Reshaping the Waistline: A Systematic Review of Rib Remodelling Techniques in Aesthetic Surgery

Background: Rib remodelling has emerged as a novel adjunct in aesthetic waist contouring. As patients increasingly seek alternatives to traditional procedures such as liposuction and abdominoplasty, rib modification techniques have evolved to meet aesthetic demands. Prior reviews grouped rib resection and remodelling together, limiting clarity on individual outcomes. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to identify clinical studies reporting outcomes of rib remodelling procedures performed for cosmetic waist narrowing between January 2015 and March 2025. Searches were performed in PubMed, EMBASE, and Scopus. Included studies reported waist reduction, complications, or patient satisfaction and were categorised into five technique groups: Traditional rib resection, rib repositioning with osteosynthesis, dorsal osteotomy, ultrasound-assisted greenstick osteotomy, and RibXcar. Results: Nine studies met the inclusion criteria. Techniques varied in invasiveness, instrumentation, and anatomical approach. Reported waist reductions ranged from approximately 6–17 cm. Patient satisfaction was consistently high, especially with minimally invasive methods such as RibXcar and ultrasound-assisted osteotomies. Complication rates were low overall, with pneumothorax occurring only in traditional rib resection cohorts. The need for postoperative compliance, especially with corset use, was a common theme across techniques. Conclusions: Rib remodelling appears to be a safe and effective complement to traditional body contouring methods. Technique-specific organisation of outcomes offers greater clarity than prior reviews. However, most studies remain limited by retrospective designs and short follow-up. Prospective research is needed to confirm safety and efficacy over time.