"It's like tuning a violin," he explains. "With each turn of the knobs, the ligaments and muscles and skin come under more tension. Each day everything gets tighter. It's incredibly painful." So much so that Conran* won't allow himself to sleep for longer than 3 hours. "I'm frightened I'll miss a dose of medication, and the pain will get ahead of me," he says. Recently, he was given morphine, and that's helped somewhat. But he's still confined to a wheelchair and can stagger only short distances around his Manhattan apartment.

Before you start pitying Conran, you should know that he was not in a horrible accident that shattered his legs, nor does he suffer from a birth defect that's finally being corrected. No, he is an otherwise healthy, 45-year-old, single attorney who is paying $70,000 for this voluntary procedure. In fact, he's been looking forward to this for much of his life. Despite how it seems, he is living his dream.

You see, Jim Conran is 5'5 3/4" tall. Or rather, he was 5'5 3/4" tall. In the past few months, he has "grown" 1 millimeter per day (about 1/25") by turning his 22 pins ever so precisely. And as he's done so, new bone has been steadily forming in the gaps where the segments of tibia and fibula are being pulled apart. When he last checked--and he checks daily--he was 5'8 1/4". When he (hopefully) reaches his goal height of 5'9" and this violin tuning ends, he's confident his life will finally be in harmony.

Short. It's a five-letter word that carries four-letter connotations for men below the national average of 5'9". Unless you're one of them, you don't know how much it hurts to be called that.

Imagine this scenario. You've been accepted at Harvard, West Point, and Annapolis. You're an A student. You've won seven varsity letters, and you nearly qualified for the Olympics. Yet to get into West Point (your first choice), you must meet a height requirement of 5'6". You're slightly below that. So the night before your admittance physical, you have your father repeatedly whack you on top of the head with a textbook in order to raise a bump. Next day, you officially measure in at 5'6 1/16". You go on to graduate with honors, serve your country overseas, and eventually end up as an aide to the president of the United States. And you know, your whole life long, that you might have missed all of this--by a quarter inch.

"From a very early age, you start getting clear, institutionalized messages that you're less desirable," says George Holdt, the soldier in question, who, like Conran, is now undergoing limb lengthening. "From the violence you experience in school to the behavior you encounter throughout your social and professional life, the discrimination is always there."

Today, height requirements in any workplace are largely a thing of the past (the military's cutoff is now 5'). But it's an example of the frustration that is the legacy of the diminutive man. And no, it isn't his imagination. Numerous scientific studies have verified the advantages of height. For example, taller men . . . . . Are more likely to be hired. When recruiters in one study from Eastern Michigan University were asked to choose between two equally qualified candidates who differed in height, 72 percent chose the taller applicant. . . . Make more money. Graduating seniors at the University of Pittsburgh who were 6'2" or taller enjoyed starting salaries $4,000 higher than counterparts 5'5" or under. Economists at the University of Pennsylvania even estimate that added height is worth nearly 2 percent in additional income per inch per annum. . . . Are chosen as leaders. Nancy Etcoff, Ph.D., a professor of psychology at Harvard medical school, points out in her book Survival of the Prettiest, "the easiest way to predict the winner in a United States election is to bet on the taller man." Of 43 American presidents, only five have been significantly below average height. What's more, Etcoff cites a study of Fortune 500 CEOs that found that more than half were taller than 6 feet, and just 3 percent were shorter than 5'7". . . . Make better first impressions. Surveys by Henry Biller, Ph.D., a professor of psychology at the University of Rhode Island and coauthor of Stature and Stigma, show that compared with shorter men, guys of average and above-average height are seen as "more mature, uninhibited, positive, secure, masculine, active, complete, successful, optimistic, dominant, capable, confident, and outgoing."

While all of this pisses off short guys, what really bothers them is how they're viewed by women. Walter W. Windisch, Ph.D., is a psychologist in Towson, Maryland, who evaluates short men who are considering limb lengthening. "The average patient," he notes, "is 28 years old, male, college educated, professional, of some financial means, the product of parents who expressed concern about height, and, in every case, single."

