Rib Remodeling Sounds Insane, But Is It?

Dr. Chang (00:04):
You are listening to Secret Services where we discuss the procedures nobody admits to, but everyone's curious about. I'm your host, Dr. Christopher Chang. Okay. Welcome back to Secret Services. I'm Dr. Chang.

Jackie (00:16):
And I'm Jackie.

Dr. Chang (00:18):
Okay. So what do you want to talk about today?

Jackie (00:21):
All right. There's this procedure that's turning right now that involves taking a small instrument, scoring your bottom three ribs, manually fracturing them, and then putting you in a corset for 12 weeks while your skeleton heels into a new shape. A lot of reality TV stars are doing it. A lot of plastic surgeons are starting to do it. What are your thoughts about this?

Dr. Chang (00:43):
You know more about this than I did. This is awesome. So what you're referring to is rib contouring surgery. So rib contouring surgery is having its moment right now in the world of body contouring. So for many years it was sculpting the torso and waist with liposuction. That became high definition liposuction. So sort of defining the anatomy with light and shadows and how to enhance the contour of where your muscles would be. Then that became lipo360 of doing that totally around the body in the arms, the chest, the back, the waist, the hips, the buttocks. And then enhancing that with fat grafting. So getting more anatomic definition, fat grafting the muscles, fat grafting the butt, fat grafting the abs and things like that, abdominal etching. And so this is the next evolution, out of South America, I think it's become popular over the number of years of essentially just being able to reshape and contour the lower ribs in the ribcage.

(01:49):
So your chest, your ribs have 12 ribs generally, but the bottom ones are floating. They're not necessarily connected. So they connect back at the spine, but they kind of float. They don't totally wrap around to the front cartilage to the sternum. They're lower down. And so a lot of these guys are talking about essentially cracking them so that you can cinch them a little tighter and change the angle of how they come away from the spine and make it a little tighter. So as it comes down from your chest and your torso, you have a little narrower silhouette into the waistline. And then as it comes back out to tips, you get a little more hourglass.

Jackie (02:26):
I just saw someone on TikTok that got this done.

Dr. Chang (02:29):
Really?

Jackie (02:29):
Yes. I mean the before and after I was a little blown away by what I saw.

Dr. Chang (02:36):
Yeah. I mean on its surface it sounds very extreme and very scary. But part of that is that we don't do it yet, so it's just not a normalized procedure. So in the beginning, it is a little bit crazy. If you said, "Okay, well, what about shaving down my forehead and my skull to reshape my brow?" You'd be like, "That sounds nuts," but it's being done every day-

Jackie (03:01):
That's true.

Dr. Chang (03:02):
For people with a brow bone or one forehead reduction or transgender surgery. It's very, very, very common now. So I wouldn't say that in our world, that's very extreme. It's common.

Jackie (03:13):
Well, I think you also brought up a good point. I think when I thought about this procedure initially, my first thought was rib removal, which seems like super extreme.

Dr. Chang (03:25):
Yeah. So I've seen that talked about, I guess, before, but nobody was ever really doing it. It was very, very restrictive. You need your ribs for supporting of your chest cavity and your diaphragm, which breathes and separating your thoracic cavity from your abdominal cavity. So you need your ribs, of course. So removing them all together seems really wild.

Jackie (03:49):
Side note, I just found out, I'm not joking six months ago because of the Bible, I always thought that women had less ribs.

Dr. Chang (03:58):
Wait a minute. What? Because of the Bible?

Jackie (04:01):
Isn't it like Adam took, or one of them, Adam took the rib from Eve and that's how they made the woman. I always thought that.

Dr. Chang (04:10):
But Eve is the woman.

Jackie (04:11):
Which one of them I thought-

Dr. Chang (04:13):
So maybe it means that-

Jackie (04:14):
One of them I thought had less than the other. And I just found out.

Dr. Chang (04:19):
You found out that they have the same number of ribs?

Jackie (04:21):
Yeah, which is sad to say, but I just thought that was a fun fact to share.

Dr. Chang (04:24):
Well, maybe Adam was a plastic surgeon.

Jackie (04:27):
If Adam was around now, he would just be doing rib remodeling.

Dr. Chang (04:31):
Yes. Well, if he was smart. He would do rib rib remodeling. It seems like a good way to go. But that also plays into the fact that people have different shapes of their bodies. Some people have square shoulders, some people have a long neck, some people have a short neck, some people have an inverted chest wall or a pigeon breast. There's just these variabilities in how our skeleton and our body's naturally formed that can affect your posture, your athleticism, and is also your aesthetic silhouette. And so I think that again, when we evaluate newer procedures, we have to think about the safety, how's it done, the efficacy and whether the juice is worth the squeeze. So did the TikTok person look really different?

