The most aggressive procedure for horizontal waistline reduction is rib removal surgery. Once thought of as a fictional procedure or one that is too ‘dangerous’ to undergo, it is actually a safe and effective body contouring procedure. It may seem an extreme effort to remove portions of ribs for aesthetic waistline reduction but that only seems so because of its unfamiliarity and lack of understanding of how it is actually performed.
One consideration in any body contouring procedures is the scar tradeoff. This is just as valid in rib removal surgery as that of a tummy tuck or breast lift. The common perception of scars from rib removal would not normally be very favorable as their perception comes from thoracic surgery where segments of rib are also removed for access to the lung. But such scars would never be acceptable for an aesthetic procedure.
Rib removal surgery is performed through small 5 cm oblique back incisions placed laterally just at the edge of the latissimus dorsi muscle. Through this incision the outer half of ribs #10, 11 and 12 can be removed. This leaves a small scar line which in many women is barely perceptible.
While scars are always a concern in any aesthetic procedure, the scars from rib removal surgery are very acceptable. Their minimal appearance is helped by being placed in a natural skin line that is identified with the patient twists their torso. This creates a discernible oblique skin fold or line into which the incision should be placed. This corresponds to the principle of related skin tensions lines (RSTL) which are known to be most favorable for scar outcomes from incisions placed into or parallel to them.
Dr. Barry Eppley