A subcostal rib shave is a cosmetic surgical procedure designed to reduce the visible edge or flare of the lower rib cage, creating a smoother and less prominent lower ribcage appearance. This can be the entire lower subcostal rib margin or it can be an isolated bump or protrusion.
What it involves
- The subcostal ribs, usually ribs 8 and 9 on the anterior (upper abdominal) surface, form the cartilaginous lower ribcage margin.
- Rather than removing the ribs entirely, they can be shaved down due to their cartilaginous composition.
- This reduces rib projection while preserving rib stability and continuity.
- While cartilage rib shaving can be done over larger areas of the lower ribcage due to the incisional access needed it is best reserved as a spot or more localized reduction technique.
Who typically seeks it
- Patients with a naturally flared or wide lower rib cage or patients with an isolated rib prominence usually on rib 9.
- This not a waistline sculpting procedures per se. It is about reducing visible prominence for a smoother contour.
Surgical approach
- Isolated subcostal rib prominences may be able to done under local anesthesia if they are localized and not too big.
A small incision is made parallel to the subcostal rib margin directly over the prominence- While access to the rib area requires splitting the overlying rectus abdomens muscle it is extraperitoneal (does not enter the abdominal cavity)
- The rib prominence shave can be performed by scalpel blades, sharp osteotomies, high speed bur or the piezotome.
- Outpatient procedure
A small incision is made parallel to the subcostal rib margin directly over the prominence
The rib prominence shave can be performed by scalpel blades, sharp osteotomies, high speed bur or the piezotome.
Outpatient procedureRecovery
- Initial soreness and tightness for 1–2 weeks
- Compression garment typically worn
- Return to light activity in ~1–2 weeks
- Full rib healing over 6–8 weeks
Risks & considerations
- Pain or prolonged tenderness
- Effectiveness of reduction is based on adequate incisional access
- No risk of encountering the pleura/lung as that lies below the ribs and is higher up at rib 7 level.
- Results are permanent (cartilage does not regrow)
Important distinction
- Rib shave ? rib removal
- Subcostal rib removal is more aggressive and less commonly performed due to the longer incision needed to do it.
- Rib shaving is a contour-focused rib preserving procedure
Dr. Barry Eppley
World-Renowned Plastic Surgeon