Background Body contouring surgery has gained increasing popularity. Waist reduction has become central to body contouring, particularly in Latin America, where hip stylization is a beauty standard. This systematic review aims to evaluate the safety and efficacy of costal cosmetic surgery for waistline improvement and to assess the quality of the evidence. Methods Search Methods for Study Identification: A comprehensive search was conducted on PubMed and other databases using the following keywords: "Removal rib," "Remodeling Rib," "Waist narrowing," "Waist-hip ratio," "Body contouring," "Aesthetic surgery," "Plastic surgery" and "Complications."Selection of Studies: We included all studies regarding surgery on the ribs with the aim of improve (narrow) the waist for cosmetic purposes. Methods Search Methods for Study Identification: A comprehensive search was conducted on PubMed and other databases using the following keywords: "Removal rib," "Remodeling Rib," "Waist narrowing," "Waist-hip ratio," "Body contouring," "Aesthetic surgery," "Plastic surgery" and "Complications. "Selection of Studies: We included all studies regarding surgery on the ribs with the aim of improve (narrow) the waist for cosmetic purposes. Results Of the 161 studies identified, 8 met inclusion criteria. Most studies were retrospective case series, with two being multicentric. A total of 444 participants were included, predominantly women. Five studies involved costal remodeling, and three performed costal resection. Anthropometric outcomes were reported in 6 studies. Complications included pain, pneumothorax and wound dehiscence. Follow-up periods ranged from 3 to 6 months. Conclusion While rib resection and remodeling appear to be safe techniques, their long-term efficacy remains uncertain. Studies with rigorous designs and longer follow-up are needed to establish robust evidence. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.