Some patients arrive at Southwest Plastic Surgery having heard it called the Barbie waist. Others say Invisarib, or RibX, or rib remodeling. The team has heard every name social media has invented.

“These are all the same procedure with different names, due to marketing or surgeon preference,” says Dr. Frank Agullo, the practice’s founder. “We tend to call it rib repositioning.”

Behind the nicknames is a piece of anatomy most patients have never been told about, and it explains years of frustration in the gym.

Why Some Waists Cannot Shrink

“The waist is defined, or restricted, by the distance between the superior crest of the pelvis and the last rib,” Dr. Agullo explains. “In some patients, this last rib almost touches the pelvis, which means that there really can be no further reduction in the waistline.”

The solution moves the boundary itself. “To create a smaller waist, what we do is cut the outer portion of the last two floating ribs so that we can reposition them in a narrower configuration. That’s the way we create a smaller waistline.”

Scarless, With Ultrasound Guidance

Rib surgery for the waist once meant removing ribs entirely, through a large incision, with real risks to the lung and nerves and sometimes chronic pain. That is not what happens at Southwest Plastic Surgery.

“The way this procedure is done now is through a small needle incision, using a device called a Piezotome, which is an ultrasonic needle device that helps us cut that outer portion of the rib with ultrasound guidance, and then the ribs are fractured into their new position. Today it is a scarless procedure with substantially fewer risks and complications.”

Dr. Agullo brings an unusual credential set to it: he is board certified in both general surgery and plastic surgery, with experience in rib fractures and rib removal from both fields, working with a technology that only emerged in the last two to three years. “I use the ultrasound to identify the ribs and visualize while I’m cutting the outer table of the ribs before repositioning, and this decreases the risk of injury to other structures.”

Who Books It

“The ideal candidate is somebody who wants to reduce their waistline and get a more feminine figure. This is very common in women who have an athletic body build and do not have much waist. It is also very common in male-to-female transgender patients. And it’s also very common in women who are already curvy but want to reduce their waist further.”

Some arrive having already done liposuction or a tummy tuck. For them, rib repositioning “would be the last option” to gain more definition.

The Numbers

Repositioning the last two floating ribs reduces most patients’ waistlines by about three to four inches, with a lung injury risk under one percent. For patients who qualify after a CT scan, treating the last two false ribs as well can take the reduction to six to seven inches, with complications around one to two percent.

Recovery Built Around the Waist Trainer

Before surgery, Dr. Agullo injects Exparel, a local anesthetic that lasts three days, for a smoother early recovery. Most patients describe mild to moderate pain.

Then the waist trainer takes over. “We actually use the waist trainer for three months to help heal the ribs in their new position,” he says. “Many patients notice that their waist trainer can be placed tighter and tighter as they heal, and many times they have to downsize to a smaller waist trainer toward the end of their three-month period.” Strenuous exercise waits the full three months.

The Full Waist Plan

Rib repositioning combines naturally with the practice’s other waist tools. Liposuction sharpens the contour when there is pinchable fat. Dr. Agullo’s tummy tuck technique plicates the rectus and oblique muscles, “like an internal corset, a triple plication, which brings in the waistline further.”

His summary of the ultimate combination: liposuction, rib repositioning, the triple plication internal corset through a standard or mini tummy tuck, and the waist trainer for recovery. Patients exploring larger transformations often fold this into body contouring or a mommy makeover plan.

About Dr. Agullo

Dr. Frank Agullo is board certified in both plastic surgery and general surgery, Mayo Clinic fellowship trained, a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, and a Castle Connolly Top Doctor for thirteen consecutive years.

Schedule a Consultation

Curious what your skeleton is doing to your waistline? Call (915) 590-7900, text 1-866-814-0038, or book online at Southwest Plastic Surgery. #StayBeautiful

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

Dr. Agullo wrote two companion pieces: the Barbie waist editorial on drworldwide.com, and the clinical candidate guide on agulloplasticsurgery.com.