Rib 11 and 12 Removal Surgery

Resection of ribs 11 and 12, the freely floating ribs, are most commonly associated with aesthetic waist refinement. Because of their lack of a sternal attachment and their proximity to the waistline removal of their lateral projecting ends reduces the structural support of the sides of the waistline. Rib 11 is longer than rib 12 and, as a result, it would be expected that its effect may be more significant and would add to the effect of rib 12 shortening.  For this reason the free floating ribs are usually taken together through the same posterolateral flank inciison.

1. Anatomical Role in Waist Shape

Rib 12 (alone)

• True floating rib
• Primary contributor to the lower flank shelf
• No effect on ribcage stability

Contour effect

• Softens the lower waist / flank bulge
• Improves back and oblique silhouette
• Subtle narrowing

Rib 11–12 (combined)

• Rib 11 is longer and more lateral than rib 12
• Greater structural influence on waist width

Contour effect

• More significant waist indentation
• Visible narrowing in frontal and oblique views
• Still modest compared to upper rib resections

2. Visual Outcome Comparison

Key counseling phrase

• Rib 12 alone = refinement
• Rib 11–12 = reshaping

3. Surgical & Risk Considerations

Rib 12 Only

• Shorter operative time
• Less muscle dissection
• Lower nerve irritation risk
• Faster recovery

Rib 11–12

• Larger dissection field but through same incision length
• Greater risk of:
  • Intercostal nerve irritation
  • Postop soreness
• Still low complication rates in experienced hands

4. Partial vs Complete Resection Differences

Rib 12

• Partial resection usually sufficient, 2 to 3 cms of the tip is sufficiient

Rib 11

• Almost always partial lateral resection
• Posterior rib segment preserved for stability

5. Patient Selection Guidelines

Best candidates for Rib 12 only

• Long, palpable 12th rib
• Mild boxy lower waist
• Lean to moderate BMI
• First-time rib contouring

Best candidates for Rib 11–12

• Broad lower rib cage
• Short waist / straight torso
• Athletic builds with visible ribs
• Revision cases after rib 12 alone

6. Combination with Other Procedures

Both options pair well with:

• Flank lipo
• Abdominal etching
• High-definition liposculpture

Rib 11–12 + lipo = additive effect

Bottom-Line Counseling Summary

• Rib 12 alone:
  “Smoother, less boxy lower waist—subtle but real.”
• Rib 11–12:
  “Noticeable waist shaping without altering the upper ribcage. Not reason to not do as the incision length is the same and the recovery is equally similar.

Dr. Barry Eppley

World-Renowned Plastic Surgeon