Remember when a tiny waist, cinched with laces and boning, became a viral sensation just months ago? While we might not have personally measured its circumference, it certainly captivated public attention, especially when Jeff Bezos was seen with Lauren Sánchez. And who could forget Kim Kardashian in 2022, straining the seams of Marilyn Monroe’s iconic “Happy Birthday, Mr. President” dress? These moments highlight a recurring fascination with extreme body shaping.
This intense focus on achieving a dramatically small, almost “tortured” waist has resurfaced as a major body preoccupation, threatening to overtake the previous obsessions with enlarged breasts and buttocks. It’s becoming the new frontier for obsession, manipulation, distortion, and even anxiety surrounding body image.
While some are opting for traditional, custom-made corsets to achieve a Scarlett O’Hara-esque figure, plastic surgeons are now developing more permanent ways to create what they call the “wasp waist,” “ant waist,” or, as one prominent surgeon in this niche field describes it, the “Barbie waist.”
This revolutionary approach to waist sculpting first emerged in Russia in 2017. A pioneering doctor sought an alternative to traditional rib removal—a method some surgeons had previously used to dramatically narrow the waist, though it was rarely practiced. The procedure involves the complete or partial extraction of the 11th and 12th “floating” ribs. As noted by Dr. Alfredo E. Hoyos and his colleagues in a medical paper titled “Waistline Aesthetic Slimming by Puncture and Parallel Approach for Rib Remodeling Procedures,” this surgery carries considerable risks and can significantly impair lung and respiratory functions.
Dr. Kazbek Kudzaev, the Russian innovator behind many of these techniques, offers an even more critical view of traditional rib removal, labeling it as “mutilating surgery.” In a translated interview, he emphasized that such procedures violate the fundamental medical principle of “primum non nocere”—first, do no harm—deeming them both “harmful and dangerous.”
This alarming practice spurred Dr. Kudzaev to seek an alternative. His initial experiments in 2017 involved making small incisions near the lower ribs on both sides of the body. Using a specialized drill, he carefully bent each rib until it fractured, creating what surgeons call a greenstick fracture. Patients were then required to wear a corset for two months, allowing the ribs to heal and fuse in a new, more cinched position. This groundbreaking technique achieved an average waist reduction of nine centimeters, or three and a half inches.
If this procedure evokes images from a David Cronenberg film, you’re not alone. Yet, many doctors performing it view it as an elegant and precise solution for a body area notoriously resistant to change. However, not everyone agrees. Dr. Robert Singer, a board-certified plastic surgeon and former president of the Aesthetics Society, cautioned against its significant potential complications. “Let’s put it this way,” Dr. Singer stated, “if my daughter or wife expressed interest in this procedure—not that I have any sway over their decisions—I would strongly advise them against it.”
The waistline has long been a stubborn area, often retaining its natural proportion to the hips regardless of strenuous exercise, strict diets, or even liposuction. Dr. Hoyos frequently uses his specialized high-definition liposuction techniques—which he pioneered in Bogotá, Colombia—to refine the waist-to-hip ratio. This involves a combination of fat removal and precise fat grafting within the muscles to sculpt an athletic physique, sometimes even achieving a coveted six-pack. However, even these advanced methods couldn’t alter the fundamental bony structure of the waist. As he noted, “Always the limitation was the bony structure.”
Dr. Hoyos learned about the Russian technique from a colleague and vividly recalled watching a video of a surgeon performing it on a woman who was casually conversing on her phone from her hospital bed. Dr. Kudzaev confirmed this, stating, “Yes, it’s true. The patient didn’t feel any pain and was able to use her phone during the surgery.” He explained that he typically performs these procedures under local anesthesia, though general anesthesia is an option if the patient prefers.
Initially, Dr. Hoyos harbored significant skepticism. “Everyone, including myself, viewed this as little more than a circus act,” he confessed. “I was hesitant from the outset. Our primary goal was to enhance its safety and reproducibility, making it a teachable method for other medical professionals. However, I now believe this procedure will fundamentally transform our understanding of body contouring.”
Since then, medical professionals globally have refined the technique, making it considerably safer, faster, less painful, and yielding more consistent results. Presently, Dr. Hoyos reports that an average rib remodeling procedure typically costs around $8,000, is completed in approximately 10 minutes, and necessitates eight to twelve weeks of post-operative recovery while wearing a corset. Patients can expect an average waist reduction of eight to twelve centimeters.
