Sun, Dec 21, 2003 page9

• Going under the knife in China to add a few centimeters in height

  In a country where height can make the difference in getting a job or getting into law school, leg-lengthening surgery is becoming increasingly popular for men and women alike, despite the cost, the pain -- and many horror stories

  • By Jonathan Watts / THE GUARDIAN
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  Kong Jing-wen has paid ?5,700 (US$10,075) to have both of her legs broken and stretched on a rack. The pretty college graduate is now lying in bed, clearly still in considerable pain three days after a doctor sawed through the flesh and bone below her knee to insert what looks an awful lot like knitting needles through the length of her tibiae.

  These giant steel pins are connected by eight screws punched horizontally through her ankle and calf to a steel cage surrounding each leg. Once the bone starts to heal, these cages will act like a medieval torture device -- each day over the next few months Kong will turn the screws a fraction and stretch her limbs more and more until she has grown by 8cm.

  

  ILLUSTRATION: YU SHA

  Despite the agony, the cost and the inconvenience, the 23-year-old says she does not regret a thing.

  "It hurts, but it will be worth it to be taller. I'll have more opportunities in life and a better chance of finding a job and husband," she says.

  Her parents, who financed the operation and are now at her bedside, agree.

  "It is our investment in her future. Because she was short, she used to lack confidence, but this should change that," they say.

  Kong is one of a growing number of perfectly healthy Chinese young men and women who are willing to break a leg for beauty in order to rise up the ladder in height-conscious China. The complex and time-consuming procedure they are willing to endure was initially developed in Russia for people with stunted growth, mismatched legs or disfigurements. But these days the operation is increasingly used for cosmetic purposes.

  In part, the popularity of such surgery can be explained by the surge of interest in fashion and beauty in a country where the rising middle classes are shaking off a dowdy Maoist cultural legacy and using the rewards of explosive economic growth to explore cosmetic possibilities. Shops and magazines in the cities show endless images of long-legged Western models, inevitably putting pressure on young women.

  Doctors have been able to pioneer new forms of this surgery because height is so socially important in China that it is often the first thing strangers will talk about. It is also listed among the criteria required on job advertisements. To get a post in the foreign ministry, for instance, male applicants need not bother applying unless they are at least 1.71m, while women must be at least 1.61m. Chinese diplomats are expected to be tall in order to match the height of their foreign counterparts.

  For more glamorous positions the conditions are even tougher: air stewardesses have to be over 1.66m. But height discrimination is evident even at ground level: in some places, people under 1.61m are not even eligible to take a driving test. To get into many law schools, women students need to be over 1.60m and men over 1.64m. Height requirements are also frequently mentioned in the personal ads of newspapers and magazines.

  All this has ensured a steady stream of business for osteogenetic surgeons like Dr Xia Hetao, who has pioneered a height-increasing technique in Beijing used by about 150 people every year.

  "More and more people want to be taller," he says. "It is so important for the image of an individual or a company that some people come here in tears begging for an operation."

  With a minimum ?4,000 price tag attached to the procedure, the patients are all well-off by Chinese standards.

  According to employees at Xia's institute of external skeletal fixation technology, it is not just women who are prepared to have their legs lengthened -- men are just as keen. The vast majority of patients are job- and spouse-hunters in their 20s, but teenagers are also among the patients and the oldest person to have the operation was a 52-year-old woman. "She was very wealthy and had everything else she wanted, so she decided to fix her height which had always been a concern for her," explained one of the staff.

  In many cases, the clients are not even particularly short to begin with. Dr Xia said one 1.74m women asked to grow 2.5cm so that she could reach the standard needed to qualify as an international fashion model. But most of the others are under average height and undergo up to two operations so that they can grow by a maximum of almost 13cm.

  Each procedure has three stages. First comes the operation in which the legs are broken and steel pins -- 27cm long and 8mm in diameter -- are pushed through the bone. These are fixed to an external frame by eight or so screws, each of which is 4mm in diameter. Next comes the stretching, which is carried out over several months (depending on how much the customer wants to grow) by turning the screws each day and lengthening the bone at the point where it was broken. When the stretching is completed the external frame is removed. In the final stage, the steel pins are left in place for about a year as a support for the newly regenerated bone.

  Once it has hardened, the pins are removed.

  Xia, who has several decades experience in the field, says his patients have not suffered any major problems since 1978, before which two women suffered bone disconnections and another became disfigured. Those cases were corrected, and since then the only risk, he says, has been a 5 percent chance of infection.

  "With my method, the bone, skin and nerves grow back and the body rebuilds itself as new," he says. "The legs are not weakened, the pain lasts only a few days and my technique leaves tiny scars."

  But if not performed carefully, the dangers are considerable. Bones stretched too rapidly will not grow strong enough to support the body's weight. Legs extended at different speeds can become misshapen and nerves can be damaged. Horror stories about other less capable surgeons appear from time to time in the Chinese media.

  Young women have reportedly been left with their feet splayed outwards on legs that are weirdly twisted; the bones of others have never properly healed and they keep breaking at the slightest knock.

  In one of the worst reported cases, a 31-year-old woman was left in the frame for a year because her bones proved so brittle that they could not support her weight after being stretched. Her feet still point in odd directions and she is unable to squat.

  Even successful operations can bring pain several months after the initial operation.

  "During the final weeks of the stretching, I was in so much discomfort that I couldn't sleep at night," says one young woman from Beijing who gave her name as Susan.

  The 27-year-old is in hospital recovering from an operation to remove the steel pins that have been inside her legs for the past 18 months. Each leg now bears eight circular scars, each 1.3cm in diameter, from the screws that were removed. But now, 4.5cm taller than before, Susan says she would not hesitate to recommend the procedure to her friends.

  "It hurt at first and had a big impact on my life for a long time because I was worried the pins might bend and so I couldn't run or move completely freely. But it has worked and I feel very good about that. Before, nobody paid any attention to me because I was short, but now they'll look at me," she says.

  Appearances are becoming increasingly important in China. Once banned as the "nonsense" of a decadent West, beauty pageants were made legal this year. Last month, the country for the first time hosted a first Miss World competition.

  Cosmetic surgery is also thought to be booming. According to the local media, consultants report a 25 percent increase in the number of women seeking nips and tucks. The most popular operation puts an extra fold in eyelids. Like nose-lengthening, jaw re-shaping and enlargement of breasts, the procedure aims to bring women closer to Western ideals of beauty.

  The fascination with such makeovers has created at least two cosmetic surgery celebrities. Last month the domestic media was filled with stories about Hao Lulu, a 24-year-old fashion writer who is undergoing a seven-month-long marathon of procedures costing ?13,150 so that she can work as a spokeswoman for the industry.

  Soon after, Shanghai newspapers announced the winner of what they dubbed the "ugliest girl in the city" competition.

  Despite the unflattering moniker, more than 50 women applied for the contest, in which the victor -- Zhang Di -- was awarded a prize of ?6,800 worth of cosmetic surgery.

  At Xia's height-increasing institute, that sum of money would buy 10cm -- the difference, say some of his patients, between social failure and success, dowdiness and attractive looks.

  Back in the wards of recovering customers, Gui Ling, a 25-year-old woman, has a smile fixed on her face after completing a 7.5cm stretch and having the frame removed from her legs.

  Wanting to share her excitement over the transformation, she is calling up her family, friends and colleagues on her mobile phone.

  "I'm so pleased," she says during a break between calls. "My friends will look at me and they won't just say I'm taller, they'll say I'm more beautiful."
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