Let's be real. If you’ve spent any time scrolling through high-end plastic surgery forums or looking at certain "cartoonish" silhouettes on Instagram, you've probably wondered how it's physically possible. Some people are just born with that genetic 1:1.5 hip-to-waist ratio. Others? They’re looking into rib removal for smaller waist results that diet and exercise simply cannot touch. It sounds medieval. Honestly, it sounds like an urban legend from the 90s—remember those rumors about Marilyn Manson or Cher? Well, those were mostly fake, but the surgery itself is very real.
It’s an extreme measure. Total commitment.
Modern rib removal isn't actually about "removing" the entire rib cage, despite the name. Surgeons usually focus on the "floating ribs"—specifically pairs 11 and 12. These are the ones that don't wrap all the way around to the front. They just sort of hang there in the back, providing a bit of protection for your kidneys but mostly just defining the lateral width of your midsection. By shortening or taking them out, a surgeon can fundamentally narrow the chassis of your body.
The anatomy of the "impossible" cinch
Your rib cage is a protective bucket. It’s flexible, sure, but it’s literally bone. No amount of planks or keto is going to shrink your bone structure. This is why people get frustrated. They hit 12% body fat and their waist still looks "boxy" because their lower ribs flare out.
Dr. Barry Eppley, a prominent surgeon based in Indiana who has become a go-to name for this specific procedure, often explains that the goal isn't just "skinny." It's structural change. When you remove the 11th and 12th ribs, you're essentially removing the kickstands that hold the waist wide. This allows the soft tissues to collapse inward. It creates a "V" or an hourglass shape that stays there even when you’re bloated or sitting down.
But it’s a big deal. You’re talking about general anesthesia and a recovery period that isn't exactly a walk in the park.
Why the "floating ribs" are the targets
The human body has 12 pairs of ribs. The first seven are "true" ribs. They attach directly to the sternum. Then you have the "false" ribs (8, 9, and 10) which connect to cartilage. Finally, at the bottom, are the floating ribs. Because they aren't anchored in the front, they are the only ones surgeons can safely mess with without collapsing your entire thoracic cavity.
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Most patients don't realize that sometimes the 10th rib is also involved, though that’s getting into riskier territory. Dr. Thomas S. Narsete, another specialist in this niche, has noted that while the surgery is effective, it’s often combined with aggressive liposuction. Why? Because if you have a layer of fat over the newly narrowed bone structure, you won't even see the difference. You need that "shrink-wrap" effect of the skin onto the new frame.
The controversy and the "Barbie" surgery label
Social media calls this "Barbie surgery." That label drives a lot of medical professionals crazy. It trivializes a procedure that involves cutting through muscle and bone near vital organs.
Is it safe? Sort of.
Everything in surgery is about "relative risk." The biggest concern isn't usually your lungs collapsing—though that’s a theoretical risk (pneumothorax)—it’s nerve damage or kidney protection. Your 12th rib is there for a reason. It acts as a shield for your kidneys. When you remove it, you’re trading a bit of physical protection for an aesthetic gain. If you're a professional kickboxer, this is a terrible idea. If you live a relatively sedentary or "normal" life, the trade-off is something you have to weigh personally.
What the recovery actually feels like
Imagine the worst core workout of your life. Now multiply that by ten and add a sharp, stabbing sensation every time you sneeze. That’s week one.
- The first 48 hours are basically a blur of pain management and trying to find a position that doesn't hurt.
- You’ll be wearing a medical-grade compression garment (basically a high-tech corset) for weeks.
- Full "reveal" of the results doesn't happen for 3 to 6 months because the internal swelling is massive.
Patients often report a weird "empty" feeling in their lower back. It’s not necessarily painful after the first month, but it's a sensory shift. You’re literally missing pieces of your skeleton. It takes the brain a minute to catch up to that reality.
