Daniela Cesin was 14 when she began thinking about her looks. “I was a little bit chubby and I started to work out at home and lose weight. I saw the difference in my body: my abs, the muscles in my arms, and I started liking it,” she says. By 31, she had the slim, toned body she had hoped for, but something was still missing. “I wanted to have that guitar hourglass shape.”
In August, Cesin travelled from Miami, where she has lived for the past 15 years, to her native Venezuela for liposuction and a fat transfer to her hips. She met her cosmetic surgeon for the first time the day before the procedure, and he realised she didn’t have enough fat to go ahead with it. Instead, he offered to perform RibXcar: a rib remodelling surgery that would involve fracturing three of her lower ribs on each side and binding them in a corset for three months, to set the ribs in a new position and give her a wasplike waist.
“I was like: ‘No, no, no, I don’t want to do anything with the ribs,’” she says. The idea of breaking the bones around her vital organs sounded a lot more invasive than a breast augmentation, which she had 10 years ago, or a rhinoplasty (nose surgery) and blepharoplasty (eyelid surgery), which she had two years ago. Also, she had never heard of the procedure.
But after the consultation, she decided to trust her surgeon. Cesin had already paid for flights and taken three weeks off from her job as a sales director. The next day she was anaesthetised, and her surgeon used an ultrasound to locate the ribs, made six small incisions in her back, and inserted a vibrating tool to create greenstick fractures – an incomplete bone break – on each rib. When she came to she was wearing a black corset with small knobs on each side that she could tighten to her preferred measurements.
The recovery has been uncomfortable. It was initially hard to stand or lie down without help, and there was soreness from the incisions. The first week, Cesin barely slept. “Your body doesn’t get used to any position, so every hour I would wake up.” But the worst part has been eating while wearing her corset, which must remain on for 23 hours a day; this causes acid reflux. Despite her discomfort, when we speak six weeks after her surgery, she is pleased with the eight centimetres she has shaved off her waist.
Cesin is one of a small but growing number of women choosing to fracture their ribs for an hourglass shape. To achieve this look, women previously underwent riskier rib removal techniques, which reduce the protective bone barrier for the liver and spleen. Kazbek Kudzaev, a plastic surgeon in Russia, realised in 2017 that he could achieve similar aesthetic results when he moved the ribs with a drill until one side fractured, then bound the body in a corset while they healed. Since his discovery, surgeons in countries including Colombia, Korea and France have refined the technique. Today, it takes about an hour and is performed under general anaesthesia as a day-surgery treatment.
It is touted as a noninvasive procedure, but many of the women I interviewed described feeling as if they had been “hit by a bus” after surgery. And there are serious risks. These include standard surgical complications, such as allergic reactions to the anaesthesia, blood clots, wound infections and seromas (pockets of fluid that build up under the skin). But also more specific dangers, including a collapsed lung, known as a pneumothorax; and a haemothorax, where blood collects in the space between the chest wall and the lungs. Both of these are potentially fatal.
Sandip Hindocha, a consultant plastic surgeon at the Private Clinic on Harley Street in London, is sceptical about the procedure. “If a patient came to my clinic and said this is what I want to do, I’d be asking the question: ‘Why do you want to do that? And why do you want to make such a permanent change to your body?’”
He references a paper published in Plastic and Reconstructive Surgery, which states that between 2018 and 2024, out of 2,351 patients who had rib remodelling, there was an overall complication rate of 3.7%. “That’s not a small number,” he says. “If we did a breast augmentation, you wouldn’t expect a complication rate like that.”
The British Association of Aesthetic Plastic Surgeons (BAAPS), doesn’t endorse the procedure. Former president Nora Nugent points out that it is relatively new, “with limited data available on long-term results and it requires advanced body contouring skills as well as the ability to treat any potential complications. It may be something that UK/BAAPS plastic surgeons bring into their practices in due course but it is not available at the moment.”
