Daniela Cesin was 14 when she started thinking about her appearance. “I was a little chubby, so I began working out at home and losing weight. I could see the difference in my body—my abs, the muscles in my arms—and I started to like it,” she says. By 31, she had the slim, toned body she had hoped for, but something was still missing. “I wanted that guitar hourglass shape.”
In August, Cesin traveled from Miami, where she has lived for the past 15 years, to her native Venezuela for liposuction and a fat transfer to her hips. She met her cosmetic surgeon for the first time the day before the procedure, and he realized she didn’t have enough fat for it. Instead, he offered to perform RibXcar: a rib remodelling surgery that would involve fracturing three of her lower ribs on each side and binding them in a corset for three months to set the ribs in a new position and give her a wasp-like waist.
“I was like, ‘No, no, no, I don’t want to do anything with the ribs,'” she says. The idea of breaking the bones around her vital organs sounded far more invasive than the breast augmentation she had 10 years ago, or the rhinoplasty (nose surgery) and blepharoplasty (eyelid surgery) she had two years ago. She had also never heard of the procedure. But after the consultation, she decided to trust her surgeon. Cesin had already paid for flights and taken three weeks off from her job as a sales director. The next day she was put under anesthesia, and her surgeon used an ultrasound to locate the ribs, made six small incisions in her back, and inserted a vibrating tool to create greenstick fractures—incomplete bone breaks—on each rib. When she woke up, she was wearing a black corset with small knobs on each side that she could tighten to her preferred measurements.
The recovery has been uncomfortable. At first it was hard to stand or lie down without help, and the incisions were sore. The first week, Cesin barely slept. “Your body doesn’t get used to any position, so I would wake up every hour.” But the worst part has been eating while wearing her corset, which must stay on 23 hours a day; this causes acid reflux. Despite the discomfort, when we speak six weeks after her surgery, she is pleased with the eight centimeters she has taken off her waist.
Cesin is one of a small but growing number of women choosing to fracture their ribs for an hourglass shape. To achieve this look, women previously underwent riskier rib removal techniques, which reduce the protective bone barrier for the liver and spleen. Kazbek Kudzaev, a plastic surgeon in Russia, realized in 2017 that he could achieve similar aesthetic results by moving the ribs with a drill until one side fractured, then binding the body in a corset while they healed. Since his discovery, surgeons in countries including Colombia, Korea and France have refined the technique. Today, it takes about an hour and is performed under general anesthesia as a day-surgery treatment.
It is promoted as a noninvasive procedure, but many of the women I interviewed described feeling as if they had been “hit by a bus” after surgery. And there are serious risks. These include standard surgical complications, such as allergic reactions to the anesthesia, blood clots, wound infections and seromas (pockets of fluid that build up under the skin). But there are also more specific dangers, including a collapsed lung, known as a pneumothorax, and a haemothorax, where blood collects in the space between the chest wall and the lungs. Both of these are potentially fatal.
Sandip Hindocha, a consultant plastic surgeon at the Private Clinic on Harley Street in London, is skeptical about the procedure. “If a patient came to my clinic and said this is what I want to do, I’d be asking the question: ‘Why do you want to do that? And‘Why do you want to make such a permanent change to your body?’”
View image in fullscreenKim Kardashian at the 2022 Met Gala. Photograph: Evan Agostini/Invision/AP
He cites a paper published in Plastic and Reconstructive Surgery, which found that between 2018 and 2024, out of 2,351 patients who had rib remodelling, the overall complication rate was 3.7%. “That’s not a small number,” he says. “If we did a breast augmentation, you wouldn’t expect a complication rate like that.”
The British Association of Aesthetic Plastic Surgeons (BAAPS) does not endorse the procedure. Former president Nora Nugent points out that it is relatively new, “with limited data available on long-term results, and it requires advanced body contouring skills as well as the ability to treat any potential complications. It may be something that UK/BAAPS plastic surgeons bring into their practices in due course, but it is not available at the moment.”
The procedure isn’t typically offered to cisgender women over 40, because they are more likely to have osteoporosis, which can cause the bones to break completely rather than fracture. Another complication is that gaining weight can change your body shape again, so pregnancy can affect the results. The procedure “needs to be done with a surgeon who has a lot of experience in it,” says Hindocha. “Maybe a surgeon who also does chest wall reconstruction.”
In the UK, plastic surgeons are advised to give patients a cooling-off period of at least two weeks to weigh up the risks and potential consequences of any procedure. But Hindocha worries that patients sometimes choose rib remodelling with less time for reflection, despite the permanence of the change. “If you put an implant in and later you don’t want it, you can, worst case scenario, remove it,” Hindocha says. But the ribs are “a structural, rigid part of you that you cannot reverse.”
