Patients call Southwest Plastic Surgery asking about rib removal. Some have seen it on TikTok as the Barbie waist. Some have read about the old operation, with the long incision and the ribs taken out, and want to know if it is safe.
The short answer from the practice: rib removal is not what Dr. Frank Agullo does. Rib repositioning is, and it is a different operation.
Is rib removal the same as the “Barbie waist” I see all over social media?
Dr. Agullo: “These are all the same procedure with different names, due to marketing or surgeon preference. You may have seen it as RibX, RibXcar, Ribella, WASP, RIBOSS, H-Curve rib remodeling, Invisarib, or the Barbie waist. We tend to call it rib repositioning. It can also be referred to as rib remodeling or minimally invasive rib contouring.”
Why Diet and Exercise Stop Working on the Waist
Why won’t my waist get smaller no matter what I do?
Dr. Agullo: “The waist is defined, or restricted, by the distance between the superior crest of the pelvis and the last rib. In some patients, this last rib almost touches the pelvis, which means that there really can be no further reduction in the waistline. You can lose fat. You can build obliques. The bones do not care.”
That is the patient the practice sees most often for this procedure: fit, lean, and stuck.
Removal Versus Repositioning
Do you remove the ribs?
Dr. Agullo: “No. This used to be done by removing the ribs in their entirety, which required a large incision, had an increased risk of injury to the lung or nerves, and sometimes led to chronic pain. That version earned its bad reputation.”
“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 the 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.”
| Rib removal | Rib repositioning at Southwest Plastic Surgery | |
|---|---|---|
| The rib | Taken out entirely | Stays, moved to a narrower position |
| Incision | Large | Small needle incision, no scar |
| Guidance | None | Ultrasound |
| Organ protection | Lost with the rib | Kept |
Don’t I need my ribs to protect my organs?
Dr. Agullo: “That’s the beauty of it. With rib repositioning, we’re leaving the ribs in place, so they’re still protecting the organs. The floating ribs are located posteriorly and protect the kidneys, and when we reposition them, they’re still doing that function.”
How Much the Waist Comes In
How much smaller will my waist get?
Dr. Agullo: “If we reposition the last two floating ribs, most patients’ waistline is reduced by about three to four inches, with a lung injury risk of less than one percent.”
Treating the last two false ribs as well can take the reduction further, to six to seven inches in Dr. Agullo’s description, but it raises the complication rate, requires a CT scan beforehand, and is not offered to every patient. The full explanation is on agulloplasticsurgery.com.
Who Asks for It
Who is a good candidate?
Dr. Agullo: “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 very common in women who are already curvy but want to reduce their waist further.”
Should I get it if I already have an hourglass?
Dr. Agullo: “It’s a very personal decision. Touch your last rib, the one on the most bottom, and keep going down. If you don’t have a lot of distance between your rib and your hip, it can come in a lot. There are no scars. I just make two little needle points and bring it in, so it’ll make the waist smaller for sure. But if your waistline is already good enough, you don’t need it. It just makes the hourglass a little bit more.”
Recovery and the Waist Trainer
This is the part of the procedure the Southwest Plastic Surgery team spends the most time on with patients, because the waist trainer is not optional.
Does it hurt, and what is recovery like?
Dr. Agullo: “I inject Exparel in the area prior to the procedure, a local anesthetic that lasts for three days and numbs the area for a much smoother recovery. Most patients describe the pain as mild to moderate, and they feel the waist trainer helps them through it.”
How much time off work will I need?
Dr. Agullo: “Five to seven days to return to normal, easygoing activity, with no heavy lifting and nothing strenuous. Then it is three months to return to full activity with no limitations, while the ribs heal in their new position.”
Why the waist trainer?
Dr. Agullo: “Corset training is not a gimmick here, it is the recovery. We actually use the waist trainer for three months to help heal the ribs in their new position. Many patients notice their waist trainer can be placed tighter and tighter as they heal, and they often have to downsize to a smaller waist trainer toward the end of the three months.”
Cost
How much does it cost?
Dr. Agullo: “As a standalone procedure, rib repositioning is ninety-five hundred dollars. If it’s done in addition to other procedures, it’s a forty-five hundred dollar add-on.”
That is as of this writing. For current pricing, see the fees page on agulloplasticsurgery.com.
Combined With Other Body Contouring
Can it be combined with other procedures?
Dr. Agullo: “Rib repositioning rarely works alone in my practice. Liposuction is a very strong tool for the waist contour, and I often combine the two: if you’re able to pinch excess fat in the waistline area, liposuction there buys more definition.”
“So the ultimate waist definition procedure would be a combination of liposuction, rib repositioning, a triple plication internal corset through a standard or mini tummy tuck, and then the waist trainer for recovery. For some patients this folds into a larger body contouring or mommy makeover plan.”
The practice covered the triple plication internal corset separately. It pairs with a tummy tuck and the wider body contouring plan.
Why Dr. Agullo
Why you?
Dr. Agullo: “This technology did not come into development until about two or three years ago, so be careful who you let near your ribs. I am a board-certified general surgeon and plastic surgeon, and I have experience with rib fractures and rib removal procedures from both careers.”
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years.
Schedule a Consultation
To ask about rib repositioning at Southwest Plastic Surgery, call (915) 590-7900 or text 1-866-814-0038. #StayBeautiful
Find Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
