Remember when someone lashed her waist with laces and boning until it was so tiny you could wrap your hands around it? Of course you remember, given that it was all of a few months ago. Not that we wrapped our arms around that particular waist, but Jeff Bezos did. There was also a time when a woman squished into a piece of vintage gossamer silk sprinkled with sequins. That was all the way back in 2022, when Kim Kardashian strained the seams of Marilyn Monroe’s “Happy Birthday, Mr. President” dress.
The tiny, tortured waist has returned as a bodily preoccupation, ready to eclipse voluminous breasts and buttocks as areas of obsession, manipulation, distortion and angst.
While some women are Scarlett O’Hara-ing themselves into gowns fitted with custom corsetry, plastic surgeons are working on more permanent methods to create the wasp waist, the ant waist, or what the leading surgeon in this emerging subspecialty calls the “Barbie waist.”
The original Barbie, circa 1959. (File/Chicago Tribune)
This new approach originated in Russia in 2017, when a doctor decided to explore an alternative to rib removal, which was the way some surgeons — though not many — had whittled the waist in the past. The procedure is exactly what it sounds like: an operation in which the surgeon completely or partly extracts the 11th and 12th “floating” ribs. It’s an operation that carries “considerable risks” and “significant detrimental effect on lung and respiratory functions,” wrote Dr. Alfredo E. Hoyos and his colleagues in “Waistline Aesthetic Slimming by Puncture and Parallel Approach for Rib Remodeling Procedures,” a medical paper.
Dr. Kazbek Kudzaev, the innovator from Vladikavkaz, Russia, is even harsher in his assessment of rib removal, calling it “mutilating surgery.” In an interview with a translator over WhatsApp, he said: “Rib removal surgery contradicts the main principle of medicine, ‘primum non nocere,’” first, do no harm. “It is a harmful and dangerous technique.”
That’s what propelled him to find an alternative. His early efforts in 2017 involved incisions near the bottom ribs on the right and left sides of the body. He maneuvered each rib with a drill, bending it until one side snapped in what’s called a greenstick fracture. From there, he instructed the patient to strap into a corset for two months, until the ribs fused together in a new position. The result was a waistline reduction of 9 centimeters, or 3½ inches.
Kim Kardashian, in wasp waist and Maison Margiela, at a gala Oct. 18 in LA. (Jennelle Fong/The New York Times)
If it sounds like a David Cronenberg film, absolutely. And yet the doctors who perform this procedure believe it’s a tidy and sophisticated solution to a recalcitrant territory. Others, including Dr. Robert Singer, a board-certified plastic surgeon in La Jolla, California, and the past president of the Aesthetics Society warn that its potential problems are greater than in other surgeries. “Let’s put it this way,” Singer said, “If my daughter or wife wanted to get this procedure — not that I have any influence over them — I’d tell them not to.”
The waist resists most efforts at reduction, maintaining its proportion to the hips despite exercise, diet and liposuction. Hoyos often applies his expertise in high-definition liposuction to manipulate the waist-to-hip ratio — a technique he created in Bogotá, Colombia, that combines fat removal and fat grafting within the muscle to sculpt it. That creates an athletic physique and sometimes even six-pack abs, but it does not affect the waist-to-hip ratio. “Always the limitation was the bony structure,” he said.
Hoyos discovered the Russian technique through a colleague and recalled watching a video of a doctor performing it on a woman who was lying in bed, chatting on the phone. “Yes, it’s true,” said Kudzaev. “The patient didn’t feel any pain and was able to use her phone during the surgery. She was under local anesthesia, and I usually perform these surgeries under local anesthesia, but if the patient requests it, it can be done under general anesthesia.”
Hoyos had his doubts: “Everybody said, including me, that this looks like a circus attraction. I was reluctant at the beginning. We needed to make it safer and more reproducible so you can teach it to other doctors. But now I think it will change the way we think about body contouring.”
