Having performed more than one hundred rib-removal surgeries for body contouring over the past decade—encompassing nearly 400 individual rib modifications—I am frequently asked about the waist-narrowing effects of this procedure, particularly as they relate to one of the most well-known patients in the world to undergo it: Pixie Fox. More specifically, patients often ask whether they can expect a result similar to hers. This question may stem either from a desire to achieve an identical outcome or, conversely, from a concern about avoiding what some might consider an extreme result.
For the vast majority of patients, the general answer to that question is no. To properly explain this, it is important to provide a factual overview of her rib-removal surgery and related details, while separating verified information from sensationalized accounts.
Pixie Fox underwent cosmetic rib-removal surgery performed by me, during which six ribs (ribs 10 through 12 on both sides) were partially removed. The explicit goal of the procedure was to achieve an extremely narrow waist. Her objective was a very slender waistline—reportedly measuring approximately 16–18 inches while wearing a corset. While the rib surgery produced a significant result, it must be understood within the broader context of the many other factors that contributed to her appearance. These included a large breast augmentation, additional body contouring procedures, her natural body shape, and prolonged corset use both before and after the rib-removal surgery.
When all of these elements are considered together, it becomes clear that her outcome is not representative of what nearly all patients undergoing rib-removal surgery can expect. In fact, a more common preoperative concern among patients is whether the procedure will produce enough of a visible result to justify the surgery. For this reason, patient selection is critical. Low body fat and a highly motivated patient are the two most important factors for achieving a meaningful outcome.
Another important area of discussion involves the safety and risks of rib-removal surgery. It is often claimed that removing ribs can compromise:
- Protection of internal organs
- Structural support of the torso
- Breathing mechanics
The concern is that the lower ribs and surrounding musculature contribute to organ protection and abdominal wall support, and that their removal could increase vulnerability to trauma or lead to other problems. While these concerns are understandable, they have not been substantiated in my extensive experience with this surgery. Similarly, the risk of pneumothorax has not occurred in my practice, as rib removal is performed as an open procedure, allowing any disruption of the pleura to be immediately identified and directly repaired.
Although rib removal performed solely for cosmetic waist reduction was once highly controversial within the plastic surgery community—due to safety and ethical concerns—this perspective is gradually changing. The growing popularity of RibXcar (percutaneously induced rib fractures) has increased general awareness of cosmetic rib-modification procedures, even though there are major differences between this technique and traditional rib-removal surgery. Increased awareness and acceptance now provide an opportunity to more accurately evaluate effectiveness, patient selection criteria, and the true safety profile of rib-removal surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon