He developed a technique
and the instrument
to perform it.
Raúl Martín Manzaneda Cipriani, plastic surgeon. Incisionless rib remodeling, ultrasound-guided — published in 2023 and sustained ever since by his own body of work.
45
published works
34
indexed in PubMed
3,805
patients in the largest series
8
countries
Plate 01
Raúl Martín Manzaneda Cipriani — Lima, Peru
He described incisionless rib remodeling in PRS Global Open (2023) and published the instrument it is performed with the following year.
02 · The technique
No bone removed.
No scar left.
Rib remodeling narrows the waist by repositioning the false and floating ribs. Unlike procedures that remove ribs, this technique works through a puncture, with an adapted instrument, and confirms each fracture with ultrasound rather than relying on sound.
That decision is measured: in a study of 100 patients the fracture «clack» was heard in 90% of cases, while ultrasound confirmed it in 100%. Relying on hearing left one in ten patients unverified.
The technique, in detail →Published work
Ultrasound-Assisted Pocket Creation in Subglandular Breast Augmentation Aesthetic Surgery Journal Open Forum · 2026 · doi:10.1093/asjof/ojag016
·
Scarless Rib Reshaping: Comparison of Straight and Oblique Approaches in Terms of Efficacy and Recurrence Plastic and Reconstructive Surgery - Global Open · 2026 · doi:10.1097/gox.0000000000007697
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Rib Remodeling (RibXcar) for Posterolateral Thoracic Deformities: A Prospective Cohort Study of Rib Angularity for Reconstructive Purposes Aesthetic Surgery Journal · 2026 · doi:10.1093/asj/sjag107
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Respiratory Function Assessment After Waist Reduction Through Scarless Ultrasound-Guided Monocortical Fracture (RibXcar) Surgery for Body Contouring Aesthetic Surgery Journal Open Forum · 2026 · doi:10.1093/asjof/ojag007
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Analysis of Bicorticality in a Cohort of Post-RibXcar Patients: A Clinical and Imaging Follow-up Study Aesthetic Surgery Journal · 2026 · doi:10.1093/asj/sjag012
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Costal Remodeling and the Effect on Abdominal Force Distribution: Intraoperative Changes in Abdominal Wall Tension, Subfascial Pressure, and Respiratory Mechanics Aesthetic Surgery Journal Open Forum · 2026 · doi:10.1093/asjof/ojag102
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Inverted-T Mastopexy With Glandular Treatment and Breast Augmentation: Outcomes and Stabilization Approach Plastic and Reconstructive Surgery - Global Open · 2026 · doi:10.1097/gox.0000000000007605
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RibXcar with Dots Point Technique: The Science of Fracture as a Safety Principle Plastic and Reconstructive Surgery - Global Open · 2026 · doi:10.1097/gox.0000000000007816
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Reply: Safety Evaluation of the RibXcar Technique Using the Piezotome: An Analysis of Surgical Complications Plastic and Reconstructive Surgery - Global Open · 2026 · doi:10.1097/gox.0000000000007799
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Osteotomía costal controlada en cirugía de contorno corporal: fundamentos de seguridad y estandarización Cirugía Plástica · 2026 · doi:10.35366/122649
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Reply: Safety in Rib Surgery: A Meta-analysis and Systematic Review Plastic and Reconstructive Surgery - Global Open · 2026 · doi:10.1097/gox.0000000000007815
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Waist Reduction Surgery by Rib Incurvation: A New Approach for Waist Narrowing Plastic and Reconstructive Surgery - Global Open · 2026 · doi:10.1097/gox.0000000000007754
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A Multicenter Cohort Study of 3805 RibXcar Cases: Safety and Efficacy in Incisionless Rib Remodeling Plastic and Reconstructive Surgery - Global Open · 2026 · doi:10.1097/gox.0000000000007929
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Safety in Rib Surgery: A Meta-analysis and Systematic Review Plastic and Reconstructive Surgery - Global Open · 2025 · doi:10.1097/gox.0000000000006783
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Safety Evaluation of the RibXcar Technique Using the Piezotome: An Analysis of Surgical Complications Plastic and Reconstructive Surgery - Global Open · 2025 · doi:10.1097/gox.0000000000007130
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The Linear Retrograde Infiltration (LiRi) Technique for Buttock Fat Infiltration: A Cohort Evolution Aesthetic Surgery Journal · 2025 · doi:10.1093/asj/sjae254
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Rib Remodeling Without Rib Resection: A Systematic Review and Meta-analysis Aesthetic Plastic Surgery · 2025 · doi:10.1007/s00266-025-05240-w
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Safety and Effectiveness of Real-time Direct Vision Liposuction Performed Using Intraoperative Ultrasonography Plastic and Reconstructive Surgery - Global Open · 2025 · doi:10.1097/gox.0000000000006848
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Body Contouring in Gender-Affirming Care Clinics in Plastic Surgery · 2025 · doi:10.1016/j.cps.2025.06.010
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Response by Manzaneda to "Waistline Aesthetic Slimming by Puncture and Parallel Approach for Rib Remodeling Procedures" by Hoyos et al Aesthetic Surgery Journal Open Forum · 2025 · doi:10.1093/asjof/ojaf137
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A New Anatomical Approach to Male Pectoral Volumization Plastic and Reconstructive Surgery - Global Open · 2025 · doi:10.1097/gox.0000000000006491
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Treatment of the High Iliac Crest With Iliac Crest Reduction (XCREST) Aesthetic Surgery Journal · 2025 · doi:10.1093/asj/sjaf044