Throughout history, waistlines have expanded and shrunk. Between the 16th and 19th centuries, corset wearing and tight-lacing became a symbol of beauty for the “leisure class” (the restrictive garments made physical labour impossible). The engineered hourglass shape fell out of fashion in the 1920s, but made a comeback with Marilyn Monroe, before slender, androgynous frames gained popularity from the 60s to the 90s. In the 2010s, the extreme curves of the Kardashians became the defining silhouette.
In recent years, tinier, waif-like frames have become popular on TikTok and Instagram, but a highly defined waist is also considered desirable. This is thanks, among other things, to the multibillion-dollar shapewear industry; global access to Instagram and filters; and easily streamed online workout videos that focus on creating a slim, hourglass silhouette through targeted training. But now there are adverts on social media for permanent surgical options too.
In July, 10 Australian influencers, who have made names for themselves globally on shows including Married at First Sight and Below Deck, prompted headlines with a trip to Bali. They were there for a brand collaboration with a rib recontouring practice called Snatched Waist. The clinic they visited looked more like a spa than a surgeon’s office, and after surgery, the influencers were soon lounging by the pool, showing off their narrow waists on Instagram.
View image in fullscreenMaking a comeback … Marilyn Monroe circa 1958. Photograph: Keystone Features/Getty Images
Not everyone is sunbathing in a bikini after the procedure. When Sophia woke up from her rib remodelling procedure in November 2025, she expected to be transferred to her Beverly Hills hotel room, a little sore but ready for recovery. Instead, she was surrounded by emergency medical technicians, who were putting her on a stretcher to take her to hospital by ambulance. The next thing she remembers is lying in a hospital bed, hooked up to an electrocardiogram and an intravenoufluid drip. A CT scan showed that Sophia had suffered a pneumothorax: 25% of one lung had collapsed. She was given oxygen and monitored for six hours before being discharged. Although she had signed all the consent forms for the procedure, “it was completely shocking to me,” she says. For at least a month, Sophia had a deep pain in her lung and some shortness of breath. She had to return to the hospital after some fluid buildup, but eventually started feeling better. The pain from the surgery itself subsided after about three weeks: coughing and sneezing was no longer agonizing. And she was able to return to her office job and hike in her corset at the weekends. Sophia is transgender and chose the procedure to feminize her body by narrowing her torso, which she felt was too wide. She began consultations for the procedure in August last year, with the surgeon planning to fracture ribs 10, 11 and 12. But by the time of her surgery in November, the surgeon felt confident he could achieve better results by going even further up the ribcage, ultimately operating on five ribs on each side. Sophia knew this would increase her risk of a pneumothorax but was willing to take the chance. “I didn’t start transitioning until I was 47 and I feel as if I’m playing catch-up, because I’m so old, and testosterone was running rampant all those decades,” she says. “That’s why gender-affirming procedures are really important to me.” The final results weren’t what she had hoped for, though. “It was a bit underwhelming.” View image in fullscreen ‘We have always done very demanding things for beauty.’ Photograph: Horst P Horst/Conde Nast/Getty Images In September this year, she went for a second round of rib remodeling with Leif Rogers, a different surgeon in Pasadena and Beverly Hills, California. Rogers removed cartilage from the front of her ribcage on ribs three to 10. On rib four, he cut out sections and secured them with titanium plates and screws. Sophia had a breast augmentation at the same time, since the inframammary incisions were already open. When she emails to update me a week and a half after her second surgery, although there has been no collapsed lung this time, she says: “Recovery has been significantly more painful, and I am experiencing more shortness of breath.” Despite the risks, Rogers expects skeletal remodeling to take off: that includes rib remodeling, clavicle shortening and pelvic widening. “Versions of it have existed for quite some time,” he says. “Limb lengthening and shortening has been around for a long time. Of course, we change the bony skeleton of the face all the time, but other than that we haven’t changed the torso very much. The changing of the skeleton of the body is a little bit newer, as for a long time people used to just put their hands up and say: ‘Too bad, this is the way you’re built.'” So why now? “The techniques have got way better. And there’s marketing for it out there.” In the US, he says, medical insurance often covers the procedure for transgender patients, “because they consider it a medical condition to have gender dysphoria. And I think on top of that, it’s just social media. Social media makes everything explode.” Rogers says the Kardashians have been highly influential. “I think Kim was part of why we wanted a big butt, and then she lost a lot of weight, so everyone wants to be like Kim, right?” In 2022, Kim Kardashian attended the Met Gala after losing a considerable amount of weight, in a sparkling dress once worn by Monroe. Her slender figure coincided with a growing movement towards thinness, a rejection of the body positivity movement of the 2010s, and the advent of the Ozempic era, when the diabetes drug became popular as a weight-loss treatment. A controversial 2022 New York Post article was headlined: “Bye-bye booty: Heroin chic is back.” On TikTok, people had begun measuring their waists using A4 sheets ofPaper, phones, and Apple headphone wires, showing off their Barbie-like proportions. View image in fullscreen. ‘Now who we are is how we look.’ Illustration: Michelle Thompson/The Guardian.
