A growing number of adults are  getting taller by undergoing limb-lengthening surgery. Waking up taller might sound like a dream come true, but specialist Dr. Shahab Mahboubian warns it's no walk in the park. During limb-lengthening surgery, which can cost anywhere from $75,000 to $90,000, he breaks the leg bones and inserts a metal rod, or nail. After surgery, the nail is gradually lengthened using a magnetic device, and new bone grows in the slowly widening gap. Here are nine things the Burbank, California, limb-lengthening surgeon said you should know before considering the procedure. 

Recovery from limb-lengthening surgery can be painful and there's a lot of physical therapy involved. You need to be really motivated to be sure you have a good outcome, Mahboubian said. 

"As you stretch out your legs through limb-lengthening, you're not just lengthening the bone, you're stretching out all the soft tissues, including the muscles, ligaments, nerves, arteries and veins," he said. This creates tightness in the legs and hips. After surgery and during the post-operative lengthening process, you'll need to do physical therapy three to five times a week, and continue therapy about twice a week for the following four or five months after lengthening is complete.  

If you have to commute to work or school and are expected to be on your feet at your job, you should be prepared to take an extended break. "After surgery, patients really have to concentrate on working on their flexibility and regaining strength," Mahboubian said. "It's not going to be easy to get around, especially if they're going to be walking around with a walker or wheelchair for four or five months," he added. Patients also won't be able to drive for at least a couple of weeks, while they're on pain medications and regaining strength in their legs.

Mahboubian said that you need to be in fairly good shape before surgery, and you may need to lose weight before undergoing a limb-lengthening procedure. "The less you weigh, the less chance of a broken limb-lengthening nail or difficulties with the lengthening process," Mahboubian said. 

Each of these nails can bear a maximum of 75 pounds on their own. Using a walker will prevent you from putting too much on these nails, but less weight means less risk of damaging the nails or impairing the growth of healthy new bone. 

"Being heavier does not disqualify someone from eligibility for limb-lengthening, but I tell them to be careful and to always use the walker for the first few months after surgery, so that they can put more weight on their arms than their legs," Mahboubian said. 

Because limb-lengthening will stretch and tighten your ligaments, you'll need to limber up before surgery, if you aren't already fairly flexible. Mahboubian said, "If someone's muscles are really tight and they try to touch their toes when they are standing and can't reach below their ankles, they really need to work on their flexibility before surgery." 

He advises that someone with limited flexibility stretch and exercise daily two or three months before their operation date. 

Mahboubian said that quitting smoking or vaping prior to surgery is a must. "If they vape or smoke marijuana a lot, I tell them they have to quit at least a month prior to surgery." 

Cleaning out impurities from the body makes way for nice, healthy new bone to form Mahboubian added. "One of the biggest antagonists for bone growth is nicotine, and smoke in general." 

Also, given that patients generally take strong painkillers during recovery, it's important to abstain from drinking during this period too. 

Pain after limb-lengthening surgery can be managed well with medications, but there may be some other strange sensations to contend with as your body adjusts to its changing stature. 

"As soft tissues get stretched along with the bone, some people get swelling in their legs or get numbness or muscle spasms," Mahboubian said. But proper stretching and medication help to manage these symptoms, and numbness usually fades once the lengthening process is over. 

Mahboubian said some patients also develop soreness far from the site of surgery during recovery. "One of the more common complaints I get is people having pain in their arms or hands, and that's just from overusing their walker," he explained. 

One of the most common reasons Mahboubian's patients want limb-lengthening surgery is to improve their love lives. But, during months of recovery after surgery, sex may be a challenge for a while. 

"I think most people are pretty creative about different positions. I haven't heard many complaints about how their sex lives change," Mahboubian said. And the wait pays off: "Most of the men talk about having a much better sex life after they are all done with their surgery," he said. 

As a rule of thumb, limb-lengthening patients can't add more than six inches to their height — and getting six inches taller can't be achieved in a single surgery. Patients have to undergo one procedure to lengthen the femurs above the knee and a second to lengthen the tibias. 

"If you're much shorter, let's say five feet tall, you're probably not going to get the full six additional inches," Mahboubian said. "You're asking a lot of a body, compared to someone who's five-foot-seven and is trying to get six inches taller, the percentage of how much your body is capable of growing." 

Mahboubian hasn't found his patients to have any limitations after they've fully recovered from surgery.  "All my patients have been able to get back to their pre-operative activity levels," he said. "Some people complain of a little tightness, in their hips for example, but for the most part patients tell me, 'I'm back to playing soccer, surfing, skateboarding, playing basketball,' so, that just shows me that they don't have many limitations." 

However, Mahaboubian said it typically takes a year before patients are back to fully participating in activities like sports. 

"This is a tough procedure. It's a long recovery, it can be painful, and there's a lot of physical therapy involved," he said. "But I've seen time and time again how the surgery really changes the confidence level in my patients. I think the sky's the limit when it comes to what you can achieve in life."