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The traditional methods of waistline narrowing, such as liposuction and tummy tucks, are very effective for most women. But when one seeks more than these procedures can achieve, deeper anatomic manipulation is needed. Once beyond skin and fat the lone remaining structures are muscle and ribs. Reducing these two internal structures is what constitutes the basis for rib removal surgery.

To reduce the lateral fullness created by the lower latissimus dorsi muscle as well as the waistline support of the lower ribs, their excision needs to be done by an incision in the immediate vicinity. In my experience with this procedure the best location for the incisions is over the lateral side of the 11th rib. This allows the outer half of the ribs to be reached and also allows the ‘mobile window’ of the incision to move up or down one rib level to remove the outer aspects of ribs #10, 11 and 12.

While this does not place the incision in the most inconspicuous location, it does allow the procedure to be fully completed. How well the back scars do then is an important esthetic tradeoff for women considering this type of waistline narrowing surgery. Because of the incision is fairly small in length (4.5 mms) and it acts a mobile window there is considerable stretching on the incision to perform all aspects of the procedure.

At several months after the surgery one expect the scars to begin to fade. Because the incision is placed obliquely along a natural skin crease that is marked before surgery with the patient turning from side to side, scar outcomes are fairly favorable. The mistake is to make the scar line perfectly horizontal. Its location should parallel the same path that the underlying ribs take.

The real test of how well any surgical scar does from an aesthetic procedure is how often do patients request  scar revisions for them. In my experience in rib removal surgery to date….zero.

Dr. Barry Eppley

Indianapolis, Indiana

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