Global Survey on Rib Remodeling Techniques: Assessing Complications and Safety in Waistline Contouring

Background: Rib remodeling, particularly targeting ribs 11 and 12, is gaining popularity in aesthetic body contouring to reduce waist circumference. Although rib manipulation techniques have been applied in other surgical fields, their use in plastic surgery has focused on achieving aesthetic goals. This study investigates the complications associated with rib remodeling techniques to enhance waistline contouring. Methods: A global cross-sectional survey was conducted among board-certified plastic surgeons who perform rib remodeling. Data from 2351 patient records (2018-2024) were collected, including demographic details, surgical information, and complications. Rib remodeling techniques assessed included surgical greenstick fracture modification and osteosynthesis. Results: The overall complication rate was 3.7% (86 of 2351 patients). Hyperpigmentation (17.4%), nonconsolidation (15.1%), burns (12.7%), and corset-related pressure ulcers (12.7%) were the most common complications. Major complications such as pneumothorax were rare (0.17%) and occurred only in RibXcar cases. Rib extraction/removal techniques had no reported complications, whereas Riboss had the lowest complication rate (1.96%) due to the use of osteosynthesis material for fracture stabilization. Conclusions: The incidence of complications related to the rib remodeling procedures in our study was 3.7%. However, some procedure-related complications-such as pneumothorax and hemothorax-can pose serious risks to the patient's life. Nevertheless, when performed by a well-trained surgeon with an adequate learning curve, these procedures can be considered safe.