The procedure isn’t typically offered to cisgender women over the age of 40, because of the increased chance of them having osteoporosis, which can cause the bones to fully break rather than fracture. Another complication for patients is that gaining weight can cause your body to change shape again, so pregnancy can affect the results. The procedure “needs to be done with a surgeon who has a lot of experience in it,” says Hindocha. “Maybe a surgeon that also does chest wall reconstruction.”
In the UK, plastic surgeons are advised to give patients a cooling-off period of at least two weeks to weigh up the risks and potential consequences of having any procedure. But Hindocha worries that patients are sometimes opting for rib remodelling with less time for reflection, despite the permanence of the change. “If you put an implant in and later you don’t want it, you can, worst case scenario, remove it,” Hindocha says. Whereas the ribs are “a structural, rigid part of you that you cannot reverse.”
Throughout history, waistlines have expanded and shrunk. Between the 16th and 19th centuries, corset wearing and tight-lacing became a symbol of beauty for the “leisure class” (the restrictive garments made physical labour impossible). The engineered hourglass shape fell out of fashion in the 1920s, but made a comeback with Marilyn Monroe, before slender, androgynous frames gained popularity from the 60s to the 90s. In the 2010s, the extreme curves of the Kardashians became the defining silhouette.
In recent years, tinier, waif-like frames have become popular on TikTok and Instagram, but a highly defined waist is also considered desirable. This is thanks, among other things, to the multibillion-dollar shapewear industry; global access to Instagram and filters; and easily streamed online workout videos that focus on creating a slim, hourglass silhouette through targeted training. But now there are adverts on social media for permanent surgical options too.
In July, 10 Australian influencers, who have made names for themselves globally on shows including Married at First Sight and Below Deck, prompted headlines with a trip to Bali. They were there for a brand collaboration with a rib recontouring practice called Snatched Waist. The clinic they visited looked more like a spa than a surgeon’s office and, post-surgery, the influencers were soon lounging by the pool, showing off their narrow waists on Instagram.
Not everyone is sunbathing in a bikini after the procedure. When Sophia woke up from her rib remodelling procedure in November 2025, she expected to be transferred to her Beverly Hills hotel room, a little sore but ready for recovery. Instead, she was surrounded by emergency medical technicians, who were putting her on to a stretcher to take her to hospital by ambulance. The next thing she remembers is lying in a hospital bed, hooked up to an electrocardiogram and an intravenous drip.
A CT scan showed Sophia had suffered a pneumothorax: 25% of one of her lungs had collapsed. She was put on oxygen and monitored for six hours before being released. Although she had signed all the consent forms for the procedure, “it was completely shocking to me,” she says.
For at least a month, Sophia had a deep pain in her lung and some shortness of breath. She had to return to the hospital after some fluid build up, but eventually started feeling better. The pain from the surgery itself subsided after about three weeks: coughing and sneezing was no longer agonising. And she was able to return to her office job and hike in her corset at the weekends.
Sophia is transgender and chose the procedure to feminise her body, by narrowing her torso, which she felt was too wide. She began consultations for the procedure in August last year, with the surgeon planning to fracture ribs 10, 11 and 12. But by the time of her surgery in November, the surgeon felt confident he could achieve better results by going even further up the ribcage, ultimately operating on five ribs on each side. Sophia knew this would increase her risk of a pneumothorax, but was willing to take the chance.
“I didn’t start transitioning until I was 47 and I feel as if I’m playing catch up, because I’m so old, and testosterone was running rampant all those decades,” she says. “That’s why gender-affirming procedures are really important to me.” The final results weren’t what she had hoped for though. “It was a bit underwhelming.”
In September this year, she went for a second round of rib remodelling with Leif Rogers, a different surgeon in Pasadena and Beverly Hills, California. Rogers removed cartilage from the anterior side of her ribcage on ribs three to 10. On rib four, he cut sections out and secured them with titanium plates and screws. Sophia had a breast augmentation at the same time, as the inframammary incisions were already open. When she emails to update me a week and a half after her second surgery, although there has been no collapsed lung this time, she says: “Recovery has been significantly more painful, and I am experiencing more shortness of breath.”