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The role of waist training after surgery
Here is the secret most surgeons don't lead with in the brochures: the surgery creates the possibility of a smaller waist, but the corset does the heavy lifting.
Post-operative waist training is almost always required. Since the ribs are gone, the space is now "pliable." By wearing a corset during the healing process, you are essentially molding the soft tissue and the remaining rib structure into that narrow shape. Without the corset, the body might just fill that space with scar tissue, and you'll end up looking much the same as before, just with a lighter skeleton and a lighter bank account.
Realities of the scar
The incisions are usually in the back. They are small—maybe two inches—but they aren't invisible. If you’re the type of person who loses sleep over a tiny scar, this might not be for you. They fade, but they’re there. Most surgeons try to hide them in the natural crease of the back or right along the line where a bikini bottom would sit.
Who is actually getting this?
It's not just "influencers."
While people like Pixee Fox (who famously had six ribs removed) make the headlines, the typical patient is often someone who has a naturally wide, masculine, or "square" torso and feels it doesn't match their gender identity or their personal aesthetic. We see a significant number of transgender women seeking rib removal for smaller waist results because HRT (hormone replacement therapy) can't change bone structure. It can move fat around, but it can't narrow a wide rib cage. For this demographic, the surgery is often seen as a final step in body feminization.
Then there are the fitness competitors. People who have hit a "wall" in their physique. They’ve done the diet. They’ve done the cardio. Their waist is 28 inches and it’s never going to be 24 because their bones are literally in the way.
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Costs and the "Travel" factor
This isn't cheap. In the United States, you're looking at anywhere from $15,000 to $30,000. It's rarely covered by insurance because it's purely cosmetic.
Because of the price, many people look toward "medical tourism" in places like Mexico, South Korea, or Turkey. Word of caution: while there are world-class surgeons everywhere, the follow-up care for rib removal is intense. If you have a complication five days after you fly home, a local ER doctor might not have a clue how to handle a specialized rib resection issue.
The long-term unknowns
We don't actually have fifty years of data on what happens to people who have their lower ribs removed in their 20s.
Will their organs shift more as they age?
Will they be more prone to spinal issues because the "girdle" of the rib cage is compromised?
Most surgeons say no, citing the fact that the 11th and 12th ribs are "vestigial" for modern humans. We don't need them to breathe, and we don't need them to stay upright. But the human body is a tensegrity structure. You move one piece, the rest of the system adjusts.
Better alternatives or complementary moves?
Before jumping straight to bone removal, many experts suggest "rib resectioning" or "rib resetting." This is a slightly less aggressive version where the ribs are notched or broken and then reset in a more inward position. It’s still surgery, but you keep your bones.
Others find that 360-degree liposuction (Lipo 360) combined with a "tummy tuck" (abdominoplasty) that includes muscle plication—where they sew the abdominal muscles tighter—gets them 90% of the way there. If your "wide" waist is caused by muscle laxity rather than bone, rib removal won't actually help you as much as a muscle repair would.
Actionable steps if you're serious
If you're looking at your reflection and thinking this is the only way, don't just book a flight.
- Get a CT scan. A good surgeon will want to see your actual skeletal anatomy before promising anything. Some people have floating ribs that are so small they aren't even causing the width.
- Try professional waist training first. Spend six months in a high-quality, steel-boned corset. If you can't stand the feeling of being constricted for 8 hours a day, you will hate the post-op recovery of rib removal.
- Check your visceral fat. This is the fat inside your abdominal wall, around your organs. No surgery—not lipo, not rib removal—can get rid of that. If your "width" is coming from internal volume, rib removal will just make you look like a squeezed balloon.
- Vet your surgeon specifically for this procedure. Ask how many rib removals they do a month. Not how many "body contouring" jobs—how many times they have specifically cut bone. It’s a specialized skill set.
This is the "final frontier" of body modification. It’s permanent. It’s expensive. And it changes the very framework of your body. Make sure the "why" behind your decision is as solid as the bone they’re taking out.