Rib remodelling is an established, evidence-backed surgical technique — documented in the peer-reviewed literature since 2021, including a 2025 meta-analysis of 318 patients — performed internationally by plastic surgeons and, in Australia, exclusively by FRACS specialist plastic surgeons (Fellows of the Royal Australasian College of Surgeons in Plastic and Reconstructive Surgery) with specialist Medical Board registration, at accredited facilities. By the end you should have a realistic sense of whether a consultation is worth pursuing — a decision you make together with your GP and a specialist plastic surgeon. For background on what the operation involves, see our procedure page, and before going further, read about the risks of rib remodelling.
Who is typically considered suitable?
Across the published literature and current surgical consensus, candidates for rib remodelling are generally:
- Adults aged 18 or over. The procedure is not offered to people under 18 in Australia, without exception.
- Within a healthy weight range, ideally a BMI below about 28–30. In the largest pooled analysis of outcomes (318 patients across 4 studies), the mean BMI was 22.4. Significant excess weight changes both the surgical picture and what waist-contour change is realistically visible.
- Weight-stable. Large fluctuations after surgery alter soft-tissue contour and make outcomes unpredictable. Surgeons prefer to see a stable weight before operating, rather than surgery being used as a substitute for weight management.
- Non-smokers, or willing to cease smoking at least 6 weeks before surgery. Smoking impairs bone and soft-tissue healing, and rib remodelling depends on bone healing: the reshaped ribs must consolidate in their new position.
- In good bone health. The technique relies on creating a controlled, partial (greenstick-type) fracture that heals predictably. Poor bone density undermines that. A bone-density check is commonly considered for patients over about 40.
- Holding realistic expectations. The pooled meta-analysis reported a mean waist reduction of 8.59 cm at 3 months (95% CI 6.92–10.27), with zero pneumothorax and zero infections across the 318 patients; across the largest global dataset of 2,351 cases, serious complications such as pneumothorax were rare, at just 0.17%. That is a meaningful, well-documented change. Published follow-up runs mostly to six months and the studies are retrospective, and outcomes vary between individuals.
- Able to commit to the aftercare protocol. Most techniques require a rigid corset worn roughly 23 hours a day for 8 to 12 weeks or more. If that commitment is not realistic for your work, family or lifestyle, this matters as much as any medical criterion — asymmetry in published series (1.85 per 100) was largely associated with corset non-compliance, a factor in the patient’s hands. Our article on the recovery corset and aftercare explains what that period actually involves.
Who is not a candidate?
Some circumstances rule out rib remodelling, either permanently or until they are resolved:
- Pregnancy or breastfeeding
- Bleeding disorders
- Significant respiratory disease — the lower ribs sit directly over the pleura and lungs
- Significant spinal disease
- Active infection
- Poor bone density
- Current smoking, where the patient is unable or unwilling to stop
- Concerns identified on body dysmorphic disorder (BDD) screening
None of these is a judgement about you as a person. They are markers of situations in which the risks rise or the healing the procedure depends on cannot be relied upon. A good surgeon declines to operate in these circumstances precisely because your interests come before a booking.
What does the pre-operative CT scan tell the surgeon?
Every rib cage is different — in rib length, curvature, angle and flare, and in how close the ribs sit to the structures beneath them. Before rib remodelling, a CT scan is performed to map your individual rib anatomy. This lets the surgeon plan which ribs to address (typically the lower ribs, 10 to 12, with some techniques also involving ribs 8 and 9), where the reshaping should occur, and what change your particular skeleton can realistically allow.
The CT scan is also part of honest expectation-setting: two people can have identical surgery and different results because their underlying anatomy differs. If imaging suggests the achievable change is small, you should be told that plainly before you commit to anything.
Why is BDD screening required — and why it is protective, not gatekeeping
Since July 2023, every Australian patient seeking cosmetic surgery must be screened for body dysmorphic disorder using a validated screening tool. It is reasonable to feel wary of this — nobody enjoys the idea of being assessed psychologically before a physical procedure. But the requirement exists for the patient’s benefit, not the clinic’s.
BDD is a recognised health condition in which a person experiences intense distress about a perceived flaw in their appearance — often one that others cannot see, or see very differently. The clinical evidence is consistent: surgery does not relieve that distress, and frequently worsens it, because the underlying condition is not surgical. Screening protects people from undergoing an operation — with real risks and a demanding recovery — that cannot deliver what they are actually seeking. Where screening raises concerns, the appropriate next step is referral to a psychologist or psychiatrist, and effective treatment for BDD exists.
Screening is not a trap or a character test. For most patients it is a short, unremarkable part of the consultation. If it does raise a flag, that is the system working as intended.
The Australian assessment pathway, step by step
Australian regulations require a referral from your GP or another independent medical practitioner, at least two pre-operative consultations (including one in person with your surgeon), screening for body dysmorphic disorder, and a minimum 7-day cooling-off period after informed consent before surgery can be booked. Rib remodelling is not available to people under 18.
In practice, the pathway looks like this:
- GP referral. You discuss the procedure with your own GP (or another independent doctor), who provides a referral. This builds an independent medical opinion into the process from the start.
- First consultation. Your medical history, medications, smoking status, weight stability and goals are reviewed; BDD screening is completed; the procedure, its limitations and its risks are explained; imaging such as the pre-operative CT scan is arranged.
- Second consultation. At least one consultation must be in person with the operating surgeon. This is where the surgical plan, the corset protocol, the realistic range of outcomes and the full risk profile — including the possibility of revision surgery — are worked through before you give informed consent.
- Cooling-off period. After informed consent, a minimum of 7 days must pass before surgery can be booked and any deposit taken. Use it. Re-read the written material, talk to the people close to you, and revisit the recovery timeline honestly against your own life.
At every step, you are free to pause or walk away — and a practitioner who makes you feel otherwise is not one you should proceed with.
If the criteria above sound like you, the clearest way to find out where you stand is a proper assessment. Request a consultation and a specialist plastic surgeon can review your health, your anatomy and your goals, and tell you plainly whether rib remodelling is likely to suit you.
Frequently asked questions
I’m over the BMI guidance — am I ruled out permanently?
Not necessarily. BMI guidance of below about 28–30 reflects where the published outcomes sit and where surgical risk is better controlled. Many surgeons will suggest reaching and holding a stable weight first, then reassessing. Your GP is the right starting point for that conversation.
Does being over 40 exclude me?
No. Age 18 is the only absolute age rule. For patients over about 40, a bone-density check is commonly considered, because the technique depends on healthy bone that can bend and heal predictably. If your bone density is adequate, age alone is not a barrier.
What if the BDD screening raises concerns?
Surgery would not proceed at that time, and you would usually be referred for assessment and support from a mental-health professional. That is not a punishment or a permanent verdict — it is the pathway doing its job of making sure surgery is only offered where it can genuinely help.
Rib remodelling is surgery, and all surgery carries risk. Possible complications include pneumothorax (collapsed lung), bleeding, infection, nerve injury and ongoing pain, asymmetry, scarring, and risks associated with general anaesthesia. Outcomes vary from person to person. Read our full risk information before considering this procedure.
Medical review: This article is general information only and does not replace a consultation with a specialist plastic surgeon. Rib remodelling carries risks — read them at /risks/. All surgery requires a GP referral, two consultations and a mandatory cooling-off period.
References
Pooled meta-analysis of rib remodelling outcomes, Aesthetic Plastic Surgery, 2025: https://link.springer.com/article/10.1007/s00266-025-05240-w
Medical Board of Australia — cosmetic surgery guidelines and reforms: https://www.medicalboard.gov.au/
Australian Health Practitioner Regulation Agency (AHPRA): https://www.ahpra.gov.au/