Jackie (05:21):
I mean, I'm going to be honest, I thought she looked really good.

Dr. Chang (05:24):
Yeah.

Jackie (05:24):
Yeah. I was like, I get it. I do.

Dr. Chang (05:28):
There are a lot of people who have a very square trunk and torso that either the distance between the top of the hip and the rib is narrow, so they just don't have a lot of space to get that elongated torso.

Jackie (05:43):
Yeah, the cinched in waist look.

Dr. Chang (05:46):
Right. And then there's people just have a wider thoracic cage and wider ribcage that doesn't taper very much.

Jackie (05:53):
Well, so that sounds like our anonymous patient question. I've already had a BBL and lipo and I'm at the gym five days a week, but my waist still won't go below 28 inches. Three plastic surgeons on Instagram are saying rib remodeling is the only way to break that ceiling. I'm 31, I have two kids and I'm seriously considering it. Talk me into or out of it. So when I read that, I do think that just could just be her body. No matter what she's going to do in the gym, she's never going to naturally be able to achieve that waistline that she wants.

Dr. Chang (06:27):
Yeah, I would be careful. I would advise the patient to be careful about being obsessed with the numbers. I do know some rib contouring doctors and sort of patients that have reported however many inches they've lost so you can have significant reduction in the number of this waste circumference. But overall, when you take a look at the silhouette and shape of the body and the torso, I think that you have to understand that it's going to help a little bit if you have the skeletal changes be a little bit more subtle, but it's a subjective thing to sort of see how much waste narrowing you're going to get. I think if you're measuring it, you could open yourself up to be a little disappointed if it's not some number that you've created in your mind that's, "Oh, I got to lose two inches or three inches." That's a very arbitrary-

Jackie (07:20):
Right. You may never be able to obtain that even after this.

Dr. Chang (07:24):
Right, right. But I think that if your body type is such that you have a very square shoulder, waist, and hip profile, it could definitely help.

Jackie (07:41):
The recovery. When they say you're on a corset for 12 weeks, is that a real corset or a binder?

Dr. Chang (07:52):
I think there's different garments that have been made for this. I think they do recommend essentially a Velcro wrap binder or corset. Some of them have more structure than others, but the idea is that the rib is weakened so they can flex inward and then they want to reheal and ossify and harden in the correct position. So you have to have that ... If you do nothing, the body will go back to how it wants to be. So let's say I do an otoplasty, I help reduce an ear so it's not as prominent. If you do nothing and you don't support it, it will want to spring back to where it was. And similarly, if you take this floating bone and you crack the bone, it's going to probably want to relapse. Or if I have my nose and my tip is droopy and I don't really do enough to support it, it might droop back down. So the body will want to go back to its natural position because that's just how it was formed. There's other forces. So I think the corset is important so that it can heal in the right spot and the bony healing can harden and firm up an ossify in the position that's desired, which is a little bit more cinched.

(09:02):
Other things like wearing a faha, a corset, are common in body contouring surgery. So you've got a BDL or if you have a tummy tuck with a lot of liposuction, you're going to be cinching yourself in pretty commonly for months.

Jackie (09:20):
So reality TV personality, Anna Chell, 34, she became the latest face of the rib XCAR rib remodeling trend telling outlets she paid roughly 12,000 to have her three lower ribs partially fractured and reshaped, then spent three months sleeping in a corset to heal into a smaller waistline. New global survey of 2,351 cases published in plastic and recon surgery global open in April 2026 reported a 3.7% complication rate with hyperpigmentation, non-consolidation burns and corset related pressure ulcers. Those are the most common and the rare cases would be a pneumothorax. Surgeons and major outlets are split on whether the procedure has a defensible place in cosmetic practice at all. What are your thoughts on that?

Dr. Chang (10:06):
So as I said, this is a relatively new procedure, so it's sort of being worked out the details. I think over the course of the past decade or so where it's been perfected, better techniques have been developed. So right now I think the most advanced technique involves using ultrasonic power or piasal electric power. The benefit of that is you can make a very, very small incision, almost not an incision, almost like a puncture, like a stabin suncture with a needle. So very small. So that means the scarring is very, very low. The Piezo system is a vibration-based system. So it's not a saw that it's sharp teeth that is just causing a lot of trauma. It's a little bit more delicate and refined using physics essentially to break the hard part of the bone allowing the soft part of bone and the area not to get injured as well as to be flexed inward.

(11:02):
So that's already a huge technological advantage. To have this newer procedure globally have a complication rate of 3% is actually a pretty good number.

Jackie (11:13):
Okay. That was going to be my question. I was like, I don't know if that's good or bad in this context.

