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He spent seven days in the hospital and the next 10 weeks, the lengthening phase, at a nearby residence. After the surgery, a sticky blood mass called a callus—the beginning of new bone—formed on each of his broken femurs. Jeff’s job was to click a remote control that signaled the rod to telescope out one millimeter a day, stretching the bone callus with it. He describes the feeling in pubescent terms, as “an intense growth spurt.” Then, during his last six to eight weeks in Germany, he waited for the bone to knit together and harden in its new, longer form.

Jeff is one of an estimated 4,000 people in the world who have chosen to undergo cosmetic limb lengthening (CLL) in recent years. “That number is increasing all the time,” says Dr. Dror Paley, an orthopedic surgeon at Sinai Hospital of Baltimore. Paley gets several e-mail inquiries about the procedure every day, the majority from affluent men between the ages of 20 and 40. “Some are very genuine,” he says, “and others are complete nutcases.”

A person could argue that to pay upwards of $100,000 for a risky, excruciating surgery that adds just a few inches to your frame is insane. CLL is by far the most extreme (and expensive) procedure that a human being can submit to in the name of vanity. Most lipo and facial-surgery patients can go home within an hour. Recovery time for calf and pec implants is a couple of weeks. And at $8,000, penile implants seem like a bargain by comparison—plus, in terms of pure physical pain, there is no contest. Beyond the agony of having your bones cut in two and stretched, CLL carries risks like pinhole infections, nerve damage, and severe deformity.

On a website called Make Me Taller, which launched two years ago, you can wade through message boards filled with self-loathing, hope, and hubris. “I would like to do 6 [centimeters] and go home sooner,” writes “12,” a patient about to undergo CLL in China. “I’ll have less possible complications and a shorter recovery time. The only thing that stops me from making that goal solid is the idea that I’ll be leaving almost an inch on the table. And yes, 2 inches is substantial, but isn’t 3 inches, like, mind-blowing?”

“What I hear is ‘People don’t take me as seriously as they would if I were taller,’” says Ellen Westrich, a psychologist who evaluates potential CLL candidates for Dr. S. Robert Rozbruch, a New York surgeon. “The dating [thing] is huge. In this culture, a certain value is placed on being taller than a woman, on being strong, being tall.” Some studies have shown that a man’s earning power and reproductive success correlate with his height. Add that information to the images of sad short-statured celebrities on shows like The Surreal Life and you can see why a man who stands well below the average American height of five feet ten deals with some very real misery.

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While most of the men Westrich screens are between five feet and five feet six, one in ten is over five eight, and some are significantly taller. At the Betz Institute, Jeff heard about a male model who left the clinic standing six feet two.

Some cases are more extreme than others. Before Akash Shukla had his surgery, he was four feet eleven and a half—not technically a dwarf but short enough to be mistaken for one. “People used to make a lot of jokes,” Shukla says. “I could never ask anyone out.” A 21-year-old engineering student from New Jersey, he took a year off from college to have CLL with Dr. Rozbruch. Six months and $200,000 later (that total includes expenses like equipment and physical therapy), he emerged standing five feet two. Though he says the surgery was “more painful than giving birth to seven children,” Shukla believes that the two and a half inches it gave him changed his life. “I have a new social confidence,” he says. He’s been approached by a number of men with questions about CLL—including a guy who was five feet eight. “I was like, ‘Oh my god, you’re actually considering cutting your bones in half to be five foot ten?’” Shukla says. “I’d give anything to be five foot eight.”

To save money, many CLL patients go to countries like Brazil, China, and Egypt, where the surgery, which isn’t covered by insurance, can cost as little as $10,000. Dr. Yasser Elbatrawy, an Egyptian surgeon, reports that 70 percent of his CLL patients come from North America; he says one was a recognizable Hollywood actor. “Some of these foreign surgeons are completely competent,” Paley says. “Others are doing it for mercenary reasons.”

And there are plenty of horror stories. On Make Me Taller, one former patient claims that he was abandoned during his lengthening procedure in Iran, shackled to an antiquated external leg-stretching device, and left with a handful of pain suppositories he had to self-administer. He returned to the United States with infections and his left leg bent at an odd angle; he was broke and near suicidal. “Tall or short, you are ugly when you limp and walk like a loser,” he writes in one post.

American doctors say they encounter cases like this regularly. “I just saw a guy who got lengthening on both tibias in the Ukraine,” Paley says. “He came back with infections, and surgeons had to shorten all the inches he’d gained. The guy still has a deformity.”

This spring, Jeff returned home from Germany. His life is, he insists, vastly improved. “The hardest thing is having to hide this,” he says. “I don’t want to be labeled as the guy that did limb lengthening.” The truth already came out with one buddy over drinks. But instead of meeting the news with ridicule, the friend, who is Jeff’s former height, was fascinated enough that he booked a flight to Germany to meet with Betz himself. “He saw my results and he’s pretty convinced,” Jeff says. Getting ready to return to work, Jeff has already bought a new wardrobe—including pants that have a 32-inch inseam. He can reach higher shelves without stretching or using a step stool. He imagines feeling the power of looking down at (or at least being eye-to-eye with) those who once towered over him. There will be new women to meet, as well—women who won’t give his height a moment’s thought. He’s also considering a career in stand-up comedy. Never mind that it was only a few inches; the way Jeff sees it, once you’ve freed yourself from the physical limits of your body, anything seems possible.

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“I’m not bitter anymore,” he says. “I’ll be a better father and husband and son. I just want to be the best person I can be.”