Indeed, if you read the personals section of your local newspaper or log onto any online dating service, you'll find lots of ads from women listing height preferences. Why are they so particular, especially when they're paying by the letter? Certainly a portion of it stems from the statistics cited earlier--that taller men earn more and enjoy a higher social status. Some of it also comes from Hollywood, where leading ladies routinely look up into the eyes of the tall, dark, and handsome man. It's the romantic ideal. But a good chunk is also based on an almost primitive assessment. Is he a good provider, a worthy protector, a gifted procreator? And on some anthropological level, it's as if she ultimately decides the short man is not. Less than one-half of 1 percent of women marry men who are shorter than they are, according to Etcoff.

"Someone once asked Sigmund Freud, 'What is the goal of life?' and his answer was, 'To love and to work,' " says Windisch. "That's a fairly good summary of what's bugging these guys. They're looking to love and be loved, to work and be valued. It's just that their stature, something totally beyond their control, is keeping them from it." About 2,500 kilometers east of Moscow, at the western edge of Siberia, is the Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics. Located in the Russian city of Kurgan, in the shadow of the Ural Mountains, it was founded in 1971 by Professor Gavriil Abramovich Ilizarov. Decades earlier, faced with treating a large number of World War II veterans with complicated limb fractures, he began experimenting with "circular external fixators" to keep bones aligned and to speed healing. Their use as limb-lengthening tools, however, was discovered by accident. While Ilizarov was on vacation, a nurse adjusted a fixator in the wrong direction. When he returned and examined the patient's x-ray, he noticed new bone forming in the gap. This set the stage for a variety of new applications, including the correction of leg-length deformities, bow legs, anchondroplasia (dwarfism), and, lately, short stature. More than a half century later, the Ilizarov method--as it's come to be known--is still being used in a surprisingly unevolved form throughout the world.

Here's how it works: After taking a series of x-rays to map out the precise dimensions of the bones, the surgeon orders a regional anesthetic and makes two half-inch-long incisions in each leg (usually below the knee). Using a surgical chisel, he then cracks the tibias and fibulas, being careful to disrupt as little of the surrounding tissue as possible. (Note: When a doctor breaks your legs, it's called an "osteotomy.") Next, he attaches the circular aluminum frames. This requires piercing each leg with 11 arrow-sharp carbide pins and pushing them in until they bottom out against bone. The pins are of varying lengths and diameters, with the thicker ones being positioned closer to the breaks for added stability. Once the pins are in position, the surgeon slowly screws them into the hard calcium-and-collagen shell that surrounds the marrow. The rest is comparatively straightforward: Affix the adjustment wires to the pins, sew the two osteotomy incisions shut, treat and bandage the pin wounds.

For all that's involved, the entire operation takes just 2 1/2 hours. Patients typically remain in the hospital for 2 to 3 days, after which they can take a dozen or so steps. But this is the easy part. The frames usually stay on for 3 to 6 months, during which time the bones are gradually separated. This is called the "distraction phase." All but one of the men we spoke with said that, even with heavy doses of narcotics, such as Vicodin, the resulting pain was just on the edge of bearable.

"It will reduce the toughest man to a crying little girl in a matter of weeks," says Jack Turner, a 39-year-old salesman who "grew" 2 1/2 inches as a result of this surgery.

"It's an act of aggression against your own body," adds Conran.

Just as difficult is the helplessness that results. Patients are dependent on wheelchairs, walkers, and the supportive arms of friends and relatives to get around. Most are bedridden except for periodic doctor visits and daily physical therapy. Work is out of the question. This is true not only during the distraction phase but also for 3 months or more after the frames come off and the new bone is hardening. "You need somebody to take care of you virtually all the time," says Rick Morgan, another patient. "Sometimes you can't even reach the bathroom."

Although some doctors make lofty promises, most legs won't tolerate being stretched past 3 inches. It's not the bones that balk, but rather the muscles and tendons that surround them. Overall, there's a 25 percent complication rate from this surgery, with the most frequent problem being pin-site infection. That's why patients are given a prescription for oral antibiotics, which they're told to begin taking at the first sign of redness, tenderness, or discolored drainage at the pin entry points. If an infection goes unnoticed, it will spread into the deep leg tissue and then the bone. A less common but still serious complication is nerve damage. In one study review of 814 limb lengthenings, approximately 10 percent of patients had experienced some form of temporary nerve damage, characterized by chronic pain or impaired motor skills.

