Plastic surgery doesn’t stop at Botox or nose jobs — it can, at times, get pretty bizarre with procedures ranging from mustache implants to “selfie surgeries.” But perhaps even more alarming are the cosmetic procedures that aim to lengthen a person’s legs, for those who wish to be taller and leggier. They can be as gruesome as they sound. In India, orthopedic surgeons first break the bones in the patient’s legs, place the implants, then wait as the patient sits in a brace for months until they are able to walk again.

In India and in many other countries, height and long legs are considered attractive features. It makes sense, then, that leg extensions would be added to the list of cosmetic surgery and body alterations already out there. For medical tourists looking for cheap procedures, the industry in India is tempting. But when lack of regulation and physician training is rampant, these procedures may do more harm than good — and in the worst cases could cripple people for life.

“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,” Dr. Amar Sarin, an orthopedic surgeon in Delhi who performs leg-lengthening operations, told The Guardian. “There are no colleges, no proper training, nothing.”

There are, of course, many leg-lengthening procedures that are done for purely medical reasons, to treat or cure existing conditions like limb deformities or injuries. In fact, the surgery was first developed by Gavriil Ilizarov, a Polish physician living in a small town in Siberia, for those very reasons. Ilizarov created the procedures to help people who had experienced limb injuries or been born with defects. Today, many procedures are still done in a reconstructive, not a cosmetic, light. But those that are cosmetic seem to be growing in popularity, and physicians like Sarin are concerned that many patients are undergoing the operations for the wrong reasons; they believe the operations should be done only when nothing else has worked, even if that means mental health treatment.

“We often turn people away,” he said. “We try counseling first, but we’ve had patients who even threaten to commit suicide if I refuse to do the surgery. Twice I’ve had to call the police in emergency situations like that.”

While the procedures may sound outlandish and painful to those of who have no desire to alter their body, for many patients, leg-lengthening helps boost confidence in addition to height. Last year, aspiring model Alexandra Transer received leg extensions to help her goal of modeling along; she grew two inches. And 24-year-old Komal from Kota in western India praises the procedure for seemingly giving her a new life: “I have so much confidence now,” she told The Guardian. “I was just 4-foot-6. People used to make fun of me and I couldn’t get a job. Now my younger sister is doing it, too.”