From 1903, a warning about the effects of corsets on internal organs and bones, in the book “Golden Thoughts on Chastity and Procreation” by John William Gibson. (Courtesy of Library of Congress)
Since then, doctors around the world have modified the technique, making it safer, faster, less painful and more consistent. Today, according to Hoyos, the average rib remodeling procedure costs $8,000, takes about 10 minutes and requires eight to 12 weeks of recovery in a corset. The average waist reduction is 8 to 12 centimeters, or about 3 to 3¾ inches.
The latest modification replaces the incision with a needle puncture and employs an ultrasonic tip that cuts the key ribs with vibrations. That’s the WASP technique (“waist aesthetic slimming by puncture”). Various surgeons have come up with their own acronyms and monikers. Hoyos is partial to “Barbie waist” because “it’s a more friendly name for the public.”
But Barbie herself, at the fine age of 66, would not be a candidate — not that she needs it. The procedure works best on women in their 30s and 40s, because older ribs do not heal as effectively. Athletes and people with strong abdominal muscles — including men — do not fare well either because their muscles often pull the ribs back to their original shape. For them, there’s Riboss (“rib remodeling by osteosynthesis”), which requires plates and screws to hold the ribs in their new configuration.
Jósmer Zambrano, 45, a doctor in Caracas, Venezuela, who specializes in aesthetics, submitted her ribs to surgery in 2023. “I always wanted to have a smaller waist,” she told me. Hoyos gave her the Barbie treatment, remodeling her ribs with ultrasound vibrations. After wearing a corset for three months to the day, she said, her waist shrank to 23 inches from an original 30 inches.
Jessica Lasher, 33, who does accounting and real estate investing in Vancouver, British Columbia, started her quest by Googling “rib surgery.” She found Dr. Josef Hadeed in Beverly Hills, California, and spent $9,300 — not including a private nurse for the first 24 hours and a hotel room for a week — to have six lower ribs partly fractured. Asked if she’d had other cosmetic procedures, she replied cheerfully: “Oh, yes. I’ve had quite a lot. I’m a repeat offender.” She ticked them off: breast implants twice (one under the muscle, then a revision to move them over the muscle “because I wanted cleavage”), facial implants, eye color alteration,” she trailed off. Lasher is considering a Brazilian butt lift or maybe an inner thigh lift with Hadeed. “I want to be more like Barbie,” she said. Her waist now measures 23½ inches.
Researchers have analyzed the power of this attraction. One study examined a group of heterosexual men as they stared at photographs of the same naked woman with her waist and breast sizes altered to various degrees. The researchers tracked the men’s “visual fixation” on the images. The men looked more often and longer at the breasts, but they rated images of an hourglass shape and a narrow waist as most attractive, regardless of the size of the model’s breasts.
Even doctors in the field feel the sway of trends in body shapes and sizes. Plastic surgeons have a name for our current moment, calling it “the Kardashian era.” Said Hoyos, “In the 2000s and 2010s, the beauty standard was big butt, big breasts.” The most popular breast implants today are smaller than they were 10 years ago, and more and more women are undergoing breast reduction surgery. The Brazilian butt lift, however, continues to be one of the fastest-growing plastic surgeries in the United States.
Not every expert is popping bottles over these developments. Dr. Steven Teitelbaum, a plastic surgeon in Santa Monica, California, who specializes in breasts and body contouring, does not do rib remodeling. “I think the results look cartoonish and ridiculous,” he said. “But that’s my taste. Plastic surgery is criticized for creating an artificial standard of beauty,” but he prefers the word “ideal,” meaning trying to create in a patient what nature creates in other people.
Hoyos is stalwart. He believes rib remodeling “will change the way we think about body contouring.” “There are surgeons who will say, ‘This is dangerous, it will be difficult to get good results,’” Hoyos said, “but we’re slowly proving otherwise.” Like it or not, it may even be a breakthrough. “A paradigm shift.”
A glamor shot from 1899, photographer unknown. (Courtesy of Library of Congress)
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