Darefit Clinic Thoracic Surgery · Rib Remodeling

Rib Remodeling

Rib remodeling,
by a surgeon trained in the chest wall.

Dr. Dongju Seo · Board-certified cardiothoracic surgeon
Darefit Clinic · Gangnam, Seoul

The
procedure

The lower ribs are kept. Their angle is changed.

The contour of the upper waist is set not only by fat but also by the width and angle of the lower ribs. Rib remodeling changes the angle of those ribs. At this clinic it is performed as RIBXCAR, an ultrasound-guided technique that does not remove any rib.

  • Outer cortex onlyAt the back of the lower rib, only the cortex facing outward is divided.
  • Bent inwardSteady pressure bends the rib inward and the angle changes.
  • Inner cortex keptThe rib is not split in two. This is an incomplete (greenstick) fracture.
  • Checked on ultrasoundA fine instrument is passed through the skin without an incision, and each step is confirmed on ultrasound.
Before Outer cortexInner cortex ↓ toward the chest cavity After Only the outer cortex is divided The inner cortex stays intactand acts as a hinge Bent inward
Fig. 1Longitudinal section of a rib. With only the outer cortex divided, the rib is bent inward; the intact inner cortex acts as a hinge and the angle changes. Schematic to explain the principle; not to scale.
Fig. 2The rib cage seen from the front. The target is mainly ribs 10–12. Ribs 11 and 12 are floating ribs with no anterior attachment; rib 10 joins the cartilage above. Rib 9 is included when needed. Schematic; not to scale. Rib length and angle differ between people.

An incomplete fracture is still a fracture. Bone healing takes months, and a binder is worn during that time.

Evidence

What published studies report.

  • In a multicenter cohort of 3,805 patients from 8 countries followed for 1 year, the angle of ribs 10–12 fell by 10 degrees and waist circumference by 11 cm on average. Patients who also had liposuction are included in these figures.1
  • In the first report of 30 patients, the rib angle change measured on ultrasound was maintained at 3 months.2
  • A meta-analysis of 4 studies (318 patients) found a mean waist reduction of 8.6 cm at 3 months. None of the studies had a control group and most involved other procedures at the same time; one co-author developed the technique.3
  • A systematic review of 8 studies noted follow-up of only 3–6 months and concluded that long-term outcomes remain uncertain.4

Study figures are averages. Results vary with each person's rib anatomy, binder use and body type, and no result can be promised.

Safety

Who should not have it.

  • Osteoporosis, osteopenia or other bone metabolic disease
  • History of rib fracture
  • Asthma, COPD or other respiratory disease
  • Connective tissue disease (Marfan syndrome, Ehlers–Danlos syndrome)
  • Chest wall deformity such as pectus excavatum or pectus carinatum — a separate field that needs its own evaluation
  • Long-term steroid use
  • Pregnancy, breastfeeding or a planned pregnancy
  • Unable to attend scheduled follow-up

Possible complications.

Pneumothorax · hemothorax

4 pneumothoraces and 1 hemothorax were reported in the 3,805-patient study.1 Confirmed by imaging; a chest tube may be needed.

Intercostal nerve injury

Band-like pain or numbness along the rib. Recovery can take months and may be incomplete.

Bicortical fracture · nonunion

If the inner cortex also breaks or the bone does not heal, chronic pain may remain.1

Asymmetry · loss of correction

Without consistent binder use the angle may not hold.

Others

Subcutaneous emphysema, infection, atelectasis or pneumonia.

The chest wall lies next to the pleura, the lungs and the intercostal nerves and vessels. Managing these complications — chest tubes, the pleura, rib fractures — is part of thoracic surgery training.

Pathway

From consultation to follow-up.

  • 1 · ConsultationGoals, medical history, body shape and fat distribution are reviewed. A consultation does not always lead to surgery.
  • 2 · 3D CTRib count, length and cartilage junctions are checked with a cartilage window and 3D reconstruction. Required before surgery.
  • 3 · ProcedureThe lower-rib angle is changed under ultrasound guidance.
  • 4 · BinderWorn so the bone heals at the new angle. Reported periods range from 6 weeks to 3 months or more.
  • 5 · Follow-upScheduled visits confirm recovery and bone healing. For patients travelling from abroad, the length of stay is discussed individually.
Physician
Dr. Dongju Seo, Director of Darefit Clinic, in grey surgical scrubs

Dr. Dongju Seo

  • Director, Darefit Clinic (Seoul)
  • Board-certified cardiothoracic surgeon
  • Asan Medical Center, Department of Cardiothoracic and Vascular Surgery
  • Observership, Massachusetts General Hospital (MGH)
  • Completed the FAT & RIB SCULPTING CAMP rib remodeling course (Changsha, China, September 2026)

Full profile →

Contact

Consulting in English.

Consultations in English are held through One-Talkie, the clinic's live interpretation chat. Please tell us your country, preferred dates, height and weight, medical history and the change you are hoping for.

  • Address4F, 162 Apgujeong-ro, Gangnam-gu, Seoul, Republic of Korea
  • Telephone+82-2-545-5101 (Korean)
Start a consultation in English
References
  1. Manzaneda Cipriani RM, Duran H, Adrianzen GA, et al. A Multicenter Cohort Study of 3805 RibXcar Cases: Safety and Efficacy in Incisionless Rib Remodeling. Plast Reconstr Surg Glob Open. 2026;14(7):e7929. doi:10.1097/GOX.0000000000007929
  2. Manzaneda Cipriani RM, Duran Vega H, Cala Uribe L, et al. Waist Remodeling without Incision, with Ultrasound-guided Monocortical Fracture. Plast Reconstr Surg Glob Open. 2023;11(12):e5499. doi:10.1097/GOX.0000000000005499
  3. Milani-Reis A, Roca Mora MM, Bicudo Bregion P, et al. Rib Remodeling Without Rib Resection: A Systematic Review and Meta-analysis. Aesthetic Plast Surg. 2026;50(2):667-674. doi:10.1007/s00266-025-05240-w
  4. Danilla S, González-Arestizábal T. Costal Surgery for Waist Improvement Safety and Efficacy: A Systematic Review of the Literature. Aesthetic Plast Surg. 2025;49(12):3433-3442. doi:10.1007/s00266-025-04815-x

※ Rib remodeling is an elective cosmetic procedure. Complications such as pain, pneumothorax, asymmetry and problems with bone healing can occur. Suitability and results vary between individuals and should be decided with the medical team after examination and imaging.

The detailed articles on this site are in Korean: columns · complications · eligibility.