For Surgeons
This section is written for colleagues rather than patients. It sets out the techniques I perform and teach, the anatomical reasoning behind them, the training I host in Japan, and how to reach me for observership, collaboration or speaking.
I came to aesthetic surgery late and from an unusual direction — eighteen years in thoracic surgery and lung transplantation. That background shapes everything below, and it is the reason I work the way I do around the chest wall.
I work inside three international groups: as Asia Ambassador for AX — Aesthetic Xpert Scientific Lab since 2025, and, since 2026, as a member of The Body Contouring Academy and the UGRAFT® Technique group.
Position
Skeletal waist contouring asks a surgeon to fracture ribs, in a controlled way, a few millimetres from the pleura. The published complication profile of the technique reflects exactly that: across a multicentre cohort of 3,805 cases from eight countries, the major complications reported were four pneumothoraces and one haemothorax.[1] They are uncommon, but they are the complications that matter, and they are thoracic.
For eighteen years, before I performed a single aesthetic case, the chest wall and the pleural space were my daily anatomy. I spent that career in thoracic surgery and lung transplantation — a field in which the recognition and management of a pneumothorax is routine rather than exceptional. I did not learn the thorax in order to narrow waists. I learned to narrow waists already knowing the thorax.
I say this not as a claim of superiority over colleagues who came through the conventional plastic surgery pathway, but because it explains my emphasis. When I teach this technique, I spend disproportionate time on plane verification, on what the ultrasound is actually showing, and on what to do in the first sixty seconds if a patient desaturates. Those are the parts I know best, and they are the parts that keep the technique safe.
Technique
Detailed technique notes, written for surgeons, with references to the published literature.
Ultrasound-guided monocortical fracture of the lower ribs using a piezotome, through percutaneous punctures. Technique originated by Dr. Raúl Manzaneda Cipriani. Patient selection, operative sequence, ultrasound protocol, fixation, and the complication data.
Technique note →Layer-selective ultrasound-assisted lipoplasty and the design logic of etching on a body habitus with different fat distribution and skin behaviour from the populations in which the technique was developed.
In preparationCombining implant and autologous fat — indications, planning, and the limits of each component in a series drawn from more than 6,000 breast procedures.
In preparationTraining
I hold RIBXCAR seminars on a regular basis for surgeons who wish to adopt the technique. Because rib remodeling carries thoracic risk, I do not teach it through observation alone — the seminar format exists so that patient selection, ultrasound interpretation, instrument handling and complication management can be taught deliberately rather than absorbed by watching.
The seminars are run in the context of my role as Asia Ambassador for AX (Aesthetic Xpert Scientific Lab), the organisation founded by the originator of the technique, Dr. Raúl Manzaneda Cipriani.
Places are limited and admission is for surgeons only. Write to me for the programme and the next available edition.
Observership
Colleagues are welcome to observe in Fukuoka or Ginza across my liposuction, fat grafting, breast and body contouring practice. Observation is arranged individually, subject to the operating schedule and to patient consent, which is sought in every case and occasionally declined.
Rib remodeling is the one exception. RIBXCAR is not offered through observership; it is taught through the seminar programme above, for the reasons set out there.
If you would like to visit, write to me with your background, the procedures you are interested in, and the period you have in mind. I will tell you honestly whether the schedule during that window is worth the flight.
Academic Record
A note on this section: I am at the beginning of my international academic record rather than the end of it. I would rather state that plainly than pad the list. What is here is accurate, and it will grow.
Contact
For observership, seminar enquiries, speaking and faculty invitations, case discussion, or collaboration on a series or a paper. Please mark your message “For Surgeons” in the subject line so that it is routed to me rather than handled as a patient enquiry.
Patient enquiries are handled separately — please use the enquiry form for international patients.