Analysis of Bicorticality in a Cohort of Post-RibXcar Patients: A Clinical and Imaging Follow-up Study

Manzaneda Cipriani R.M.; Duran H.; Adrianzen G.A.; Flores E.; Romero Algara E.; Mendoza Guerra C. · Aesthetic Surgery Journal (2026) · DOI: 10.1093/asj/sjag012

Resumen

Background: RibXcar is a minimally invasive technique for waistline contouring that uses ultrasound-guided monocortical rib fractures to achieve controlled angulation while preserving thoracic stability. Although its safety profile is favorable, bicorticalization fracture extension through both cortices remains a potential complication requiring systematic evaluation. Objectives: This study aimed to assess the incidence, clinical evolution, and radiologic characteristics of bicorticality in a prospective cohort of RibXcar patients. Methods: A prospective cohort of 328 female patients (mean age 28.3 ± 6.7 years; BMI 25.3 ± 1.8 kg/m²) underwent RibXcar between January and December 2023, performed by a single surgeon. Eligible patients were women aged 18-40 years with BMI < 30 kg/m² and visceral fat < 13%. All completed 1-year clinical and radiologic follow-up. Postoperative pain, complications, and imaging findings were analyzed using Wilcoxon tests (P < .05). Results: Bicorticality occurred in 15 patients (4.6%), mostly within the first 20 postoperative days. Pain was reported by 41 patients (12.5%), but in 7.9% was related to corset misuse rather than fracture status. Bicorticality correlated with higher visceral fat (12.7% ± 0.5 vs 8.0% ± 0.3; P < .001) and longer operative time (48.9 ± 6.3 vs 43.3 ± 8.3 minutes; P = .01). No hemothorax or pneumothorax occurred. At 1 year, 98.2% demonstrated satisfactory healing; 1.5% showed callus irregularity; and only 1 patient (0.3%) had persistent bicorticality. Conclusions: RibXcar achieves controlled monocortical fractures with a low bicorticalization rate and predictable consolidation. Visceral fat and operative duration appear more influential than BMI in complication risk, supporting the technique's safety and reproducibility. Level of Evidence: 4 (Therapeutic): For image description, please refer to the figure legend and surrounding text. © The Author(s) 2026. Published by Oxford University Press on behalf of The Aesthetic Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)