Rib remodeling 411: Get the lowdown on this trending procedure

As body contouring techniques continue to evolve, rib remodeling has emerged as one of the most innovative and nuanced procedures in the world of aesthetics. Traditionally associated with waistline refinement and enhanced torso contour, rib remodeling often involves reshaping or repositioning the lower ribs to create a more tapered, defined silhouette. It was once considered controversial and rarely performed, but advances in surgical techniques, imaging and safety protocols are bringing renewed attention to this procedure, for all the right reasons.

Today, many patients seeking more dramatic waist definition are exploring rib remodeling as part of a comprehensive approach to body contouring. Surgeons are refining this procedure with improved techniques that prioritize safety and preserve the ribs' underlying framework. As innovation continues, rib remodeling is evolving from a niche concept into a carefully considered option for patients seeking to achieve proportion and balance in new ways.

We reached out to ASPS Member Surgeon Johnny Franco, MD, for his insights around this trending procedure and what we can expect in the years to come with rib remodeling.

ASPS: For patients unfamiliar with the procedure, what is rib remodeling, and how is it typically performed?

Dr. Franco: In the past, we've always just talked about, "That is your body's frame, and there is nothing we can do about it." Now, with rib remodeling, we can change the actual frame.

But what it does is use a highly specialized ultrasonic saw that cuts only bone and cartilage, which allows you to free the rib and mobilize it. You can adjust placement and better define the waist. The real magic happens when wearing a corset post-procedure. You've basically created the ability to move the bone into the position, and the idea behind the corset is to retrain your body to hold it in a specific spot.

This procedure is especially interesting from a plastic surgery perspective, because it is one of the few where you need the patient's help for its success. If they do not follow the postoperative instructions, like wearing the corset, they are not going to get the results they want.

ASPS: How have rib remodeling techniques evolved in recent years?

Dr. Franco: It has evolved immensely since the first introduction! The first iteration had a large incision, which was much more invasive. Now, the incision is usually smaller than a liposuction incision and is done subcutaneously (under the skin between the fat and muscle) with the use of an ultrasound device to find the exact bone location. The ultrasonic saw is another one of the most significant recent innovations.

The procedure has advanced beyond just focusing on rib 12; it now goes as far as ribs 10, 11 and 12. It has also been exploring the anterior ribs for those who have a protruding chest. Basically, you can cut right at where the cartilage and bones meet and move that whole subunit from the sternum to the ribs about an inch or two to get rid of a protruding chest. This has not been as widely done here in the United States as it has abroad, but over the next year, you are likely going to see more of it. It has become a hot topic at some international conferences.

ASPS: What technological advancements have improved safety and precision in this procedure?

Dr. Franco: There have been some safety concerns with this procedure in the past, and some surgeons have been hesitant to bring it into their practice because of this. Outside of the U.S., some complications, such as the incisions getting into the lungs, have occurred where surgeons have been overzealous. In the U.S., surgeons have taken a more cautious approach in bringing this into their practice. Additionally, using ultrasound with these techniques has significantly improved safety.

ASPS: Who is typically a good candidate for rib remodeling?

Dr. Franco: One, your patient who comes in for body contouring, typically like a Brazilian butt lift (BBL) or a liposuction and fat transfer procedure, and they are so thin that there is nothing left to liposuction out. They have been turned down for body contouring, and there is really nothing that can be done for them in that area.

Two, someone who has had a tummy tuck or BBL and is looking for another way to enhance body structure. It has actually become more commonplace to use this in conjunction with other procedures, such as a total treatment for a patient. We'll do liposuction, targeted fat transfer and rib remodeling to improve their contour.

ASPS: How does rib remodeling differ from traditional body contouring procedures, like liposuction or tummy tucks?

Dr. Franco: I think rib repositioning is completely different. You need to address those kinds of overarching issues first, such as liposuction or tummy tucks. If you have loose skin, you are not going to see it corrected with rib repositioning. Likewise, if you have excess fat tissue, you are not going to see results. I see this as an adjunct (additional) procedure to those undergoing these body contouring procedures if they still want further contouring.

ASPS: What are some key considerations patients should understand when pursuing rib remodeling?

Dr. Franco: I think that patients need to have realistic expectations. Some of the people who we turn down for this procedure are those who have a lot of skin laxity. You are not going to see the changes when your skin is lax. Another difficulty lies with patients with high BMIs. The procedure is really challenging, and a lot of fat can make it hard to move the bones into the right position. You also have to be careful with the corset if you are undergoing other body contouring procedures. It is critical to make sure that patients are fully committed to postop protocols, or they are not going to see the changes they desire.

ASPS: Are there any long-term considerations that patients should be aware of with rib remodeling?

Dr. Franco: I do not think there are long-term effects that you will have to worry about. We do get some questions around pregnancy. You can still get pregnant, and it is not going to change your results. Once the bones are set, you have a new foundation that's going to stay!

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.