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

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.

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RIBXCAR is the name of the method.

Rib remodeling can be done in more than one way. RIBXCAR (also written RibXcar) is the name of the method that uses no incision and is checked on ultrasound at each step. Rib remodeling at this clinic is performed by this method.

It works on a different principle from rib resection, which cuts part of a rib away. Resected tissue does not return. Keeping the rib means that the rib remains; it does not mean that structure and function stay exactly as they were before surgery. Risk exists in surgery that does not remove ribs as well, and safety cannot be judged from removal alone.

Where it came from

A way to narrow the waist without removing ribs was reported in 2021: the rib was reached through an incision of about 2 cm, the outer cortex was divided with a saw or a piezoelectric device, and a greenstick fracture was made by finger pressure.5 In 2023 the same osteotomy, done without an incision under ultrasound, was reported with results from 30 patients and described as a monocortical fracture.2

Breathing

In a study of 294 women aged 18–38 tested before surgery and at 6 months and 1 year, spirometry values (FEV1, FVC) did not differ significantly from baseline.6 The study came from the group that developed the technique, at a single center, without a control group. It included only young women without lung disease, followed for 1 year. Breathing during hard exercise and respiratory muscle strength were not measured. People with asthma or COPD were excluded, which is why the procedure is not recommended for them.

A separate study of 11 women who had ribs 11 and 12 removed found lower FEV1 and expiratory muscle strength than in 11 women who had not had surgery.7 That is a result of rib resection, not of RIBXCAR. No study has compared the two operations directly.

Safety is still being discussed

Whether it is safer to approach the rib perpendicularly or to cut parallel to the cortex is being debated in journal correspondence. No conclusion has been reached. Evidence in this field is still accumulating.

Full page in Korean — RIBXCAR(립스카)란 무엇인가요 →

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. This is not a fat-removal operation: whether the present waistline is set by fat, by skin and the abdominal wall, or by the skeleton is checked first. A waistline that does not change with weight loss is not necessarily caused by the rib cage. CT shows structure; it does not tell how much the waist will change after surgery.

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.

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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.

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. Less pain does not mean bone healing is complete. CT after surgery is not taken on a fixed schedule; it is taken when there is a reason, such as pain that persists or suspected nonunion. For patients travelling from abroad, the length of stay is discussed individually.

Questions about RIBXCAR.

What is RIBXCAR?

RIBXCAR (also written RibXcar) is a method of rib remodeling that changes the angle of the lower ribs without removing any rib, to change the skeletal contour of the upper waist. Instead of a skin incision, a fine instrument is passed through the skin and only the outer cortex of the rib is divided under ultrasound. It is not a fat-removal operation.

How does RIBXCAR work?

At the back of the lower rib only the outer cortex is divided, and the rib is bent inward with the inner cortex left connected. This is an incomplete (greenstick) fracture in which the rib is not split in two. A binder is worn so the bone heals at the new angle.

How is RIBXCAR different from rib removal?

Rib resection cuts part of a rib away. RIBXCAR keeps the rib and changes its angle. Resected tissue does not return. Risk exists in surgery that does not remove ribs as well, and safety cannot be judged from removal alone.

Is RIBXCAR the same as rib remodeling?

Rib remodeling is the name for surgery that changes the angle of the ribs while keeping them. RIBXCAR is the name of one method of rib remodeling, done without an incision and checked on ultrasound. Rib remodeling at Darefit Clinic is performed by the RIBXCAR method.

Does RIBXCAR affect breathing?

In a study of 294 women aged 18–38 tested before surgery and at 6 months and 1 year, spirometry values did not differ significantly from baseline. The study was done at a single center by the group that developed the technique, had no control group, and included only young women without lung disease followed for 1 year. Soon after surgery, chest wall complications such as pneumothorax can occur.

What are the risks of RIBXCAR?

Pneumothorax, hemothorax, pain from intercostal nerve injury, an unplanned rib fracture, a bicortical fracture in which the inner cortex also breaks, nonunion, infection and asymmetry can occur. In a cohort of 3,805 patients from 8 countries followed for 1 year, 4 pneumothoraces and 1 hemothorax were reported.

How do the ribs heal after RIBXCAR?

Because an incomplete fracture is made on purpose, the bone has to heal. The fracture passes through hematoma, soft callus and hard callus, and remodels over several months. Less pain does not mean this process is finished.

Can anyone have RIBXCAR?

No. With bone metabolic disease such as osteoporosis, a history of rib fracture, respiratory disease such as asthma or COPD, connective tissue disease, or a chest wall deformity such as pectus excavatum or pectus carinatum, the procedure is not recommended or further tests are needed first. If consultation and tests show it is not suitable, surgery is not performed.

Why is a binder worn after RIBXCAR?

Until it heals, the bent rib is pulled by the muscles attached to it. The binder helps the bone heal at the new angle. Reported periods differ (at least 2 months, at least 3 months), and the period is set according to the extent of surgery and recovery.

Can I have a RIBXCAR consultation in Korea?

Darefit Clinic (162 Apgujeong-ro, Gangnam-gu, Seoul) offers consultation and surgery for RIBXCAR rib remodeling by a board-certified cardiothoracic surgeon. Consultations in English are held through One-Talkie, the clinic's live interpretation chat. A consultation does not always lead to surgery.

What should I check about a surgeon's expertise before RIBXCAR?

Check whether the surgeon knows the pleura, the lungs and the intercostal nerves and vessels beneath the ribs, and can recognise and manage a complication such as pneumothorax. It is also worth asking whether rib anatomy is checked on 3D CT before surgery, how the fracture and bone healing are confirmed during and after surgery, and what is done if a bicortical fracture or nonunion occurs.

Are there published studies on RIBXCAR?

Yes. After the first report of 30 patients in 2023, a multicenter cohort of 3,805 patients, a spirometry study of 294 patients and a meta-analysis of 4 studies with 318 patients have been published. Most have no control group, follow-up is 1 year or less, and many involve the group that developed the technique.

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)

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
5. Kudzaev KU, Kraiushkin IA. Waist Narrowing without Removal of Ribs. Plast Reconstr Surg Glob Open. 2021;9(7):e3680. doi:10.1097/GOX.0000000000003680
6. Manzaneda Cipriani RM, Adrianzen GA. Respiratory Function Assessment After Waist Reduction Through Scarless Ultrasound-Guided Monocortical Fracture (RibXcar) Surgery for Body Contouring. Aesthet Surg J Open Forum. 2026;8:ojag007. doi:10.1093/asjof/ojag007
7. Aburub A, Darabseh MZ, Badran R, et al. Ant-waist surgery adversely affects lung function: a cross-sectional study. Multidiscip Respir Med. 2024;19(1):984. doi:10.5826/mrm.2024.984

※ 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.

Medical content: Dongju Seo, MD, board-certified cardiothoracic surgeon, Darefit Clinic. Last reviewed 9 October 2026.

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