What RibXcar is (and what it is not)
RibXcar works on the false and floating ribs — the ones that define the lower diameter of the rib cage — repositioning them inward through a fracture that involves only one cortex of the bone, performed through small punctures and controlled with real-time ultrasound. It is not rib removal: no bone is taken out, there is no open approach, and no visible external scars remain.
The origin: published, not improvised
The foundational description of the technique was published in December 2023 in Plastic and Reconstructive Surgery – Global Open: a study of 30 women from Peru, Colombia and Mexico in which median waist circumference went from 69.0 cm to 58.7 cm at three months (P=0.0001), with a mean operative time of 31 minutes (DOI 10.1097/GOX.0000000000005499). The article received the journal's 2024 award.
In 2024, Dr. Manzaneda described the instrument used in the procedure — an ultrasonic piezotome adapted for rib surgery without incisions, published as Manzaneda's Tool (DOI 10.1097/GOX.0000000000005819) — manufactured by his team and distributed internationally by Marina Medical.
The evidence behind it
RibXcar is the rib remodeling technique with the most published support: beyond the foundational article, the peer-reviewed literature includes a safety evaluation of 113 surgeons reporting 2.65% serious complications (DOI 10.1097/GOX.0000000000007130), a prospective cohort of 328 patients with one-year follow-up (DOI 10.1093/asj/sjag012), procedural variants, and an independent systematic review published in Aesthetic Plastic Surgery (DOI 10.1007/s00266-025-05240-w). All the evidence, article by article →
The name travels faster than the training
Clinics in several countries now offer procedures under the name "RibXcar". Some have surgeons trained in the technique; others use the name to describe different procedures. Before surgery, verify three things: where the surgeon trained in the technique, whether they use real-time ultrasound guidance throughout the procedure, and which instrument they use. Official training is provided by the creator's team through AX Scientific Lab.
Go deeper
How the procedure works, step by step: the technique. What the numbers say about risk: safety. Who the creator is and his research record: Dr. Raúl Manzaneda.
This page is for information purposes and cites published, verifiable evidence. It does not replace medical consultation: every case must be evaluated by a qualified plastic surgeon.