“We have always done very demanding things for beauty,” says Heather Widdows, a philosophy professor and author of the 2018 book Perfect Me, who mentions foot binding and extreme corsetry. “But they were always about adornment. I think what’s different with the global ideal now is that increasingly things are becoming normalised and naturalised. We’re seeing things that are purely about adornment being recategorised as health and hygiene, and then they become invisible, and if you don’t do them you start to look abnormal,” she says. “It becomes about standard presentation.”
As we move from a text-based culture to a visual culture, increasingly, “who we are is how we look,” she says, “and that is a form of identity that is a massive and dramatic change, but one that’s snuck up on us, that we don’t talk about enough. So the visual is becoming the dominant way of presenting ourselves, being ourselves and thinking about ourselves.”
Elizabeth Rivera trained in high-level gyms alongside American football players, baseball players, and Ms Bikini Olympia, to try to reach her beauty ideal. This was the X-frame specific to bodybuilders: broad shoulders, prominent glutes, and a small waist. For her, she says: “That looks like health. That’s a visible indication of discipline.” Rivera was “busting ass,” trying to reach this aesthetic ideal, but “it was not working for me. And I was making myself very sick from overtraining.”
Rivera is a 35-year-old licensed masseuse and she has lipedema, a chronic condition that causes abnormal fat deposits, which can be painful and are resistant to diet or exercise. “Once I accepted that my inability to lose fat wasn’t my fault, I said: ‘OK, I can accept that.’ But I still would like to have a smaller abdomen. I still would like to have more of an hourglass. So surgery was the next option.” A friend had recently had her ribs remodelled, and Rivera was impressed with the results.
She stands up halfway through our Zoom call to show off her waist. It’s objectively tiny, and the effect is exaggerated by her breast implants and petite Brazilian butt lift (BBL). “I can go most places in Chicago [where she lives], and there’s no one shaped like me. And I’m not saying that in a bad way. I’m saying that because it looks more extreme with the ribs, it’s noticeable.”
In Miami where Cesin lives, she says she doesn’t feel her shape puts her in the minority. There, cosmetic surgery is widely accepted and expected. “The girls in Miami, all of them look the same, because it’s a lot of fillers, a lot of buttocks, a lot of surgery and BBLs,” she says, adding that it’s easy, as a result, to get carried away. But she doesn’t want to end up like that. “People say rib remodelling was a little bit extra, that I didn’t need to do anything, but it makes me happy, so that’s why I did it. But I’m done. No more surgeries.”
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Frequently Asked Questions
Here is a list of FAQs based on the topic of rib remodelling for aesthetic purposes
1 What exactly is rib remodelling
It is a cosmetic surgery procedure where a surgeon removes a small section of your lower ribs to make your waist look narrower and create an hourglass figure
2 Is this the same as rib removal
Yes people often call it rib removal but that is a bit misleading The surgeon doesnt take out the whole rib just a small piece of the floating rib at the bottom The rest of the rib stays in place
3 Why are people getting this done
The main goal is cosmetic People want a smaller waistline and a more dramatic curve between their waist and hips It is often combined with other surgeries like a tummy tuck or liposuction
4 Who is a good candidate for this surgery
You are a good candidate if you are generally healthy at a stable weight and have realistic expectations It is not a weightloss surgery It is usually for people who are already close to their goal body shape but want to change their bone structure
5 How much smaller will my waist actually get
Most surgeons say you can expect to lose about 1 to 2 inches from your waist The exact amount depends on your natural anatomy and how many ribs are shaved or removed
6 Is it safe What are the risks
It is a major surgery so there are risks These include infection bleeding and reactions to anesthesia There is also a risk of nerve damage or a collapsed lung though this is rare with experienced surgeons
7 Does it hurt
Yes it will be painful for the first few weeks You will likely need pain medication Most people feel significant soreness and have trouble moving around normally for a while
8 How long is the recovery time
You will need to take it easy for at least 4 to 6 weeks You wont be able to lift heavy things or do intense exercise during that time Most people take 1 to 2 weeks off work
9 Will removing ribs affect my breathing or organs
The ribs removed are floating ribs which dont connect to the breastbone
