Cultural interest surrounding a sculpted, snatched waistline is nothing new, and now, a somewhat out-of-the-box bone reshaping procedure known as rib remodeling is making this look more attainable. This once-unthinkable surgery is on the verge of blowing up as the next big thing in body contouring, and there’s a lot to unpack around it.
Prior to the 1920s, women relied heavily on waist-cinching corsets to create an hourglass figure. Fast-forward to 2025, and waist trainers and shapewear are go-tos for creating the illusion of a smaller-looking, more defined waist, as are diets, exercise, and even GLP-1s, which can reshape the body’s silhouette. Although somewhat controversial, the “Barbie waist,” a look inspired by the doll’s voluptuous body shape, is quickly emerging as the latest body modification surgery, and unlike its earlier predecessors, this one’s a little more humane, safe, and consistent in terms of results.
Dr. Charles Galanis, M.D., a board-certified plastic surgeon and contour specialist in Beverly Hills, California, says there hasn’t been what he calls a “major advance” or paradigm shift in the body-contouring industry for close to two decades. “Rib remodeling is really the next iteration of procedures and a breakthrough,” he says. “It allows surgeons to achieve changes that, previously, were not possible, all while creating balance, harmony, and contours where anatomical structural constraints once existed.”
With aesthetic trends returning to more natural-looking results via undetectable work, it’s fitting that people want subtle results that better define proportions from head to toe. Following less exaggerated lips, modified Brazilian Butt Lifts (BBL) that give a slight booty pop, and a renewed interest in fat transfer to enhance the breasts and the face, rib remodeling is staking its claim as a low-risk, less invasive procedure that can bring natural balance and harmony to the body, for the waistline of your dreams.
Ahead, TZR dives deep into the new and fascinating world of rib remodeling, how it works, who it’s for, and how it compares to more traditional waist-snatching surgeries, like liposuction, so you can ultimately decide if the procedure is right for you.
Before rib remodeling entered the plastic surgery chat, surgical options addressed only subcutaneous fat, intra-abdominal or visceral fat, and excess skin to improve the size of the waist, says Galanis. “We weren’t able to address the width of the ribcage, which can change with age and childbirth, the width of the pelvic bones, or the height and distance between the ribs and pelvic bones.” But all of that is changing. Now, he says, rib remodeling allows plastic surgeons to modify and reshape those anatomical structures to create a more hourglass figure through this significantly less invasive yet highly effective procedure.
Rib remodeling, also known as waist-narrowing surgery, is a relatively new surgical technique that reshapes the lower three ribs on each side of the body to whittle the waist by a few inches without removing the ribs. Using tiny incisions, which are virtually invisible to the naked eye once fully healed, small cuts are made in the ribs to bend them inward, reshaping them and creating a more tapered silhouette.
If the idea of altering the ribs rings a bell, it’s because rib remodeling is a refined take on the rib removal procedure (also known as rib resection), which initially gained attention for medical reasons. It was historically used in thoracic surgery, tumor resections, lung conditions, and to treat compression conditions that lead to numbness, long before it evolved into a waist-contouring and shaping procedure. There are even rumors that some celebrities, like Marilyn Monroe and Cher, had the surgery. The original procedure was risky, and involved a far more invasive technique that fully or partially extracted the “floating” ribs through incisions at the bottom of the ribs. Dr. Alexander Earle, M.D., a double board-certified plastic surgeon in Miami, says the risks, such as large scars, reduced rib protection, and an unnatural or sunken-in appearance to the waistline accompanied by nerve and chronic pain, outweighed the benefits, which is why it never really caught on.
Unlike the older rib-removing technique, this iteration doesn’t remove the ribs; instead it partially fractures the lower floating ribs (11 and 12, which do not attach in the front) to reposition them. Dr. Josef Hadeed, M.D., a Beverly Hills plastic surgeon, notes that rib remodeling surgery is a far safer and more natural alternative to rib resection, offering a waist-slimming effect that a procedure like liposuction alone cannot achieve.
Some plastic surgeons market rib remodeling procedures under branded names such as RibXcar (developed by Peruvian plastic surgeon Dr. Raul Manzaneda, M.D.) or the Barbie waist. Galanis says RibXcar reshapes the ribs with a highly controlled micro-vibrational manipulation of the floating ribs, without fully breaking them. “With RibXCar, we can safely and effectively reshape the underlying structure and size of the waist like never before,” he adds. While these branded procedures all achieve similar results, Chicago double-board-certified plastic surgeon Dr. Ramsen Azizi, M.D., points out that their safety, technique, and outcomes depend on the surgeon, not the name it goes by.
