Fat contouring in the face and neck

Fat contouring of the face and neck has gained wide acceptance. At this point in its evolution, it is recognized to be just another tool and not a panacea for all patients. Like any tool, it can be overused or used badly. Fat necrosis is ongoing, sometimes unpredictably after open or closed procedures. Uniform and generously thick fat flaps should be left, anticipating partial dissolution postoperatively. The patient should leave the operating room undercorrected. Slight excesses of fat are easy to remedy. Overexcisions may be impossible to improve and may mar or preclude secondary surgery. In addition, I would promote a personal prejudice. Surgery is easy when the surgeon can see. There is a distinct advantage in control to be gained by open procedures under direct vision, when the operator can see what is to be operated on and avoid what is not--and most important, leave what should be left.