Vector Matters: A Critical Review of Biomechanics, Safety, and Evidence Quality in Aesthetic Rib Remodeling

Abstract

Aesthetic rib remodeling includes parallel corticotomy, perpendicular puncture, and rib-resection approaches, but comparative safety remains uncertain. We conducted a structured narrative review of evidence published from January 2015 through June 2026. Clinical reports, systematic reviews, functional studies, directly relevant biomechanical work, and official publication-status notices were considered. Three reviewers screened the original evidence independently and resolved disagreements by consensus. Historical record-level exports and extraction sheets were not retained; therefore, no retrospective screening counts or pooled unique-patient total were reconstructed. The literature consists mainly of uncontrolled observational reports with heterogeneous selection, cointerventions, techniques, surveillance, follow-up, and potentially overlapping cohorts. Published parallel-technique cohorts appear less morbid in their reporting of major pleural events than some perpendicular-technique reports, but no head-to-head comparison, adjusted analysis, or verified unique pooled denominator establishes a causal safety advantage. Recent RibXcar reports include pulmonary-function, imaging, complication, fatalities, and patient-reported outcome data, although cohort overlap cannot be excluded. Ultrasound may assist localization, visualization, and documentation, but its incremental safety or efficacy effect has not been isolated. Current evidence supports cautious technique-specific reporting and prospective comparative studies with unique denominators, standardized complication surveillance, operator and technique-fidelity documentation, adequate follow-up, and validated patient-reported outcomes.