At 5-foot-3, Sam was shorter than most guys entering freshman year of high school. Still, it didn’t bother him. He was a late bloomer and knew teens went through growth spurts at different times. I’ll grow, he reassured himself. I’ll catch up. Years went by, though, and Sam wasn’t getting any taller. He accepted his fate at first, figuring it wasn’t something he could ever change. But what remained of his self-confidence disappeared when, as a summer camp counselor, many of the middle-school campers towered over him.

And so, before bed every night, Sam would yearn to be taller, often scouring the internet for information on stature lengthening. He learned the procedure was based on a principle known as “distraction osteogenesis,” in which the femur bone is broken in two and slowly stretched apart. Then, four times a day, the external fixator — a scaffold on the outside of the leg holding the broken bones in place with pins — would be used to slowly pull the bone segments apart, allowing new bone tissue to regrow within the gap and lengthening the leg by one millimeter per day.

A patient I spoke with described the pain as “unfathomable.” All of that, though, changed in 2012 with the introduction of an internal lengthening implant called the Precise Nail, which “revolutionized limb-lengthening surgery dramatically,” explains S. Robert Rozbruch, chief of the Limb Lengthening and Complex Reconstruction Service and director of the Limb Salvage and Amputation Reconstruction Center at the Hospital for Special Surgery in New York. The procedure was suddenly more predictable, less painful and included a much quicker recovery. “The outcomes we’re getting are the same,” Rozbruch said in 2016, “but the experience for the patient is night and day.”

Men have been lining up to shatter their femurs in hopes of adding an average of three inches to their height ever since — at a cost of $15,000 (in Syria) to more than $300,000 (in Florida). If they opt to expand both the femur and the tibia, that typically doubles their growth (and, of course, the price). To ensure they’re psychologically stable for the procedure, Rozbruch requires that his stature-lengthening patients be evaluated by a psychologist, Dr. Ellen Katz Westrich, who explains height dysphoria is a fundamental dissatisfaction with one’s stature. “Often patients are generally happy in their lives,” she explains. “They have good friendships and healthy relationships. But there’s a nagging sense that something about their stature is holding them back.”

Case in point: 5-foot-1 redditor Guerilla00oo says he’s satisfied with most everything in his life save for a lack of intimacy and companionship — which he blames entirely on his height (or lack thereof). “I would be so much happier,” he explained in a post last month. “It’s boring to life your life alone.” Fearful he’ll never not be alone, Guerilla00oo has begun to save for a leg-lengthening procedure. “Is there any reason why I shouldn’t go through with it?” he asked members of the r/relationships subreddit.

“Extreme pain, long recovery times and risk of severe infection to begin with,” warned Aunty_Fascist. “It strikes me as a very drastic measures for a guy who claims to be ‘satisfied’ with most things in his life.”

Guerilla00oo pointed to studies showing that 71 percent of women wouldn’t date a man shorter than them. “Now consider that I’m extremely short,” he noted. “My experience with online dating would indicate that number to be more like 80 percent, and even that’s a kind estimation. So instead of 80 percent rejecting me due to my height, only 30 percent will.”

Another commenter, Mufasaddai, called bullshit on him, however, pointing out that 5-foot-5 is still pretty fucking short, and likely won’t reduce the rejection rate by more than half. “You’re still looking at three out of four women swiping left. If I were you, I’d get a shtick and become a vegan or something.”

But back to the stature-lengthening process itself, during which Rozbruch breaks the thigh bone with a chisel and inserts a titanium rod down the center of its marrow cavity. Interlocking screws hold the Precise Nail to the bone. The whole thing is done under an epidural anesthetic and takes about three hours — or 90 minutes per side.

After four days, the lengthening process begins. The patient is given a magnetic device that communicates with tiny gears inside the Precise Nail that slowly lengthens the rod, averaging one inch per month. As such, after three months, there’s typically an increase of three inches. It takes an additional month or two for the new bone to calcify enough to bear weight. It’s actually fairly discreet, as cosmetic surgeries go, since the Precise Nail is entirely internal. To justify the days in a wheelchair and weeks on crutches to curious coworkers, most patients lie and explain they “had to get some work done” on their knee. “We usually get people up and walking unassisted after about four months,” Rozbruch says.

Leg-lengthening surgery was pioneered in 1951 by Soviet Professor Gavriil Ilizarov in order to treat World War II veterans with leg injuries. The surgery is controversial and banned in some countries, like China, but is popular elsewhere. For example, the last decade alone has seen 10,000 patients flock to the Ilizarov Center, a Cold War era leg-lengthening factory in the rural town of Kurgan in Eastern Russia. In Korea, where height is crucial to success, up to 600 limb-lengthening surgeries are performed every year, each promising patients an additional 5 inches in height. (The largest increase I came across was a man growing six and a half inches, from 5-foot-7 to be over 6-foot-1.)

