Rib remodelling

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What is the Piezo-Assisted Rib Remodeling?

Waist narrowing surgery (Ribxcar, rib reshaping) is a minimally invasive plastic surgery that allows achieving a waist reduction of 6-15 cm without removing ribs. The technique involves incising and fracturing the lower rib pairs. These may include the 9th, 10th, 11th, and 12th pairs of ribs. Depending on the patient’s anatomy, the doctor selects the most suitable rib pairs for correction.Then, the patient wears a special supportive corset for 2-3 months, allowing the ribs to heal in an aesthetically favorable position. The Rib repositioning surgery is performed on both women and men.

Photo: Liposculpture after 2 years and rib remodelling after 6 months

 Waist Narrowing Before and After Photos

The most optimal and advanced technique for rib remodeling today is piezo-assisted rib scoring. This method involves a controlled micro-fracture of the ribs using a specialized piezoelectric device. Unlike traditional methods, the ultrasonic vibrations delicately score the bone structure while strictly preserving the surrounding soft tissues.

The primary advantage of this ultrasonic technique is that it is significantly less traumatic than mechanical rib cutting. As one of the few surgeons with over 7 years of experience performing this specific procedure, I have witnessed a dramatic evolution in patient recovery. Previously, mechanical saws were used; while they provided aesthetic results, they often caused severe pain for the first 7–10 days.

Today, the landscape has changed completely. With piezo technology, we achieve outstanding aesthetic outcomes with minimal postoperative discomfort. Patients can typically move freely and care for themselves from the very first day, without the need for strong pain medication. It is a proven, safe, and effective pathway to the desired silhouette.

Clinical research results on waist narrowing with rib preservation in 93 women aged 19 to 43 can be found in the PRS Global Open Journal

Photo: Waist narrowing using the Kudzaev method + buttock augmentation with 250 ml implants

Why I Am Against Rib Removal Surgery

Rib Removal Surgery poses significant risks to the patient's health. By removing the lower pair of ribs, internal organs such as the liver, kidneys, stomach, and spleen are left unprotected. This can lead to negative consequences such as kidney descent, pyelonephritis, chest deformities, and diseases of the urogenital and cardiovascular systems.

Who Is a Candidate for Rib remodelling

This operation is not suitable for every person!

The main criterion is a body mass index not exceeding 25

Ideal candidates are patients with a normal and slim body structure, without excess fat deposits, with a mild difference between waist and hip circumference due to anatomical characteristics. 

Preparation for the Operation

• The patient must undergo necessary tests and examinations to exclude any health and life risks. See the list of required tests and timelines >>>

• A chest CT scan is required for this procedure. Based on its results, the surgeon will be able to plan the operation: where exactly to make the incisions, which rib pair to modify, and so on.

• One month before the surgical procedure, it is recommended to quit smoking, avoid alcohol consumption, and refrain from taking medications that affect blood clotting (analgin, aspirin, etc.)

Step-by-Step Process of Rib Reshaping Surgery

The surgical procedure of Rib repositioning is performed with the patient lying on their stomach.

1. Two incisions, each 1.5-2 cm long, are made at the level of the lower ribs, one on the left and one on the right side of the spine. These incisions provide access to the ribs.

2. The surgeon delicately performs a controlled micro-fracture of the ribs using a piezoelectric device. The ultrasonic vibrations score the bone while minimizing trauma to the surrounding tissues, allowing for the formation of a beautiful curve. The ribs are not amputated or relocated; their position remains stable, but their curvature is altered. This modification achieves a more rounded shape, effectively contributing to a 'wasp waist'.

3. Following this, the wound is sutured with a cosmetic suture and sealed with a special adhesive. No dressings or suture removal are required.

4. A corset is applied to the patient with maximum tension.

Anesthesia: local or general

Duration of the operation: 30 min - 1 hour

Sutures: Incisions heal as thin strips that become less noticeable over time

! The site of rib fractures heals within 2-3 months. 

Fig: A- CT of a 37-year-old patient before the operation. B - CT 2 months after waist reduction by Kudzaev. Arrows indicate the locations of rib fractures. Clinical effect: reduction of waist circumference from 71 cm (top) to 60 cm (bottom). The red lines indicate symmetrical increase in the distance between the ribs

Wearing a corset on a constant basis is a mandatory condition for the operation until the rib fragments have fused, altering their curvature, and the lower part of the chest has obtained an aesthetically smooth narrowing. Rib fusion progress is monitored through CT scans, performed before the operation and 2 months after it.

Based on the CT results, a decision is made to discontinue corset wear.

