Melbourne Advanced Facial Anatomy Course (MAFAC)
A Brief History 2009-2019

Dedicated to Simon Bernard
(1967-2011)

I hear and I forget
I read and I remember
I do – and I understand

1.

INTRODUCTION: THE PHILOSOPHY OF MAFAC

“Experience is the foundation of true understanding and providing expertly guided dissection is the way to impart that experience.”

– Foundation Member and Head of Faculty, Bryan C Mendelson

The Melbourne Advanced Facial Anatomy Course (MAFAC) commenced in November 2009, at the University of Melbourne, Department of Anatomy.

From the outset, MAFAC was designed to be an immersion in facial anatomy. It was to be a teaching course that brought all the anatomy of the face together to provide practical, advanced knowledge and understanding for surgeons who wanted to perform better facial surgery. This provision of advanced anatomy with safe, practical application has become one of MAFAC’s most appreciated attributes.

The teaching methodology and philosophy was simple but ambitious, based on the belief that participants will benefit from changing the way they approach facial anatomy; from learning it to ‘thinking it’, from seeing the where to understanding the why. This is a working, evolutionary perspective, as distinct from textbook learning, and it changes our understanding of the anatomy and, by extension, what we observe. MAFAC’s dissection days allow attendees to explore what is revealed when they start ‘thinking the anatomy’, but with the benefit of guidance from skilled demonstrators.

‘What they’ll see,’ says Bryan Mendelson, ‘will be the anatomy they never get to see during surgery, and that will be critical for their future surgery.’ MAFAC provides a 2:1 ratio of participants to cadaver heads, and a 4:1 ratio of skilled demonstrators to participants. This ensures that participants have surgical quality exposure to the heads, so they can experience the anatomy for themselves. MAFAC’s demonstrators include some of Australia’s most highly trained surgeons and their skill and dedication – and innate friendliness – has been integral to the success of the course.

“If you provide someone with a cadaver, but insufficient guidance, at the end of the day they’ll be not much the wiser. But if you guide them, show them how to get into a facial space, then how to expand the space, then find the next space, and let them experience how you connect these spaces and
what’s in between, you give that person a way of dissecting a face that reveals the anatomy.

Then they will be able to work their way, in safety, almost the entire way around the face, finding the boundaries, the nerves, the safe spaces and the connecting tunnels. It’s like being guided through a complex building from behind the cavity walls.”

– Bryan C Mendelson

2.

BRIEF HISTORICAL OVERVIEW

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).

3.

HISTORY

FROM PILOT COURSE TO PRIVATE BARISTAS

“You should be teaching this. I’ll organise the course and you do the teaching.”

– Simon Bernard

MAFAC was instigated by the late Simon Bernard (MD, FRACS). Whilst completing a fellowship with Bryan Mendelson, Simon was so impressed by the advanced anatomical research and surgical techniques he observed, he suggested that he and Bryan work together to create a teaching course.

Although Bryan Mendelson regularly taught and demonstrated his techniques in Australia and overseas, Simon was convinced that a regular, annual course was needed to provide surgeons with predictable access to the information. It would be a hands-on dissection course, with Bryan Mendelson leading the dissection. Simon’s proposal was simple: ‘I’ll organise the course and you do the teaching’ and this is what happened.

With characteristic energy and enthusiasm, creating list after list, Simon propelled the first course along. In an email to Bryan Mendelson three months prior to the event in 2009, he wrote, ‘I really think we can make this into a world class meeting within 12 months,’ and went on to speculate about a future where 200-250 surgeons might attend. (2)

That first course, in 2009, was called the Workshop of Facial Anatomy. It was a pilot course largely attended by local surgeons and was hugely successful, receiving enthusiastic feedback. The faculty comprised Professor Ian Taylor AO, Professor Norm Eizenberg, Dr John Ladakis, and Drs Chin-Ho Wong and Simon Bernard (both of whom had completed a fellowship with Bryan Mendelson), with Bryan Mendelson as Head of Faculty.

