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Leg lengthening has been a procedure of last resort because of its high complication rate and significant morbidity with a relatively long period of disability during the process even when no complications occur. The new techniques of lengthening hold promise that orthopedists will be able to achieve more length with fewer complications. It is interesting to note, however, that, while it is the technology of these techniques that has stimulated the greatest enthusiasm, it is the biologic principles that are likely to offer the greatest ultimate benefit. The modern era of leg lengthening has therefore brought two things: new technical versatility to correct complex and coexisting deformities and new concepts of the biology of lengthening that are not device specific and can be applied with most lengthening devices.