The most recent refinement in this field eliminates the need for incisions altogether, replacing them with a simple needle puncture. An ultrasonic tip is then used to precisely cut the targeted ribs using high-frequency vibrations. This advanced method is known as the WASP technique, an acronym for “waist aesthetic slimming by puncture.” While other surgeons have coined their own terms, Dr. Hoyos personally favors the “Barbie waist,” believing it offers a more approachable name for the general public.
Interestingly, Barbie herself, despite her famously slender figure, wouldn’t be an ideal candidate for this procedure at her age of 66—not that she would ever need it. The technique yields the best results for women in their 30s and 40s, as younger ribs tend to heal more efficiently. Athletes and individuals with exceptionally strong abdominal muscles, including men, are also less suitable, as their robust musculature often counteracts the desired outcome by pulling the ribs back to their original position. For these cases, an alternative known as Riboss rib remodeling by osteosynthesis is available, which involves the use of plates and screws to securely maintain the ribs in their newly sculpted configuration.
Jósmer Zambrano, a 45-year-old aesthetics doctor from Caracas, Venezuela, underwent this rib surgery in 2023. “I always wanted to have a smaller waist,” she shared. Dr. Hoyos performed the “Barbie treatment” on her, using ultrasound vibrations to reshape her ribs. After meticulously wearing a corset for precisely three months, she reported a remarkable transformation: her waist size decreased from an initial 30 inches to a slender 23 inches.
Jessica Lasher, a 33-year-old professional in accounting and real estate investing from Vancouver, British Columbia, began her journey to a smaller waist by searching online for “rib surgery.” This led her to Dr. Josef Hadeed in Beverly Hills, California. For $9,300—a cost that didn’t even cover a private nurse for the first 24 hours or a week-long hotel stay—she had six of her lower ribs partially fractured. When asked about other cosmetic procedures, Ms. Lasher candidly and cheerfully admitted, “Oh, yes. I’ve had quite a lot. I’m a repeat offender.” She detailed a history of procedures, including two breast implant surgeries (one sub-muscular, then a revision to over-the-muscle “because I wanted cleavage”), facial implants, and even eye color alteration. Looking ahead, Ms. Lasher is contemplating further enhancements with Dr. Hadeed, such as a Brazilian butt lift or an inner thigh lift, driven by her aspiration to “be more like Barbie.” Her current waist circumference measures 23.5 inches.
The compelling allure of a small waist has been the subject of scientific inquiry. One study investigated a group of heterosexual men as they viewed photographs of the same nude woman, whose waist and breast sizes had been digitally modified to varying degrees. While researchers observed that the men’s gaze lingered more frequently and for longer periods on the breasts, they consistently rated images featuring an hourglass figure and a narrow waist as the most attractive, irrespective of the model’s breast size.
Even plastic surgeons acknowledge the powerful influence of shifting body shape trends. They refer to our current period as “the Kardashian era.” Dr. Hoyos noted that “in the 2000s and 2010s, the beauty standard was big butt, big breasts.” Interestingly, today’s most popular breast implants are smaller than those chosen a decade ago, and a growing number of women are opting for breast reduction surgery. Despite this, the Brazilian butt lift remains one of the fastest-growing plastic surgeries in the United States.
However, not all experts are celebrating these evolving beauty standards. Dr. Steven Teitelbaum, a plastic surgeon in Santa Monica, California, specializing in breast and body contouring, explicitly avoids rib remodeling procedures. “I think the results look cartoonish and ridiculous,” he stated, acknowledging it’s a matter of personal aesthetic preference. He addressed the common criticism that plastic surgery invents artificial beauty standards, countering that he aims for an “ideal”—to replicate what nature might create in others, striving for natural-looking enhancements.
Despite differing opinions, Dr. Hoyos remains steadfast in his conviction. He firmly believes that rib remodeling “will revolutionize our approach to body contouring.” While he acknowledges that “there are surgeons who will argue, ‘This is dangerous, achieving good results will be challenging,'” Dr. Hoyos asserts, “we are progressively demonstrating the opposite.” Whether one approves or not, he suggests this procedure might represent a significant breakthrough, calling it “a paradigm shift.”