It was underwritten by the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), which Bryan had been an active member of for many years, and this relationship between MAFAC and ASAPS was to continue as MAFAC developed.

Many lessons were leant from the 2009 Workshop. The name was changed to the Melbourne Advanced Facial Anatomy Course (MAFAC) and the structure became more heavily focussed on dissection and less around theory. To implement this, a higher ratio of cadaver heads to participants was required. In 2009 there had been one head per four participants and it was agreed that this ratio needed to be halved as quickly as possible. In 2010 the ratio was one head per three participants, and in 2011 the required ratio of one head per two participants was achieved. The number of demonstrators to participants was also increased – MAFAC in Melbourne now has a regular ratio of just over 30 attendees (the maximum capacity) to 15 or more faculty.

Scheduling was also improved. More than one and a half days was required to provide the dissection time that participants needed. Ideally, participants would also have the opportunity of an afternoon on the second day to go over what they had learnt, using the second side of the cadaver head. In 2010 MAFAC became a full two day course and by 2011 the pre-course afternoon was being used to provide introductory talks about the principles of anatomy. This was an important step, enabling attendees to begin the process of ‘thinking about the anatomy of the human face’, in preparation for what they would learn in the following two days of dissection.

Although MAFAC does conduct abbreviated courses overseas, the two and a half days format remains the preferred length; most people stay right to the end of the second day and emerge exhausted.

Two and half days of intense concentration means that quality food and care needed to be provided to attendees. In 2009 Simon had lugged shopping bags full of drinks to the workshop from the local Aldi! It was a lesson quickly learnt. The next year professional caterers provided lunchboxes and participants couldn’t believe the quality. In 2011, MAFAC’s third year, a barista was employed – probably the first dissecting course to employ its own barista. Again people couldn’t believe it. But it was an important step and one that has been repeated every year. People need to be able to leave the dissecting room and sit down and relax for a while, and a good coffee is part of that relaxation.

After Simon’s untimely death in January 2011, the MAFAC faculty wondered if it could continue without his energy and enthusiasm, but decided it must do so in his memory. Professor Mark Ashton, Head of Plastic Surgery at Royal Melbourne Hospital, took over Simon’s role as MAFAC Course Chairman. Simon had always wanted MAFAC to have its own scrub hats, with the MAFAC logo. After his death, and in his memory, embroidered scrub hats were ordered for faculty members, with every participant given their own MAFAC scrub hat.

In 2013 a landmark transition occurred, with the move to the Royal Australasian College of Surgeons. The Anatomy Department of Melbourne University had been designed for 150 medical students, and MAFAC needed better lighting, a less cavernous theatre and more pleasant environs. It moved to the Special Skills Laboratory at the Royal Australasian College of Surgeons, starting with a ‘short course’ at the invitation of the Australian Society of Plastic Surgeons for their 2013 Congress. Participants now enjoy the pleasant atmosphere, amenities and smaller dissection room of the College, as well as the spacious courtyard where they can relax at lunchtime.

The Savage Club dinner, held midway through the course in Melbourne, has become a much-loved social highlight of MAFAC. Everyone immediately appreciates the wonderfully bohemian atmosphere of this historic club, and a sense of community builds as the guests from many countries unwind together. It also imparts a feeling for the type of city Melbourne is. As one visitor commented, that night, we felt like we had become a special, private club ourselves, within the fabulous surrounds of the Savage Club.

4.

AN AUSTRALIAN TEACHING EXPORT

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.

5.

WHY HAS MAFAC BEEN SUCH A SUCCESS? THOUGHTS ON OUR METHODOLOGY
by BRYAN MENDELSON

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:

  1. 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.

2. 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.

3. 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 Alfred 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.

-Bryan C Mendelson

6.

MAFAC TIMELINE 2009 – 2019

2009 – Inaugural Workshop

November
Melbourne University, Department of Anatomy
Fifteen attendees from Australia and New Zealand

2010

November
Melbourne University, Department of Anatomy
Twelve attendees from Australia and New Zealand

‘… a brilliant course in facial anatomy and techniques. The mix of precise anatomical teaching and dissection leads to more expert knowledge that will lead to safer and improved patient outcomes.’