But the most catastrophic possibility doesn't present itself until the frames are removed. Even though the doctor will have taken x-rays to gauge structural integrity (the whiter the area, the stronger the bone), there's still a chance that what took months of agonizing pain and tens of thousands of dollars to build will, at the moment of truth, snap. Or the new bone will hold, only to buckle and break weeks later. Either way, doctors call this a refracture; there's a one-in-12 chance of its happening.

If you're a short man seeking salvation through surgery, you've probably heard of the International Center for Limb Lengthening, in Baltimore. An affiliate of Sinai Hospital, the ICLL was the first facility of its kind in North America and remains the largest--half of all the limb lengthenings for height are performed here. The bulk of its business, however, deals with correcting functional deformities. "I'm very strict when it comes to doing this surgery on otherwise healthy people," says 47-year-old chief surgeon Dror Paley, M.D., himself 6'. "In fact, I try to discourage it. The magnitude of what you have to go through is so large, it's not in the realm of having your nose done or your tummy tucked."

Dr. Paley generally will not operate on men over 5'6" (or women over 5'2"), and he requires that all prospective patients first undergo an intensive, 10-hour psychological exam by Windisch. Only about 10 percent go on to have the operation. "You must be careful," says Dr. Paley. "I've had some real nutcases--people who were willing to sell their houses, steal their wives' money, do unbelievable things for a few extra inches."

Depending on the facility and the specifics of the case, those inches typically run between $50,000 and $80,000. When limb lengthening is done on a healthy person, medical insurance won't pay for it. However, if done to correct a leg-length discrepancy, bow legs, or any other limb deformity, it is usually covered.

Some of those people who can't raise the necessary funds or who don't pass the screening process go elsewhere--like Jack Turner, who ended up in Italy after being "dumped," as he calls it, by Dr. Paley. "The cost turned out to be one-eighth what it was in America," he explains, "and I felt I got better care."

And yet, even though it's been almost 3 years since Turner had his operation, he says he's still at only 80 percent of his former physical ability. "I don't think anyone can break both legs and come back 100 percent," he says. "For instance, I can't run as fast, and I have pain when the weather is damp."

The long-term effects are unknown. Although some doctors insist that dwarves who were lengthened as much as a foot decades ago show no traces of bone weakening or arthritis, other experts remain skeptical. "There's an enormous risk," says Michael Ain, M.D., a 4'3" orthopedic surgeon at Johns Hopkins Hospital in Baltimore. "Nobody really knows what's going to happen to people getting this surgery."

Neither the American Society for Aesthetic Plastic Surgery nor the American Academy of Orthopedic Surgeons (AAOS) endorses cosmetic limb lengthening. Others condemn it outright. "I'm appalled that our society has become so imbued with self-image that patients are willing to put their necks on the line like this. There are just too many risks," says William Tipton, M.D., director of medical affairs for the AAOS. "And the surgeons who are doing these operations on otherwise healthy people should remember this: Primum non nocere. That's Latin for 'First, no injury.' "

One of those surgeons is S. Robert Rozbruch, M.D., director of the Institute for Limb Lengthening and Reconstruction at the Hospital for Special Surgery, in New York City. He counters: "Seeing the profound impact this surgery can have on someone has convinced me that, for a very select group of people, it should be brought out of the closet and done more freely."

Paul Steven Miller, for one, thinks limb lengthening is unnecessary. Miller is an attorney and the commissioner of the U.S. Equal Employment Opportunity Commission. He also happens to be a 4'5" dwarf, who has experienced height discrimination firsthand. "One law firm told me they feared their clients would think they were running a circus freak show if they hired me," he recounts. Nonetheless, Miller says cosmetic limb lengthening is "silly." "I have a hard time believing it really makes a difference in these people's lives."

With predicted advances in limb lengthening, combined with the recent FDA approval of growth-hormone therapy for short children (see "Booster Shots," earlier in this story), will Diminutive Man soon take his place next to Cro-Magnon in the Museum of Natural History? Are we entering an era of stature cleansing?