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May 22, 2026

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Comparing Two Different Approaches to Rib Contouring

A New Era in Rib Contouring Surgery

Rib contouring procedures performed to achieve a slimmer waistline and an hourglass body shape have become one of the fastest-evolving fields in aesthetic surgery over the past few years. Due to the high complication risks associated with traditional “rib removal” procedures — including pneumothorax, loss of organ protection, and nerve damage — alternative techniques have been developed.

Today, among the rib contouring methods practiced worldwide, the two most notable techniques are RIBOSS and the Ribella procedure.

In this article, we comprehensively examine the differences, advantages and disadvantages, patient selection criteria, and outcomes between:

RIBOSS, a method in which the ribs are surgically cut and stabilized with titanium plates and screws (the pioneer and predecessor of this technology), and
Ribella, a scarless, sutureless technique performed without incisions (the most advanced and up-to-date version of rib contouring surgery).

What Is RIBOSS?

(Rib Osteotomy with Osteosynthesis Stabilization)

RIBOSS, short for Rib Osteotomy with Osteosynthesis Stabilization, is considered the pioneering modern rib contouring technique.

Developed in 2022–2023 in Bucaramanga, Colombia by Dr. Aguilar Villa and his team, the method entered the scientific literature through a clinical study published in the prestigious journal Plastic and Reconstructive Surgery in 2025.

RIBOSS represents the foundational technology that later inspired the development of the Ribella procedure.

How Does the RIBOSS Technique Work?

The core principle of the RIBOSS technique is the adaptation of orthopedic osteosynthesis principles — traditionally used for fracture fixation — for aesthetic purposes.

The procedure is performed in the following steps:

Surgical incision: An incision is made through the back to access the ribs
Osteotomy: Controlled cuts are made, usually on the 11th and 12th floating ribs, using piezotomes or specialized osteotomy instruments
Repositioning: The rib tips are bent inward to narrow the waistline
Fixation with plates and screws: The new rib position is permanently stabilized using titanium plates and self-tapping screws
Closure: The incision is closed with sutures

This technique is essentially an aesthetic adaptation of orthopedic bone-healing principles used for decades.

Which Ribs Are Targeted in RIBOSS?

Primary target: 11th and 12th floating ribs
Alternative approach: In approximately 22% of cases, the 10th and 11th ribs are preferred due to anatomical shortness of the 12th rib
The intervention is performed exclusively from the posterior (back) side
Because these ribs are located at the lower border of the rib cage, the impact on respiratory function is minimal

Clinical Outcomes of RIBOSS

In a 27-patient study conducted by Aguilar Villa and colleagues, remarkable outcomes were reported:

Average waist reduction of 12.1 cm at 1 month and 13 cm at 3 months
Hip circumference reduction of 6.2–8.7 cm when combined with additional procedures
Very high patient satisfaction rates
Only 1 case of wound dehiscence and 1 case of mild pain reported
Average pain score decreased from 2.4 during the first week to 0.26 by the first month

Corset Independence in RIBOSS

One of the greatest disadvantages of classical osteotomy techniques is the requirement for continuous corset use for approximately 3 months.

A key advantage of RIBOSS is that titanium plates and screws already provide anatomical stabilization, significantly reducing the need for prolonged corset dependency.

However, an important limitation should be emphasized:

Because RIBOSS involves surgical scars on the back and permanent titanium implants within the body, some sports federations may consider these implants problematic under athletic eligibility or implant regulations. This may potentially create risks for professional athletes.

For this reason, the scarless and implant-free Ribella procedure is often considered a more suitable option for athletes and professionals in competitive sports.

What Is the Ribella Procedure?

The Most Advanced Version of Rib Contouring

Ribella is a rib contouring technique patented and developed in Türkiye in 2024 by Hasan Ersöz.

Unlike RIBOSS, Ribella follows an entirely different philosophy:

Performed without incisions, without sutures, without visible scars, and without implants, Ribella represents the most advanced and comprehensive evolution of rib contouring surgery to date.

While RIBOSS is generally limited to the 11th and 12th ribs, Ribella can extend up to the 7th rib, allowing contouring across a much wider rib range and producing a more dramatic waist curvature.

Additionally, because Ribella can be performed from both the anterior (front) and posterior (back) sides, rib flare deformities in the front can be corrected simultaneously with waist narrowing.

This three-dimensional approach creates a significantly narrower and more curved waist appearance from side view, achieving waist reduction results that are substantially greater than those possible with RIBOSS.

How Does the Ribella Technique Work?

