You might say our insecurities as a community are most honestly pronounced on the internet forums that provide us with anonymity. If Reddit and Quora are anything to go by, Indians truly struggle with the perceived limitations of their own height, or lack thereof. It’s not surprising then the lengths people from our country are willing to go simply to increase their own height.

Ever since a Guardian article about limb-lengthening in India took the internet by storm, there has been much debate on the ethics of the procedure. Mostly unregulated, the limb-lengthening industry in India is silently fulfilling the dreams of many citizens, even as it may be endangering them simultaneously.

In a Hindustan Times article about the same, the reasons for cosmetic surgery to improve height ranged from failing job prospects, broken engagements to social ridicule. “After a broken engagement, Charu Singh’s family came to the city from Alwar in Rajasthan. She, according to her family, was more presentable now — at 4’11,” having gained four inches. “People looked at me like I was a freak, it’s changed now,” she said. “Thanks to doctor sahib, I’m like everyone else,” she mentioned in the article.

However, Charu represents the exception rather than the norm. The research went on to state that 9 out 10 people who got the invasive surgery were actually men. While women fret and fume over countless other physical insecurities (whether it’s fair skin, body hair removal or slim figures) height is perhaps Indian men’s most potent insecurity–one of the few that finds them on a backfoot in our patriarchal society. Unfortunately for them, however, it’s the one insecurity for which corrective procedures can go woefully wrong too.

The unsuccessful surgery of a Hyderabad techie which had the whole state fuming over the Orthopaedic association and even made the news, is a prime example. Times of India published a report saying that “those who performed the surgery on Nikhil Reddy have been asked to appear before the ethics committee of TSMC to explain why he was selected for the limb-lengthening technique (Ilizarov technique) in the first place as there seems to be no such emergency in the case. (The) 5’7’’ (figure) is not short stature,” said Dr E Ravindra Reddy, chairman, TSMC. Reddy had spent lakhs of rupees to gain two inches and raised an alarm when his height increased only by 10 cm. His father lost considerable amount of money as his 45 acre farm could not produce crops in his absence.

Most of these limb-lengthening surgeries operate with the same Ilizarov technique that was invented by Gavriil Ilizarov in the 1960s, a Polish orthopedic surgeon in Siberia. Mostly used in bone deformities, accidents, poor bone-development and polio cases, the method is popular in India for limb-lengthening. Many doctors advise against the use of this technique for cosmetic purposes. It can take more six months to completely recover from the surgery, which involves physically breaking the shin bone and increasing the space between them over time for new bone to develop in the gap left by the separation.

Metal rods pierced in various lengths of the leg, is one of the radical measures people are ready to take just to be a few inches taller too. Dr. Amar Sarin is the man of the moment in this regard as he is one of the best known orthopaedic surgeons in the country when it comes to limb lengthening. The Delhi-based doctor learned these techniques in Russia and has been carrying various surgeries since 1996. He tries to counsel people to not undergo the surgery but gives in to repeated requests. “It’s one of the most difficult, complex and unnatural orthopaedic/cosmetic procedures and it is totally unregulated in India. If performed by an untrained, non-specialised doctor, the downside can be intense. For example, non-union of the bones, chronic bone infections, bone doesn’t harden properly, permanent nerve damage and even death on the operation table,” he said in a report by The Quint. Dr. Sarin’s website claims he has patients all over the world and one can toggle the world map to find his reach, right from Tokyo to San Francisco.

In the same report, Dr. Sachin Bhosle, another orthopedic surgeon in Mumbai, says they turn away most patients who want such procedures unless they really really want it and understand the depths of post-operative care required for months. If the lack of inches affects the patient’s mental health, Dr Bhosle goes ahead with the procedure, “I feel happy when I change someone’s life for the better,” he said. If stature can mean improvement in mental health, high self-esteem and a better life, the options are many but safety is where the buck must stop. Although surgeons take people under the 5 foot frame for limb lengthening procedures, people in the 5 foot and above category also routinely get it done. The Ilizarov technique itself has been termed ‘quack’ by experts but the industry doesn’t seem to be slowing its popularity down.

The Guardian article quotes a girl named Komal and how her life changed after gaining three inches after months of painful post-operative recovery, which included walking with braces attached to her bones. Her parents had to sell the family’s ancestral lands so she could get the surgery, but for Komal, the extra height is worth it. “I have so much confidence now,” she said. “I was just 4’ 6” [137cm]. People used to make fun of me and I couldn’t get a job. Now my younger sister is doing it too.”

Dr. Sarin has been quoted saying that many people have threatened to commit suicide if he doesn’t operate on them. Even more people believe that they are not taken seriously because of their short stature and lose out on promotions and possible life-partners. He mentions how every orthopaedic surgeon is not worth his salt and patients should trudge carefully. “This is one of the most difficult cosmetic surgeries to perform, and people are doing it after just one or two months’ fellowship, following a doctor who is probably experimenting himself. There are no colleges, no proper training, nothing,” he explains.

At the end of the day, the demand makes it most clear. To opt for a surgery that is high on risk, complications, loss of limbs and even life, amounts to a deep-rooted insecurity far deeper than just vanity. It points to the exceedingly high pressure put by a society that gives far too much importance to people needing to look a certain way. As long as we continue to give importance to such things, procedures like cosmetic limb-lengthening will continue to thrive.