Often considered a last resort, Galanis says many of his patients turn to rib remodeling after doing everything possible with diet and exercise, as well as other body-sculpting techniques, but still not being able to reach their goals. If someone has a naturally wide ribcage or prominent rib flare, Earle shares that no amount of fat removal will create the waist shape they may want. “This is where rib remodeling comes in since it fills that gap by addressing the underlying structure, not just fat or skin,” he explains.
The surgery is performed under general anesthesia and takes about an hour. First, small, needle-hole-sized incisions are made over each treated rib, and ultrasound is used to visualize the lower floating ribs on each side. Local anesthetic is injected on top of each rib before a special surgical instrument is inserted into the incision, and the soft tissues directly on top are carefully displaced to allow access to the bone. Then, a piezoelectric device, guided by ultrasound, selectively manipulates the bone. Careful back-and-forth motion cuts are made in the outer part of the rib, creating initial fractures (not breaks) only on the outer part of the ribs so they can be safely repositioned. “We move the structures inward to reshape the waist, creating better proportions to the body and a new silhouette,” Galanis says.
Once the fractures are created on the ribs, Hadeed has his anesthesiologist deflate the lungs. “This safety maneuver lifts the diaphragm and the lungs out of the way, which allows me to confidently reposition the lungs without injuring them,” he says. By applying slow, controlled, and steady pressure to the part of the rib that curves outward, they are slightly repositioned inward, and the process is repeated on the other ribs. Finally, ultrasound is used again to confirm that the ribs have been properly fractured and repositioned and that the lungs are fully reinflated. “The results are instantaneous and immediately visible on the operating room table, with the hourglass shape obvious.”
While the procedure may sound painful and intimidating because patients imagine their ribs being physically broken (which they are not), plastic surgeons say it’s anything but that. “People naturally react to the word ‘ribs,’ but rib remodeling is much more like other bone-contouring procedures, such as jawline, nose, or chin reshaping,” Earle says. “Any time we refine bone structure, it can sound intimidating, but with modern tools, a trained surgeon, and the right safety environment, it’s predictable and controlled.” Plus, the lower ribs are superficial, naturally flexible, don’t have nerves on them, and sit above a strong layer of muscle with the organs underneath well protected; this makes the procedure perfectly safe in skilled hands, according to Azizi, who says that the risks of serious complications are extremely low, especially when imaging and the anatomy are properly evaluated beforehand.
After the ribs are adjusted, the incisions are closed with sutures, and a compression garment is placed over the lower torso to help reduce swelling during healing.
Both rib remodeling and liposuction serve a purpose in body contouring, each delivering distinctly unique results. Liposuction removes small pockets of excess fat for more of a de-bulking effect, especially at the waistline, but it doesn’t change the structure of the ribs. Although there is less fat after liposuction, a wide torso will remain wide unless addressed.
With rib remodeling, fat and tissue are not touched. Instead, the focus is entirely on the bone structure itself. “We have always been limited to how much waistline reduction we can achieve with liposuction alone due to the bony constraints of the rib cage,” Hadeed says. “Rib remodeling allows for an even greater reduction in the waistline, in addition to contouring the waist, to get more of an hourglass shape.” In some cases, liposuction and rib remodeling are combined, which he says works especially well for those with stubborn fat they can’t get rid of.
Rib remodeling works best for people who are at a stable weight with a BMI between 28 and 30, and want additional contouring with little to no remaining fat to remove. It also works well for those who are thin and have either a naturally straight or H-shaped body without waist definition. “Those with a naturally wide, flared rib cage, considerably expanded ribs from pregnancies or age, or a short-waisted torso with little space between their bottom rib and their hip tend to do well with the procedure,” Galanis says.
Age and medical history are also major considerations. “Anyone with very low bone density or ongoing medical issues isn’t a good candidate, which is why anyone 45 and under is best suited for this procedure,” Azizi shares. A bone scan will assess the current state of the ribs, ensuring that no one with osteopenia or low bone density undergoes the procedure, as these conditions can interfere with healthy healing.
Having realistic expectations about what rib remodeling can and can’t do, as well as what the body will look like post-surgery, is important, and every surgeon stresses this. Earle says the best results come from enhancing a patient’s natural proportions rather than forcing an unrealistic size. “When someone brings in heavily Photoshopped or AI-edited pictures and says they want to look like that, it’s an indicator that they may not have the most realistic expectations, because no one really looks like that,” Azizi says. If future pregnancies are still in the cards, it’s best to put off the surgery until you’re done having children, since pregnancy can impact the results, potentially forcing the ribcage to expand to accommodate room for the growing fetus.