Despite the risks, Rogers expects skeletal remodelling to take off: that includes rib remodelling, clavicle shortening and pelvic widening. “Versions of it have existed for quite some time,” he says. “Limb lengthening and shortening has been around for a long time. Of course, we change the bony skeleton of the face all the time, but other than that we haven’t changed the torso very much. The changing of the skeleton of the body is a little bit newer, as for a long time people used to just put their hands up and say: ‘Too bad, this is the way you’re built.’”
So why now? “The techniques have got way better. And there’s marketing for it out there.” In the US, he says, medical insurance often covers the procedure for transgender patients, “because they consider it a medical condition to have gender dysphoria. And I think on top of that, it’s just social media. Social media makes everything explode.”
Rogers says the Kardashians have been highly influential. “I think Kim was part of why we wanted a big butt, and then she lost a lot of weight, so everyone wants to be like Kim, right?” In 2022, Kim Kardashian attended the Met Gala after losing a considerable amount of weight, in a sparkling dress once worn by Monroe. Her slender figure coincided with a growing movement towards thinness, a rejection of the body positivity movement of the 2010s, and the advent of the Ozempic era, when the diabetes drug became popular as a weight-loss treatment. A controversial 2022 New York Post article was headlined: “Bye-bye booty: Heroin chic is back”. On TikTok, people had begun measuring their waists using A4 sheets of paper, phones and Apple headphone wires, showing off their Barbie-like proportions.
“We have always done very demanding things for beauty,” says Heather Widdows, a philosophy professor and author of the 2018 book Perfect Me, who mentions foot binding and extreme corsetry. “But they were always about adornment. I think what’s different with the global ideal now is that increasingly things are becoming normalised and naturalised. We’re seeing things that are purely about adornment being recategorised as health and hygiene, and then they become invisible, and if you don’t do them you start to look abnormal,” she says. “It becomes about standard presentation.”
As we move from a text-based culture to a visual culture, increasingly, “who we are is how we look,” she says, “and that is a form of identity that is a massive and dramatic change, but one that’s snuck up on us, that we don’t talk about enough. So the visual is becoming the dominant way of presenting ourselves, being ourselves and thinking about ourselves.”
Elizabeth Rivera trained in high level gyms alongside American football players, baseball players and Ms Bikini Olympia, to try to reach her beauty ideal. This was the X-frame specific to bodybuilders: broad shoulders, prominent glutes and a small waist. For her, she says: “That looks like health. That’s a visible indication of discipline.” Rivera was “busting ass”, trying to reach this aesthetic ideal, but “it was not working for me. And I was making myself very sick from overtraining.”
Rivera is a 35-year-old licensed masseuse and she has lipedema, a chronic condition that causes abnormal fat deposits, which can be painful and are resistant to diet or exercise. “Once I accepted that my inability to lose fat wasn’t my fault, I said: ‘OK, I can accept that.’ But I still would like to have a smaller abdomen. I still would like to have more of an hourglass. So surgery was the next option.” A friend had recently had her ribs remodelled, and Rivera was impressed with the results.
She stands up halfway through our Zoom call to show off her waist. It’s objectively tiny, and the effect is exaggerated by her breast implants and petite Brazilian butt lift (BBL). “I can go most places in Chicago [where she lives], and there’s no one shaped like me. And I’m not saying that in a bad way. I’m saying that because it looks more extreme with the ribs, it’s noticeable.”
In Miami where Cesin lives, she says she doesn’t feel her shape puts her in the minority. There, cosmetic surgery is widely accepted and expected. “The girls in Miami, all of them look the same, because it’s a lot of fillers, a lot of buttocks, a lot of surgery and BBLs,” she says, adding that it’s easy, as a result, to get carried away. But she doesn’t want to end up like that. “People say rib remodelling was a little bit extra, that I didn’t need to do anything, but it makes me happy, so that’s why I did it. But I’m done. No more surgeries.”
