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 and waist by ultrasound before, immediately after, at one month and at three months. It is the most cited article in the niche and won the PRS Global Open 2024 award.
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
Independent validation
Rib Remodeling Without Rib Resection: Systematic review and meta-analysis (2026)
An independent meta-analysis (with groups from Mayo Clinic, Brazil and Spain) examined the efficacy and safety of rib remodeling without resection from PubMed, Cochrane and Embase. That the technique is the subject of an independent systematic review confirms its scientific relevance.
Aesthetic Plastic Surgery 50(2):667-674 · DOI: 10.1007/s00266-025-05240-w
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.