take off in time but for now, we remain one of a few places in the world that offer this."

Fitbone surgery is presently available in only selected medical centers in Europe and Asia. In Singapore, the Fitbone procedure costs around US $42,000 (http://www.singaporemedicine.com/5myths_medical_tourism/intro.asp) per telescope nail.