Ribella is performed using a minimally invasive approach:

Tiny needle entry points: Instead of surgical incisions, only millimeter-sized needle entry sites are used
Extended rib reshaping: Controlled micro-fractures are created from the 7th to the 12th ribs to reposition them inward
Anterior + posterior intervention: Both front and back areas are treated simultaneously to correct rib flare deformities and create a 3D waist contour
Cryotherapy (nerve block): Specialized techniques temporarily block regional nerves for approximately 3 months, reducing pain sensation almost to zero
Corset support: A Ribella corset is used to maintain rib positioning during bone healing
3D simulation: Advanced visualization technologies allow patients to preview expected outcomes before surgery

Key Advantages of Ribella

No visible scars because no incisions or sutures are required
No foreign materials such as implants, plates, or screws are placed in the body
Greater waist reduction potential due to intervention extending up to the 7th rib
Simultaneous correction of rib flare deformities through anterior and posterior access
Highly effective pain management thanks to cryotherapy
Usually performed as same-day discharge or with only 1–2 nights of hospitalization
Patients typically return to daily life within approximately 1 week
Full recovery generally takes around 8 weeks
Ideal for athletes because there are no implants or visible signs of surgery

Limitations of Ribella

Strict corset use for approximately 3 months is mandatory
The outcome depends heavily on patient compliance with external stabilization (corset use)
Poor corset compliance may lead to asymmetry or insufficient narrowing
Some studies reported residual asymmetry rates of approximately 2.5% due to corset noncompliance

Which Procedure Is Better for Which Patient?

Ideal Candidates for RIBOSS

Patients who believe they may struggle with long-term corset compliance
Individuals seeking mechanically stabilized results
Revision cases with previous rib osteotomy healing problems
Patients unconcerned about surgical scars or implants

Ideal Candidates for Ribella

Athletes and professional competitors
Patients who absolutely do not want visible scars
Individuals concerned about postoperative pain
Patients with rib flare deformities
Those seeking extended contouring up to the 7th rib
Individuals aiming for maximum waist narrowing and a 3D contour
Patients capable of maintaining strict corset discipline
Those wanting faster return to social life
Patients preferring minimally invasive techniques

Safety Profile

It is important to note that both techniques are still considered relatively new and under ongoing investigation in international medical literature.

According to comprehensive meta-analysis studies published in 2025, the overall complication profile of rib contouring procedures was reported as follows:

Pneumothorax: 1.9%
Skin burns: 6.7%
Residual contour asymmetry: 2.3%
Severe postoperative pain: 9.2%

Although these rates are significantly lower than those associated with traditional rib removal surgery, more long-term clinical data are still needed.

Frequently Asked Questions (FAQ)

Do the screws used in RIBOSS remain permanently in the body?

Yes. The titanium plates and screws used in RIBOSS are generally permanent. Titanium is highly biocompatible and MRI-compatible. Removal is only necessary in rare complication cases.

Why is Ribella more suitable for athletes?

Because Ribella involves no implants, screws, plates, or visible surgical scars. Only tiny needle entry points are used, making the procedure virtually undetectable during physical examinations or athletic evaluations.

What happens if the corset is not worn after Ribella?

Insufficient corset use may prevent proper bone healing in the new position, increasing the risk of asymmetry or inadequate waist narrowing.

Which method provides greater waist reduction?

Ribella generally achieves significantly greater waist narrowing because:

It can extend up to the 7th rib, whereas RIBOSS is limited mainly to the 11th and 12th ribs
It addresses both anterior and posterior rib structures, including rib flare deformities

Which method offers more permanent results?

Both techniques are designed to provide permanent outcomes. RIBOSS achieves permanence through mechanical fixation, while Ribella relies on bone healing in the new anatomical position.

Conclusion: The Evolution of Rib Contouring Surgery

RIBOSS and Ribella represent two different evolutionary stages in rib contouring surgery.

RIBOSS established the foundation of modern rib contouring through its engineering-based mechanical stabilization approach.

Ribella, however, advanced this concept further with:

scarless minimally invasive techniques,
expanded intervention up to the 7th rib,
anterior and posterior contouring capability, and
implant-free methodology.

As a result, Ribella is increasingly regarded as the most advanced current version of rib contouring surgery.

Ultimately, the right procedure depends on:

your anatomy,
aesthetic expectations,
lifestyle,
ability to comply with corset use, and
sensitivity regarding scars and implants.

Therefore:

Consult with an experienced thoracic or plastic surgeon
Carefully evaluate the clinical evidence and long-term outcomes of both procedures
Maintain realistic expectations
Use 3D simulation technologies whenever available to visualize potential outcomes

In aesthetic surgery, the best choice is not necessarily the most popular procedure — but the one most appropriate for your anatomy and personal goals.

RIBOSS and Ribella: