In the years since the first pilot ‘workshop’ in 2009, MAFAC has developed in ways that could not have been foreseen. Some parts of the course have had to be given up, including, unfortunately, some wonderful lectures by Professors Eizenberg and Taylor, to meet the demand for more dissection ‘hands on’ time for participants.
There has been a constant process of improvement regarding methodology, the ratios of participants to cadaver heads and demonstrators, and the quality of equipment and setup. MAFAC has also set new standards in its personal care of participants, recognising the contribution of quality food and coffee in allowing attendees, many of whom have flown across the world, to maintain their energy and enthusiasm during two days of intense work.
More than 400 surgeons from 36 countries have attended MAFAC. (1) Since 2014, MAFAC has been exported to America, where it now appears as part of the annual meeting of the American Society of Aesthetic and Plastic Surgery (now known as The Aesthetic Society).
From April 2014, MAFAC became an Australian teaching export, with the entire faculty flying to America to provide an abbreviated MAFAC at the invitation of the American Society of Aesthetic Plastic Surgery (ASAPS, now known as The Aesthetic Society) at their annual meeting in San Francisco.
MAFAC has been part of The Aesthetic Society meetings since then, including Montreal in 2015, Las Vegas in 2016, San Diego in 2017, New York in 2018 and New Orleans in 2019. Sometimes this has meant providing the course in hotel ballrooms and similar facilities, but each is carefully transformed to provide the optimal teaching experience. The name ‘Melbourne’ is always retained, as the Australian faculty travels to present the course, and valuable exposure for Australia is created. As one American surgeon commented after attending MAFAC at the 2016 ASAPS meeting in Las Vegas: Australia … too far away, the ASAPS [conference] offers easy access.
In 2017, MAFAC presented its first Graduate Course, designed specifically for, and limited to, surgeons who had previously completed MAFAC. It was developed at the request of former attendees, (some of whom have attended MAFAC two, three, even four times). The Graduate Course allowed these surgeons to develop a higher level of anatomical understanding, building upon their previous learning and subsequent surgical application. It featured internally renowned plastic surgery anatomy teachers, Dr Giovanni Botti from Silo, Italy and Dr Daniel Labbé from Caen, France.
RATIOS and UNIQUE APPROACHES
We now have the desired ratio of two people per cadaver head, with one dissection demonstrator per four attendees. This ratio is part of the success of the course. The faculty comprises mostly plastic surgeons from Australia, who are really good teachers with a wonderfully informal way of imparting their knowledge. As one attendee wrote; The teachers take responsibility for ensuring your understanding and make it clear that any issues are probably due to their explanations rather than the delegate’s stupidity! This encouraged a lot of questions, which helped expand the applicability of the anatomical principles and enhanced understanding.
Our approach is to take attendees through each step. First, I demonstrate and then they do it themselves, with guidance and oversight from the dissection demonstrator. This is a unique approach that builds confidence and understanding.
QUALITY OF SET UP and EQUIPMENT
We set up the dissecting room with great care, so when people enter they see immediately that it has the precision of an operating theatre, from the position and layout of the instrumentation to the quality of the lighting. We aim deliberately, from that first moment, to blur the distinction between operating and dissection.
Our equipment is surgical quality, not cadaver quality. Some is of higher quality than many surgeons operate with. This is important and we are fortunate to have instruments donated by our sponsors. Johnson and Johnson provide the suture material and have been excellent supporters of the course. The providers of our headlights also provide a talk on optics and lighting. To ensure that attendees are able to duplicate this quality approach later, we list what we use in the programme.
OUR SCHEDULE
We start the course on the afternoon of the registration day, with two talks on basic principles. Professor Mark Ashton, the Course Chairman, describes the latest understanding of the vasculature and the lymphatics, with a fascinating summation of their research on this. I speak about the evolution of the human face, and use our Australian freshwater crocodile to show how our face has evolved differently in the upper, middle and lower third, creating an anatomy that is necessarily compacted and congested as a result.
This gets the basic principles of what we are about to look at out of the way, but more importantly, it starts the questioning process. Attendees begin to see the ‘why’ of anatomy and not just the ‘where’. By the end of these talks, they are starting to realise that this is a whole new way to think about anatomy, and they’re ready and motivated for the start of the course proper in the morning.
And they will learn a new way to think about anatomy. They will learn to understand it from an evolutionary and working perspective, rather than the textbook recitation of ‘these are the ligaments, these are the nerves’ – the type of learning they have probably done thus far. Our approach mirrors how surgeons think about and meet with the anatomy intra-operatively, rather than in a medical school or exam passing way.
People come to MAFAC because they want to do things better, but this desire can’t be realised without someone showing the way. We have two days of hard work to help them, so we maximise their ‘hands on’ time. Our aim is to help clarify their understanding of anatomy and their ability to identify landmarks.
Some areas of the face have up to 14 different names, so clarity is critical. Importantly, we show attendees what to look for – they might have been there before but they didn’t know what they were looking for. In teaching, nobody talked about spaces and temporal ligaments so they paid no attention to them.
Our guide is Albert Einstein: He who knows what he seeks, appreciates what he finds.
When we get to an area around the facial nerve, you can sense it in the room, Ah! There it is! It’s quite different to surgery, where you’re meant to operate around the nerve but not actually see it. If attendees can see it in the first dissection session, they’ll follow you enthusiastically. There is real excitement in the room.
Finally, on the second afternoon, we allow people to dissect what they want, using the second half of the face. This is greatly appreciated and we watch with pleasure as many stay on until the very last minute, before emerging exhausted.
We have been delighted by the number of people who have returned to MAFAC once, twice or even more, and by the success of its graduate course. The course is a testament to the professionalism of every person involved in it.
MAFAC’s success has been based on doing things differently and better. We have a unique approach that ensures this original Australian course excites the attendees, whilst also showcasing the talent and enthusiasm of the Australian surgeons who give their time so generously to helping other surgeons. It has developed a respected reputation internationally in just ten year existence.
I believe this is due to three key aspects of the course:
