Simultaneous lengthening of the femur and tibia can be effectively and safely accomplished. However, the following issues must be kept in perspective: (1) patient selection is essential, and (2) meticulous attention to detail in all aspects of the operative procedure is vital. The advantages of performing such an ambitious operation include: (1) reduced morbidity, (2) reduced number of operations (not procedures), and (3) more rapid recovery when compared to performing the operations sequentially. This kind of program should be carried out only by those experienced in the limb lengthening procedure.