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Muscle Amplification With the Ultrasound-guided Rectus Abdominis Fat Transfer Technique: Assessment of Intramuscular Graft Evolution Plastic and Reconstructive Surgery - Global Open · 2025 · doi:10.1097/gox.0000000000006877
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Andean Body: Plastic Surgery With a Cultural Perspective Aesthetic Surgery Journal Open Forum · 2025 · doi:10.1093/asjof/ojaf025
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Is "Clack" Enough? Rib Remodeling Guided by Ultrasound Plastic and Reconstructive Surgery - Global Open · 2024 · doi:10.1097/gox.0000000000005843
·
Manzaneda's Tool: Adaptation of the Piezotome for Rib Remodeling Surgery without Incisions Plastic and Reconstructive Surgery - Global Open · 2024 · doi:10.1097/gox.0000000000005819
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Waist Reduction through Conversion from False to Floating Ribs Plastic and Reconstructive Surgery - Global Open · 2024 · doi:10.1097/gox.0000000000005900
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Jawline Aesthetic Definition: Enhancement with Masseteric Augmentation Using Ultrasound-Guided Fat Transfer Plastic and Reconstructive Surgery - Global Open · 2024 · doi:10.1097/gox.0000000000005695
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Depression, Anxiety, Body Dissatisfaction, and Eating Disorders in Plastic Surgery Patients Plastic and Reconstructive Surgery - Global Open · 2024 · doi:10.1097/gox.0000000000005555
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Superficial Intramuscular Gluteal Lipograft by Doppler Ultrasound: A Report of 24 Patients Plastic and Reconstructive Surgery - Global Open · 2024 · doi:10.1097/gox.0000000000005743
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Ultrasound-guided Deep Waist Fat Liposuction: Complement to a Narrow Waist Plastic and Reconstructive Surgery - Global Open · 2024 · doi:10.1097/gox.0000000000006213
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Ribs with Anterior Protrusion (Winged Ribs) Treated Using Percutaneous Chondroplasty Plastic and Reconstructive Surgery - Global Open · 2024 · doi:10.1097/gox.0000000000006178
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Ultrasound-Guided Female Equilibrated Minimal Muscularization and Enhancement (U-Femme) Aesthetic Surgery Journal Open Forum · 2024 · doi:10.1093/asjof/ojae103
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Waist Remodeling without Incision, with Ultrasound-guided Monocortical Fracture Plastic and Reconstructive Surgery - Global Open · 2023 · doi:10.1097/gox.0000000000005499
·
Anatomical Bases for Aesthetic Costal Surgery: Assessing the Thoracoabdominal Limits Plastic and Reconstructive Surgery - Global Open · 2023 · doi:10.1097/gox.0000000000005376
·
Ultrasound-guided Fat Graft of the Obliques-Serratus Complex Plastic and Reconstructive Surgery - Global Open · 2023 · doi:10.1097/gox.0000000000005390
·
Intramuscular Posterior Thigh Volumization: An Aesthetic and Harmonious Transition to the Gluteal Region (Hv-FAT) Plastic and Reconstructive Surgery - Global Open · 2023 · doi:10.1097/gox.0000000000004918
·
Deep Back Liposuction: Ultrasound-Guided Deep Fat Liposuction of the Subiliac Crest Aesthetic Surgery Journal · 2023 · doi:10.1093/asj/sjad236
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Ultrasonography as a Tool to Improve Preoperative Marking in Body Contour Surgery Plastic and Reconstructive Surgery - Global Open · 2023 · doi:10.1097/gox.0000000000005431
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Echo-guided Lower-back Sculpture and Volumization as a Complement to High-definition Liposuction (XPINE-FAT) Plastic and Reconstructive Surgery - Global Open · 2022 · doi:10.1097/gox.0000000000004424
·
Aesthetic Preferences of the Anterior Thigh as a Beauty Factor in Women Plastic and Reconstructive Surgery - Global Open · 2022 · doi:10.1097/gox.0000000000004055
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Lipo Definition in Thighs: Volumizing and Defining the Vastus Muscles by Fat Transfer Plastic and Reconstructive Surgery - Global Open · 2021 · doi:10.1097/gox.0000000000003945
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Pérdida permisible de grasa en liposucción: fórmula y aplicación informática para cuantificar un nuevo concepto Cirugía Plástica Ibero-Latinoamericana · 2021 · doi:10.4321/s0376-78922021000100004
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Planteamiento de subunidades estéticas del abdomen en base al análisis antropométrico del tejido celular subcutáneo Cirugía Plástica Ibero-Latinoamericana · 2018 · doi:10.4321/s0376-78922018000100005
·
Lipomarcación de Alta Deinición: Reporte de dos casos Horizonte Médico (Lima) · 2015 · doi:10.24265/horizmed.2015.v15n2.11
45 published works · 34 indexed in PubMed · generated from the bibliography
04 · The instrument
The material proof
of authorship.
Dr. Manzaneda adapted a piezotome so ribs could be operated on through a puncture. The instrument is published in PRS Global Open (2024), manufactured by his team and distributed by Marina Medical Instruments as the «RibXcar Tip», explicitly crediting him as its creator. That chain — authorship, instrument, manufacture, distribution — is what no narrative can substitute.
See the instrument →05 · The academy
Where it is taught.
The technique is transmitted through AX Scientific Lab, where Dr. Manzaneda trains plastic surgeons in the procedure, with its own certification and locations in several countries.
The training programme →06 · Safety
What the evidence
cannot promise.
All surgery carries risk, and the risks of this technique are published. In the series of 3,805 patients, 5 major complications were documented: 4 pneumothoraxes and 1 haemothorax. The main risk is pneumothorax, known in any surgery on the chest wall and not exclusive to this technique.
This page reports on published evidence. It does not replace a medical consultation nor determine whether you are a candidate: that decision belongs to a board-certified plastic surgeon who examines you.
All the safety evidence →