Rehabilitation and Recovery Timeline

Corset. From the moment of the Ribxcar surgery, all patients are fitted with a corset, which sets a new shape for the ribs and contributes to a better result. After 1–2 weeks, it is recommended to wear an additional belt over the corset to enhance the effect and form the narrowest possible waist.

! The corset is worn 24/7 for a minimum of 2 months, preferably 4 months. It can be removed for a shower for no more than 1 hour per day.

Hospital stay. Most patients stay in the clinic for one day. However, I recommend staying an additional day - being in the clinic allows for more effective pain management and monitoring. After discharge, it is advisable to spend an additional 5–7 days at a hotel for a more comfortable recovery.

Sports. Physical activity is allowed 45 days after surgery.

Pain sensations vary depending on the sensitivity threshold; for most people, they are moderate. Mainly, discomfort is associated with the unfamiliar feeling of wearing a corset.

Some patients may experience pain syndrome after the rib remodeling procedure, which usually subsides within 3–10 days. During this period, a combination of painkillers and anti-edema medications is prescribed. At the same time, narcotic drugs are not used.

Stitches. Postoperative incisions are sutured with absorbable thread and sealed with special glue, therefore no additional bandaging or stitch removal is required. 

Bruises and hematomas. Bruising may occur after the surgery, but it resolves on its own.

Result assessment: after 2–3 months

Contraindications

• Excess weight, BMI over 25
• Poor skin tone
• Round belly
• General medical contraindications: infectious and viral diseases, blood clotting disorders, oncology (full list)
• Pregnancy and lactation
• Age under 18 years

Combining RibXcar with Other Surgeries for Maximum Results

The most common option is a combination of Ribxcar surgery with liposculpture. In this case, it's not just about reducing waist circumference but also an opportunity to eliminate localized fat deposits on the lower back and create rounder buttocks.

Rib remodelling can be combined with almost any plastic surgery that doesn't require extensive intervention: facelift, breast and buttock augmentation with implants, and liposuction of small areas. However, it's not recommended to combine it with a full abdominoplasty; it's better to split the procedures into several stages.

4 Parameters Influencing the Perception of a Beautiful Waist:

1. Thickness of the Subcutaneous Fat Layer
   The most universal and effective method suitable for most women is circumferential liposuction (abdomen, flanks, and lower back). It enhances the waist's appearance regardless of body type.

2. Rib Shape
   Changing the shape of the ribs (controlled fracture of the lower ribs or their removal) is suitable for patients with a wide rib cage and minimal fat layer, when liposuction alone does not deliver the desired results. I prefer combining 360° liposuction with rib reshaping using the Kudzaev method. 
   
   

   When there is a sufficient fat layer around the waist, I consider rib reshaping with the Kudzaev method to be unnecessary. I do not practice rib removal as controlled fractures are a safer option for the patient.

3. Proportions
   The aesthetics of the waist depend on the ratio of its circumference to the width of the pelvis and hips. To create harmonious proportions, it’s often not enough to simply reduce the waist — it's essential to widen the pelvis and hips. This can be achieved through lipofilling.

4. Intra-Abdominal Volume
   This parameter is influenced by muscle tone, the amount of visceral fat, and intestinal health. To address this, I recommend wearing a corset, performing specific exercises, and maintaining proper nutrition.

To achieve the ideal waist, it is important to address all four parameters. In my practice, I often combine BBL (waist-to-hip contouring) surgeries with rib reshaping, supplemented by corset use, dieting, and exercises.

Two weeks after Ribxcar, I recommend starting exercises such as front and side planks with a pulled-in stomach. This helps reduce intra-abdominal volume without affecting the survival rate of the fat transferred to the buttocks.

Conclusion

Narrowing the waist using the Kudzaev method is an innovative way to reduce waist circumference without removing ribs. This plastic surgery is minimally traumatic, has a short recovery period, and offers clear clinical results. Importantly, it preserves the ribs' main function: protecting internal organs from injury.

Patients from various countries, including Germany, the Czech Republic, the United Kingdom, the USA, Spain, Italy, and France, seek body contouring and waist narrowing. In my practice, I use modern RibXcar and rib remodelling techniques, which allow for body shaping with minimal intervention. Safety and an individual approach for each patient are the guiding principles.

Content author - plastic surgeon Valentyn Zykov

• Practicing surgeon since 1998
• I perform more than 500 operations a year
• Laureate of the 21st national program "Person of the year"
• I operate in Poland (Warsaw) and Greece (Athens)

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Patient Reviews on Rib Remodeling

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FAQ – Waist Narrowing

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