Which Method For Waistline Narrowing Its Better – Rib Removal or Rib Osteotomies?
Q: Dr. Eppley, I am aware that your office performs rib removal for body contouring purposes. After doing some research into rib removal and other methods of waistline reduction I have come across the Kudzaev method of waist narrowing. This procedure is currently only popular and performed in eastern Europe and involves performing a partial osteotomy on the floating ribs and then using a corset tightened with a belt on top for 3 months during the healing process where the modified ribs heal and get affixed into their new position. Reading the patent of this method it seems like the incisions that are performed are also smaller (2-3cm) than what is normally done for removal. Additionally, it is claimed that this procedure has little pain compared to removal and can be done under local anesthesia.
A recent academic paper Aesthetic Contouring of the Chest wall with Rib Resection claims that the Kudzaev method doesn’t have clinical trials: “On the other hand, Kudzaev patented a method of narrowing the waist, in 2017, in which the author performs osteotomies on the 11th and 12th ribs by small skin incisions. Thus, he promotes costal fracture, and complements the narrowing of the waist by the use of a corset. In this way, costal resection and its complications are avoided and waist narrowing occurs. However, there is no publication of clinical trials with this approach.”
However, this method seems to have been used frequently in the past with little side effects pertaining to rib contouring when performing extrapleural thoracoplasty for tuberculosis so this technique doesn’t seem particularly new or experimental. It’s only novelty is being used for aesthetic purposes.
Despite the patent saying that only the floating 11-12 ribs can be reshaped, I have talked with a couple Russian plastic surgeons and they claim that the 10th ribs are also able to be narrowed with this method after analyzing a CT scan. Looking at results on Instagram for the surgeons that are performing this, it seems like they are reshaping the 10th rib many other examples I can provide.
Some additional information can be found at as well.
I am wondering if you are aware of this method and what your thoughts of it are. Many of the plastic surgeons that perform this operation claim it’s a much safer operation than removal long term as you retain your ribs. I am also interested if you would be able to perform this operation since I have considered flying to Russia but I would very much prefer to stay in the US for something like this.
A: Thank you for your inquiry and detailing the osteotomy method for waistline narrowing of which I am well aware. Having removed hundreds of ribs for waistline narrowing, and never yet see a single complication or any negative byproduct of removing the outer half of ribs #10,11 and 12, I can not speak for whether rib osteotomies vs rib removal is safer, has a quicker recovery or produces comparative results. What I can say is the following:
1) The skin incisions needed to perform either technique would be similar. I use a 4.5cm single incision per side which can not be made smaller no matter method is used.
2) No form of multiple rib manipulations should be attempted to be performed under local anesthesia. There is no benefit for the patient or the outcome in doing so and may well make the whole experience far less pleasant and even less successful.
3) The key to the technique is obviously the patient’s compliance with the corseting.
4) One of the key components of waistline narrowing is the reduction of the thickness of the lateral border of the latissimus dorsi muscle. This soft tissue reduction provides as much waistline narrowing as that of the rib bone changes.
5) Rb removal has surprisingly less pain afterwards than one would think because there is no bone to heal, it is just a muscle recovery. Whether leaving the ‘fractured’ ribs in place will lead to more postoperative or even long-term rib pain I can not say.
That being said I believe rib osteotomies are a valid method for waistline narrowing….which is probably better called ‘rib osteotomy-assisted corseting’. In the properly motivated patient it is a useful technique But whether it produces similar results to rib removal surgery no one can yet say. They are both similarly safe but one is not safer than the other.
Dr. Barry Eppley