A growing number of women and transgender individuals are undergoing a controversial cosmetic procedure known as rib remodelling or RibXcar, which involves fracturing ribs to achieve a narrower waist and pronounced hourglass figure. The surgery has gained attention as a more accessible alternative to rib removal, a practice previously used to alter waistlines but associated with higher risks.
Daniela Cesin, 31, who traveled from Miami to Venezuela in August for the procedure, illustrates the rising interest in rib remodelling. After traditional fat transfer methods were ruled out due to insufficient fat for liposuction, her surgeon proposed RibXcar, a technique where the lower ribs are fractured and then bound with a tightly fitted corset for approximately three months to reshape the waist. Cesin described the recovery as uncomfortable, citing difficulty standing, lying down, and eating, but noted satisfaction with the eight centimeters lost from her waist six weeks post-surgery.
Rib remodelling was first developed by Russian plastic surgeon Kazbek Kudzaev in 2017, who used a vibrating drill to partially fracture ribs and reposition them while constraining the torso in a corset. Since then, the technique has spread to surgeons in various countries, including Colombia, South Korea, and France. The procedure generally takes about an hour and is performed under general anesthesia as an outpatient treatment.
Despite being promoted as minimally invasive, the surgery carries significant risks. Complications reported include allergic reactions, blood clots, infections, fluid accumulation beneath the skin (seromas), collapsed lungs (pneumothorax), and internal bleeding in the chest cavity (haemothorax), some of which can be life-threatening. Skeptics within the medical community warn of a complication rate of nearly 4%, which some experts consider high compared to common cosmetic surgeries like breast augmentation.
Sandip Hindocha, a consultant plastic surgeon based in London, expressed reservations about the procedure, emphasizing concerns about its permanence and potential long-term effects. The British Association of Aesthetic Plastic Surgeons does not currently endorse rib remodelling, noting limited data on outcomes and the specialized skills required to manage complications. The surgery is typically not recommended for cisgender women over 40 due to increased risks linked to osteoporosis and bone fragility.
The procedure has also attracted transgender patients seeking body feminization. Sophia, a transgender woman from Beverly Hills, underwent rib remodelling in November 2025 to narrow her torso. Her surgery resulted in a pneumothorax requiring hospital treatment, and although she experienced ongoing pain and breathing difficulties, she pursued a second operation later that year. The second procedure, which involved cartilage removal and titanium plate fixation, brought more intense pain and shortness of breath but no lung collapse. Sophia highlighted the importance of such surgeries for gender affirmation despite the risks involved.
Surgeons like Leif Rogers from California anticipate that skeletal remodelling surgeries will become more widespread, aligning with advances in surgical techniques and increased social media exposure, which have amplified demand. Rogers noted parallels with procedures like limb lengthening and facial bone restructuring but emphasized that altering the torso’s skeleton is relatively novel.
The pursuit of the hourglass figure through rib remodelling is influenced by evolving beauty standards shaped by celebrities, social media, and the global shapewear market. The silhouette popularized by figures like the Kardashians in recent decades contrasts with previous trends toward slender, androgynous looks. Concurrently, platforms such as TikTok have promoted extreme body measurements, increasing pressure to conform to highly defined waistlines.
Philosophers studying body image trends point to a shift from external adornment toward normalization of surgically altered appearances, where cosmetic interventions are framed increasingly as health or hygiene measures. This shift may contribute to wider acceptance and demand for irreversible procedures like rib remodelling, despite their risks and the lasting impact on patients’ bodies.