It’s likewise a growing trend in India, explains Amar Sarin, an orthopaedic surgeon in Delhi, who told the Guardian in 2016 that he gets “around 20 calls a day with people telling me, ‘I have to be taller to find work or love.’” Those calls, too, aren’t just from inside the country; increasingly, they’re from Europe, and North America as well, where the price tag for leg lengthening often runs hundreds of thousands of dollars.

Also, here in the U.S., there are only a handful of doctors who perform the FDA-approved procedure. In addition to the aforementioned Rozbruch in New York, there’s Dror Paley in West Palm Beach, considered the most experienced limb-lengthening surgeon in the world, and Shahab Mahboubian, a former student of Rozbruch’s (and the only stature lengthening doctor in the West Coast), whose North Hollywood office happens to be minutes away from my home. “There’s a lot of research showing that taller men have a higher income,” Mahboubian tells me from behind his desk, effortlessly slipping into sales mode.

There is data to back him up. One 2004 study, for instance, found that over the course of a 30-year career, a man 6-feet tall was predicted to earn nearly $166,000 more than a 5-foot-5 male colleague. And a survey of Fortune 500 CEOs found CEO’s average height to be exactly 6 feet, more than two inches taller than the average American male, with one in three being over 6-foot-2. All told, 90 percent of CEOs are above average height. “This is one of the only psychological problems that can be remedied with surgery,” Mahboubian says. “People look up to people that are taller — literally.”

Given the fragile psyches involved, I ask Mahboubian’s office manager and patient coordinator, Clara Pruett, about the disposition of men who inquire about leg lengthening. Some are really timid about why they want to do it, she explains, while others unfurl a lifetime of insecurities in the initial phone call. “A man we’re currently treating said, ‘I think I’ll have better success with women if I’m taller.’ When he finished the procedure and grew an additional three inches, he asked one of the nurses, ‘Now that I’m taller, would you be willing to date somebody like me?’ I think that reflects the society we live in more than anything.”

Pruett is the point-of-contact throughout the three-month lengthening process and says the biggest challenge patients face relates to what they describe as “intense, pulling pain” resulting from their broken femur — along with the attached muscles and ligaments — being slowly separated, millimeter by millimeter, for 90 days. “There’s nothing in the world that can prepare you for pain like this,” warns Akash Shukla, who underwent leg lengthening in 2004 and documented his ordeal in a book entitled Measure of a Man, explained on HuffPost Live in 2014. “I tried to deal with it by watching Friends reruns and Bollywood movies — anything to take my mind off it.”

Curious how many men are yearning to grow approximately the equivalent of four rungs of a ladder, I ask the Short Men of Reddit if they’d ever consider having a leg-lengthening procedure. A few of their answers:

Yamoth : “Not even once. You can put me in the category of short dudes that are perfectly happy with their height. Hell, even if there was some magic pill that would make me 2 or 3 inches taller, I wouldn’t do it.”

“Not even once. You can put me in the category of short dudes that are perfectly happy with their height. Hell, even if there was some magic pill that would make me 2 or 3 inches taller, I wouldn’t do it.” Shortandspicy : “If it were as simple of a procedure as getting braces for teeth, absolutely. As of right now though it’s too costly, painful and risky.”

“If it were as simple of a procedure as getting braces for teeth, absolutely. As of right now though it’s too costly, painful and risky.” MrProdigal884 : “No. I have a habit of holding grudges. With every person I date afterwards I’ll subconsciously blame them for all the pain I had to endure, constantly wondering if they would’ve ever considered me beforehand.”

“No. I have a habit of holding grudges. With every person I date afterwards I’ll subconsciously blame them for all the pain I had to endure, constantly wondering if they would’ve ever considered me beforehand.” King0Fisher : “Not yet. I’d rather wait ten years and see what sort of advancements have been made in the field of height increasing.”

“Not yet. I’d rather wait ten years and see what sort of advancements have been made in the field of height increasing.” Purushrottam: “I considered it and then just went ahead and did it and I’m now 5’9” (formerly 5’6”).”

Sam also grew three inches. After removing the Precise Nail 10 months later, Rozbruch asked how the increase affected him psychologically. “It’s been great,” Sam replied. “I’m able to grab things! When I walk around, I notice my literal perspective has changed on so many things. It’s awesome because guys on the basketball court don’t even notice I’m three inches closer to the basket.”