01
RibXcar
Rib remodeling
Rib remodeling with no incisions. Monocortical fracture of ribs 10 to 12 guided by piezoelectric ultrasound.
3,805 patients
11 cm mean reduction
DOISee plate →
Authorship
Described
and published
Authorship
Raúl Martín Manzaneda Cipriani · Lima, Peru
02 · The technique
Plastic and reconstructive surgeon. Creator of incisionless, ultrasound-guided rib remodeling (RibXcar) and of the instrument used to perform it. Six further body-contouring and fat-grafting techniques carry his name.
03 · Published work
He described incisionless rib remodeling in PRS Global Open (2023) and published the instrument it is performed with the following year.
Meet the doctor
46
published works
34
indexed in PubMed
3,805
patients in the largest series
8
countries
The techniques
Nine, each with its own data.
02
High RibXcar
Ribs 8 and 9
High variant of rib remodeling, on the false ribs 8 and 9, above those RibXcar works on.
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03
FrontXrib
Anterior winged ribs
Percutaneous chondroplasty of ribs 1 to 7. Corrects anterior costal protrusion with no incisions.
32 patients
51.1 min operating time
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04
XPineFat
Lower-back sculpture
Fat grafting over the erector spinae, focused on the longissimus, to sculpt the lower back.
15 patients
66.4% more thickness
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05
FatTrap
Trapezius
Volumisation of the trapezius with fat grafting, for the masculine V silhouette.
40 patients
101.67% increase
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06
VDVFat
Thigh definition
Intramuscular fat grafting in the thigh, over the vastus lateralis and vastus medialis.
52 patients
88% more thickness
DOISee plate →
07
HVFat
Posterior thigh · hamstrings
Volumisation of the hamstring muscles of the posterior thigh, with high-retention grafting.
19 patients
95.29% retention
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08
XCrest
Iliac crest reduction
Treats the high iliac crest, which is what prevents a narrow waist when bone — not fat — defines the contour.
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09
MassFat
Jawline definition
Augmentation of the masseter with ultrasound-guided fat grafting, to define the line of the jaw.
DOISee plate →07 · The film
What the work
looks like.
01
Incisionless
The waist is narrowed by repositioning the false and floating ribs through a puncture, removing no bone and leaving no scar.
02
Ultrasound-guided
The fracture sound is heard in 90% of cases. Ultrasound confirms it in 100%.
03
Its own instrument
A straight piezotome needle, published in 2024 and distributed by Marina Medical, which credits Dr. Manzaneda as its creator.
04
Published evidence
Forty-six papers, thirty-four indexed in PubMed, and a multicentre series of 3,805 patients across eight countries.
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 →03 · 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
- 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
- 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
- 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
- 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
- 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
46 published works · 34 indexed in PubMed · generated from the bibliography
04 · The instrument
The material proof
of authorship.
He developed a straight piezotome needle that allows the ribs to be operated through a puncture, with no incisions. It is published in PRS Global Open (2024), built by his team and distributed by Marina Medical, which explicitly credits him as its creator.
The instrument is published in PRS Global Open (2024), manufactured by his team and distributed by Marina Medical Instruments, explicitly crediting him as its creator. That chain of authorship, instrument, manufacture and distribution is what no narrative can substitute.
The adaptation of the piezotome and the decision to bend the rib instead of fracturing it are documented step by step.
See the instrument →05 · The process
How it goes, step by step.
Each patient's anatomy is assessed and it is decided whether the technique applies. No reduction figure can be estimated before this step.
Pre-operative tests are indicated in consultation, case by case.
Marking is done with ultrasound on the skin, before surgery. A dedicated paper came out of that work: ultrasound improves preoperative marking in body contouring surgery.
Surgery is performed through a puncture, with the adapted instrument, and each fracture is confirmed with ultrasound rather than by sound.
Follow-up and compression garments are indicated in consultation.
The published series followed all 3,805 patients for one year.
06 · The academy
More than four hundred
surgeons trained.
The technique is taught through AX Scientific Lab. The figure and the countries are the ones Dr. Manzaneda himself presented at AESURG 2026, the IAAPS annual conference, in Mumbai.
400+
surgeons trained
22
countries
Perú · México · Colombia · Brasil · Chile · Argentina · Ecuador · Bolivia · Guatemala · Panamá · República Dominicana · Estados Unidos · Portugal · Francia · Polonia · Marruecos · India · China · Japón · Taiwán · Malasia · Tailandia
07 · Recognition
What third
parties say.
His study Waist Remodeling without Incision, with Ultrasound-guided Monocortical Fracture (PRS Global Open, December 2023) was awarded Best Cosmetic Paper 2024 by the journal.
In March 2021 he received the Marca Perú distinction, and was the first plastic surgeon to obtain it.
See the distinction at the journal →08 · Independent adoption
Other teams
perform it and publish it.
The hardest signal to manufacture is that other surgeons, with no link to his team, use the technique and publish their results. It happens:
- A Chilean team published a series of 220 patients operated with the technique, with waist reductions between 6 and 11 cm at six months. PubMed
09 · 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.
The published debate →10 · Published
Covers
and publications.
Dubai AllureEmiratos Árabes · 2026
Marie ClaireRib Remodeling Can Offer a Smaller Waistline
Marie ClaireEstados Unidos · 2025
The CutI Fractured My Ribs to «Remodel» Them
The CutEstados Unidos · 2025
The Zoe ReportRib Remodeling Is On The Rise
The Zoe ReportEstados Unidos · 2025
COSASUn doctor en HD
COSASPerú · 2021
El CapitalinoRedefinir la cintura desde la estructura ósea
El CapitalinoMéxico · 2026
PublimetroInvestigación e innovación en cirugía plástica
PublimetroMéxico · 2026
El Dominical«Revolucionó la cirugía»
El DominicalPerú · 2023
Consultation
Indication is decided
by examining.
No web page can say whether a procedure applies in a specific case. That decision belongs to a board-certified plastic surgeon, after assessing the patient.
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