The RibXcar technique reshapes the lower ribs through a monocortical, ultrasound-guided fracture, without incisions. In the foundational study (30 women), waist circumference went from a median of 69.0 cm to 58.7 cm at 3 months (~10 cm; P = 0.0001), with 100% satisfaction. It was created by Dr. Raul Manzaneda Cipriani and published in PRS Global Open in 2023.
What was measured, and by how much
The study measured the costal angle and waist circumference by ultrasound at four time points: before, immediately after, at one month and at three months.
| Variable (median) | Pre | Immediate | 1 month | 3 months |
|---|---|---|---|---|
| Waist circumference (cm) | 69.0 | 60.0 | 59.0 | 58.7 |
| Costal angle 10th (°) | 168.0 | 158.0 | 160.0 | 160.4 |
| Costal angle 11th (°) | 170.5 | 160.5 | 152.5 | 163.5 |
| Costal angle 12th (°) | 172.0 | 162.0 | 154.0 | 165.0 |
- Satisfaction: 100% at 3 months (n = 30); 95% did not notice the puncture site.
- Operating time: mean of 31 minutes (range 21–40).
- Complications: no pneumothorax, hemothorax, infection or respiratory complication; two skin burns < 0.5 cm, treated.
All figures are the median reported in e5499 (case series of 30 patients) and are shown for informational purposes. Results are individual; they are not a promise of outcome.
A study that opened a line of research
e5499 is the origin of a series of peer-reviewed publications documenting the instrument, safety and follow-up cohorts — each with its verifiable DOI.
The «Manzaneda's Tool» instrument
The adapted piezotome, specific to the incision-free technique.
Safety assessment
Survey of 113 surgeons: 2.65% serious complications.
Bicorticality cohort
One-year follow-up; 4.6% bicorticality, 98% satisfactory healing.
Independent systematic review
External validation (PubMed, Cochrane, Embase).
See the full body of evidence · How the technique works
Frequently asked questions
How much is the waist reduced?
In the study (30 women), the waist went from a median of 69.0 cm to 58.7 cm at 3 months — about 10 cm, measured by ultrasound (P = 0.0001). Results are individual.
Who created the RibXcar technique?
Dr. Raul Manzaneda Cipriani, creator of the branded RibXcar technique and lead author of study e5499 (PRS Global Open, 2023).
Does it leave scars?
It is performed through ultrasound-guided puncture, without an incision. In the study, 95% of patients did not notice the puncture site at 3 months.
Is it safe?
In the foundational study (30 patients) there were no pneumothorax, hemothorax, infection or respiratory complications; there were two burns < 0.5 cm, treated. Safety evidence is expanded in later studies. No procedure is free of risk; each case must be evaluated by a qualified surgeon.
This page is informational and cites published, verifiable evidence. It does not replace medical consultation: every case must be evaluated by a qualified plastic surgeon.