The foundational studies
Waist Remodeling without Incision (2023)
The foundational RibXcar study. Applied the technique in 30 women (Peru, Colombia, Mexico), measuring the costal angle by ultrasound and the waist with a tape measure before, immediately after, at one month and at three months. It is the most cited article in the niche and was published in PRS Global Open (2023).
PRS Global Open 11(12):e5499 · DOI: 10.1097/GOX.0000000000005499
Manzaneda's Tool (2024)
Describes the instrument bearing his name: a piezotome adapted in three steps (tip redesign, coating and sterilization) specific to incisionless rib remodeling. It is the basis of the proprietary instrument, distributed by Marina Medical.
PRS Global Open 12(5):e5819 · DOI: 10.1097/GOX.0000000000005819
RibXcar safety evaluation (2025)
Complications analysis across a survey of 113 surgeons using the technique: 2.65% reported serious complications (pneumothorax/hemothorax), via multivariable logistic regression.
PRS Global Open 13(9):e7130 · DOI: 10.1097/GOX.0000000000007130
Bicorticality in post-RibXcar cohort (2026)
Prospective cohort of 328 patients (one surgeon, one-year follow-up). Bicorticality in 15 (4.6%), mostly within the first 20 days; correlated with higher visceral fat and longer operative time.
Aesthetic Surgery Journal 46(7):737-744 · DOI: 10.1093/asj/sjag012
RibXcar for posterolateral thoracic deformities (2026)
Prospective cohort study extending RibXcar to a reconstructive use (thoracic deformities), beyond aesthetic contouring, with one-year follow-up.
Aesthetic Surgery Journal · DOI: 10.1093/asj/sjag107
The 3,805-case multicenter study
The largest published cohort on the technique: 3,805 patients from 8 countries, with one-year follow-up. Mean waist reduction of 11 cm and 5 major complications (4 pneumothorax, 1 hemothorax).
PRS Global Open 2026 · DOI: 10.1097/GOX.0000000000007929 · See in detail
International systematic review
Rib Remodeling Without Rib Resection: Systematic review and meta-analysis (2026)
A multicenter meta-analysis (with groups from Mayo Clinic, Brazil and Spain, and Dr. Manzaneda among the twelve authors) examined the efficacy and safety of rib remodeling without resection from PubMed, Cochrane and Embase. That the technique is the subject of an systematic review with groups from Mayo Clinic and universities in Brazil and Spain confirms its scientific relevance.
Aesthetic Plastic Surgery 50(2):667-674 · DOI: 10.1007/s00266-025-05240-w
The published safety debate
The technique's safety was argued through cross-letters in indexed journals. Dr. Manzaneda replied twice, under his own name and in the same pages where he was challenged. A procedure drawing this exchange is not a warning sign: it is how the literature argues.
Reply on the safety survey (2026)
Clarifies that the 2.65% refers to potentially life-threatening complications among surveyed surgeons, not a per-patient rate. And it acknowledges a typographical transposition between a table and the main text, supporting its formal correction.
PRS Global Open 2026 · DOI: 10.1097/GOX.0000000000007799 · See in detail
Reply on safety in rib surgery (2026)
A second reply, signed by Dr. Manzaneda and seven co-authors, prompted by the field's systematic review and meta-analysis.
PRS Global Open 2026 · DOI: 10.1097/GOX.0000000000007815 · See in detail
More publications on the technique
| Title | Journal · Year | DOI |
|---|---|---|
| Is "Clack" Enough? Rib Remodeling Guided by Ultrasound | PRS Glob Open · 2024 | 10.1097/GOX.0000000000005843 |
| Waist Reduction through Conversion from False to Floating Ribs | PRS Glob Open · 2024 | 10.1097/GOX.0000000000005900 |
| Waist Reduction Surgery by Rib Incurvation | PRS Glob Open · 2026 | 10.1097/GOX.0000000000007754 |
| RibXcar with Dots Point Technique: Fracture as a Safety Principle | PRS Glob Open · 2026 | 10.1097/GOX.0000000000007816 |
| Respiratory Function Assessment After Waist Reduction (RibXcar) | ASJ Open Forum · 2026 | 10.1093/asjof/ojag007 |
The full list of ~37 publications is available in the internal dossier. This page cites only published, verifiable evidence.
Complementary work on the waist
These are not rib remodeling studies. They are publications by the same author on neighbouring structures — the hip, the lower back — and on the ultrasound guidance the technique relies on. They are included because they address the same anatomical region from another angle.
XCREST: iliac crest reduction (2025)
The waist is not defined by the ribs alone, but also by the upper border of the hip bone. In 200 patients the waist went from 83.11 cm to 72.06 cm at six months, and the distance between the last palpable rib and the iliac crest increased by 3.8 cm.
Aesthetic Surgery Journal 2025 · DOI: 10.1093/asj/sjaf044 · See in detail
XPINE-FAT: echo-guided lower-back sculpture (2022)
Fat grafting inside the erector spinae muscle under ultrasound guidance, as a complement to lipodefinition. In 15 patients muscle thickness increased 65.3% and 66.4%. No adverse events during the study.
PRS Global Open 2022 · DOI: 10.1097/GOX.0000000000004424 · See in detail
Ultrasound for preoperative marking (2023)
Across 100 patients and 5 surgeons, palpation-based marking agreed with ultrasound only 49% of the time on the midline and between 11% and 26% for every other structure. It is the equivalent, for touch, of what the «clack» study showed for hearing.
PRS Global Open 2023 · DOI: 10.1097/GOX.0000000000005431 · See in detail