Dr. Chang (11:18):
Well, I haven't read the study, but if you said globally three and a half percent complication rate and the complications include hyperpigmentation.

Jackie (11:32):
And I was going to say the corset related pressure ulcers, I mean I wouldn't even-

Dr. Chang (11:37):
These are all minor complications. I would say yes, obviously you want to reduce all complications, but those are things that could probably happen with a tummy tuck and high definition liposuction like we talked about.

Jackie (11:50):
I was going to say you could get that from like a binder to which I would say, would you even really, really consider that like a surgical complication? I would say that's kind of like a secondary adverse reaction.

Dr. Chang (12:03):
I'd call it a minor classification versus a major. Now a pneumothorax is a major complication, right? So that means you get air into the thoracic cavity and you need to probably have a drain to relieve pressure on the lung to help the lung expance. So that's possible. But I'm pretty sure with better technology imaging techniques that that is going to be a very rare complication as long as people are well trained in this.

Jackie (12:29):
Where is the incision made?

Dr. Chang (12:33):
So the incision, again, it's a very small stab incision from what I've seen.

Jackie (12:38):
On the side or from the back?

Dr. Chang (12:39):
It's from the back.

Jackie (12:40):
From the back.

Dr. Chang (12:40):
It's from the back. Just kind of off the midline, there's the spine and then just off either side and often the surgeons will use imaging like ultrasound and they've gotten a CAT scan ahead of time to kind of identify which are the target ribs. And yeah, I mean, it's just sort of like putting a needle in back there. I just saw this procedure being presented at the Baker Gordon finale, which is a big aesthetic meeting in Miami, Florida. And it was very, very interesting to see two different surgeons presenting their techniques and doing it. And it's very, very impressive and seems quite straightforward and simple, to be honest with you, not as complex or dangerous as you might think.

Jackie (13:32):
Right. Yeah. I mean, I think this sounds fascinating. So one surgeon was calling this the year of the waist. What do you think is actually driving this?

Dr. Chang (13:41):
Anytime you see something like this that can change the game substantially for people, I think it's going to be a really good change. I mean, you have to use your judgment a litle bit. There are going to be patients that aren't really good candidates for this who I'm sure other docs will find a way to justify doing it, but I think that there will be a huge adaptation of this technique and technology. It'll be going to be really good. And skeletally, we said this before we talked about craniofacial surgery, skeletal changes are so powerful for the body. Everything that we have on top of the skin, the muscles, the fat that lays on top of the skeleton is one thing. But if you have good bones or beautiful aesthetic structure, it really affects the final outcome. So similarly with the waist, if you narrow the bony structure, the waist will have much nicer shape and contour.

Jackie (14:40):
It is interesting because as we've discussed in the past, the Ozempic GLP-1 trends, I'm like, I wonder if people, you're losing the weight, but if you're still not getting that silhouette you desire. And I can't help, but think about the Met Gala, everyone was wearing these tiny little corsets. All three of the Kardashians, I believe, the big three, Kim, Kylie, Kendall that are always there, they all were wearing really tiny corsets. I was like, wow, their waist looks so small. Now I'm wondering.

Dr. Chang (15:16):
Wait, were they wearing corsets under their outfits or external?

Jackie (15:20):
That is their outfit.

Dr. Chang (15:22):
Oh, that is their ... So I only saw Kylie, I think it was. She was wearing the nude strapless top with the false nipple things. So was that supposed to represent essentially naked at the top?

Jackie (15:36):
I think so.

Dr. Chang (15:36):
And the dress being pulled down from the top or something?

Jackie (15:38):
Yeah. So it highlighted her waist and then at her hips the actual dress came out, but I was like, her waist looked ...

Dr. Chang (15:48):
Really small?

Jackie (15:48):
Tiny.

Dr. Chang (15:49):
Oh, because when I looked at that, I thought she looked like one of those lipopads we had, or it looks like the barrel floating down Niagara Falls. She looked good. I'm not saying she doesn't ... That's what I thought because it looked so padded up.

Jackie (16:06):
I think see, look at her waist.

Dr. Chang (16:09):
Wow, she does look good.

Jackie (16:12):
You were distracted by the fake nipples.

Dr. Chang (16:16):
Were they fake?

Jackie (16:17):
I think so.

Dr. Chang (16:19):
Yeah.

Jackie (16:19):
I think so.

Dr. Chang (16:19):
Well, it was definitely attention seeking, but got everybody's attention.

Jackie (16:26):
But yeah, look at her waist and then Kim's and then ... I don't know. Now I'm wondering were they getting-

Dr. Chang (16:31):
Is that Kim on the left?

Jackie (16:33):
Kim's in the orange.

Dr. Chang (16:35):
Kim has the blonde hair.

Jackie (16:37):
Oh yeah.

Dr. Chang (16:39):
I'm too behind. This was just yesterday. Well, she looks like a superhero. She's wearing a Marvel superhero or something.

Jackie (16:47):
But their waists look tiny. Yeah.

Dr. Chang (16:50):
Well, I wouldn't put it past them. The Kardashians would be the front runners.

Jackie (16:54):
They would be on the up and up here.

Dr. Chang (16:56):
They don't shy away from trying something.

Jackie (16:58):
Well, it's interesting. I do want to just bring up the pneumothorax risk because obviously that stands out. It's a rare complication, but how would you discuss that with your patients?

Dr. Chang (17:10):
Every procedure has some risk. So when we do liposuction, there's a possibility you could puncture the bowel or an internal organ. It's rare, but it's happened and it's well documented and it's happened. It's happened to people who are not board certified plastic surgeons, but it's also happened to board certified plastic surgeons, people who have a lot of experience. So there are risks that you have to say we're operating in this anatomical area. Anything could happen. I would try to do everything I can to prevent any complications or any risks to the patient, but you would be lying to say that there's no risk or to deny the risk.

Jackie (18:02):
Right. Yeah. So I think anyone doing this, just like any other procedure we do, you're just open and honest about these are risks. You let them know and then you make your decision from them. But as we've discussed here, everything we do technically carries a risk like that.

Dr. Chang (18:21):
Yeah. And based on the number that we heard from this PRS Global Open study, the risk is going to be lower than three and a half percent.

Jackie (18:31):
Even lower. Yeah, because that included everything.

Dr. Chang (18:34):
It's everything, right. So if you said, well, you have a 97% chance of not having a complication, it's a lot easier to digest than saying, "Okay, well, there's a complication. You could get a pneumothorax."

Jackie (18:44):
Yeah. And that's why it's important if you want to get this done, you see someone who's had the proper training in this new procedure.

Dr. Chang (18:52):
Right, exactly.

Jackie (18:54):
But I do think, I mean, I don't know. Like I said, I wonder if it was this girl that I saw. I'm not sure who I saw on TikTok, but I was very impressed with what I saw. I was like, wow.

Dr. Chang (19:06):
Yeah. We're going to be doing it. I'm excited. I think that we're going down to the center where they developed the procedure down in South America. So I'm very, very excited to work down there with some of the Latin American surgeons and see what it's all about and really get hands on and do some cases because we get to do some cases down there with them.

Jackie (19:28):
It sounds really exciting. And also, I mean, you use a piazotome already, so it's not like something-

Dr. Chang (19:37):
I've been using it for years. And I think a lot of the guys who are just starting out are trying to figure out how to really become facile with it, but it's a great tool.

Jackie (19:46):
Yeah. And so you've already got that down.

Dr. Chang (19:48):
Yeah, that's one of the things I don't think it'll be that big of a leap because we use it to cut and to shape bones all the time in rhinoplasty. I think that there's a good translation there of how it's going to work. But anyway, I think we're here to always think about the next level to push forward and see what we can offer for patients and also demystify things because those questions come up all the time and things you've seen online and you're not sure is this some crazy thing going on, but it's been around for a little while. So anyway, so don't get all your information from online sources. Leave us a comment, give us a call. We'd be happy to answer your questions and help get you in for consultation to discuss these types of things. But other than that, we'll make sure that we give you the honest truth.

Jackie (20:41):
The year of the waist. Who knew?

Dr. Chang (20:42):
Yeah, yeah. I haven't heard that slogan before, but since it's the year of the waist, I know you'll want to try it next.

Jackie (20:49):
Yeah. You never know.

Dr. Chang (20:50):
Yeah, you're in. All right, guys. Well-

Jackie (20:54):
Yeah, we'd love to hear what you think about this.

Dr. Chang (20:56):
If it's too extreme for you, let us know. But if you're down, give us a call.

Jackie (21:00):
Give us a call.

Dr. Chang (21:00):
Drop us a comment.

Jackie (21:01):
All right.

Dr. Chang (21:02):
Have a good one. We'll see you next time.

Jackie (21:04):
Thanks guys. Bye.

Dr. Chang (21:06):
Thanks for listening to Secret Services, the podcast where we see everything and say nothing except right here. I'm Dr. Christopher Chang, double board certified plastic surgeon located in Tysons, Virginia. Follow us on TikTok @CongressionalPsurgery or on Instagram @congressionalplasticsurgery. To send us a classified message or to hear more episodes, go to secretservicespodcast.com. Links to everything we talked about on today's show are available in the show notes. Oops, patient's here. We got to go.