Screw hemiepiphysiodesis is widely used as an effective surgical technique for guided growth in skeletally immature patients with varus or valgus malalignment. This video discusses limitations of conventional application of this technique and advantages of modification with retrograde guide pin placement. In addition, the case presentation reviewed in the video demonstrates bilateral medial distal femur hemiepiphysiodesis, and pearls for setup and the sequence of the procedure are highlighted.