2011

November
Melbourne University, Department of Anatomy

Nineteen attendees from Australia, New Zealand, Bahrain, Philippines, Russia, Singapore, Thailand, Turkey and United Arab Emirates

‘An outstanding course!’
‘You gave me the courage of going down to the SMAS. I learnt a lot in two days.’
‘Great course. Mandatory for anyone doing facial aesthetic surgery.’
‘Great course. Good organisation. Excellent instructions, talks, hands on cadaver dissection to
reinforce the didactic teaching.’

2012

November

Melbourne University, Department of Anatomy

Twenty nine attendees from Australia, Greece, Hong Kong, New Zealand, Philippines, South Korea, Sweden, Thailand and Turkey

2013

April
Royal Australasian College of Surgeons, Melbourne
MAFAC’s first one-day abbreviated course, provided at the invitation of the Plastic Surgery Congress, Australian Society of Plastic Surgeons. The was first course held at the Royal Australasian College of Surgeons.
Twenty three attendees – 14 observers

2013

November
Royal Australasian College of Surgeons, Melbourne
Twenty six attendees from Australia, Canada, New Zealand, Hong Kong, Singapore, South Korea, Switzerland, the UK and USA.
It is a course that will bring the practice of facial surgery to the highest level.’
‘The structured and progressive approach to complex facial anatomy was immensely useful in furthering my understanding. I am sure it will help my patients.’
‘I would definitely recommend this course … A really enjoyable couple of days.’

2014 – First international presentation of MAFAC

April
Moscone Center, San Francisco, USA
MAFAC’s first international presentation, a six hour course at the invitation of the Aesthetic Meeting 2014, (American Society of Aesthetic Plastic Surgery). Nineteen attendees.
‘I thought the course in San Francisco was one of the most exceptional educational
experiences of my career.’

2014

May
Royal Australasian College of Surgeons, Melbourne
‘I will tell my colleagues that MAFAC is the most excellent anatomy course in the world!’
‘This was an outstanding educational experience run in a professional and organised manner and delivered by enthusiastic and knowledgeable faculty.’
‘Excellent course that gave participants a deep understanding of facial anatomy all in 2 days!’

2014

October
Royal Australasian College of Surgeons, Melbourne
Thirty seven attendees from Australia, Germany, Indonesia, Israel, Japan, Malaysia, Russia,
Singapore, South Africa, South Korea and Taiwan
‘World class faculty and course. As a Melbournian, I am proud that this course exists here. Congratulations to all concerned!’
‘The most productive two days of further conviction I have had in many years.’

2015

May
Palais des Congres de Montreal, Quebec
A six hour course at the invitation of the Aesthetic Meeting 2015, American Society of Aesthetic Plastic Surgery
Thirty eight attendees from Australia, Argentina, Canada, Indonesia, Brazil, Taiwan, Germany, Bulgaria, the UK and the USA

2015

November
Royal Australasian College of Surgeons, Melbourne
Thirty two attendees from Australia, Argentina, Belarus, Brazil, Canada, Hong Kong, Kuwait,
New Zealand, Russia, South Africa, South Korea, Taiwan, Turkey, Germany and the UK.
‘An excellent Panel. Friendly sincere guidance. New productive teaching for facelift.’
‘This was the best academic activity I have done in my career!’
‘Probably the best facial anatomy Course in the world. Logically structured program, attentively prepared lectures and nicely organised dissection sessions. I strongly recommend it, especially young plastic surgeons who pursue excellence in their facial rejuvenation practice.’

2016

March
Mandalay Bay Hotel and Delano Hotel, Las Vegas, USA, at the invitation of the Aesthetic
Meeting 2016, American Society of Aesthetic Plastic Surgery.
Twenty seven attendees
‘Superb course, transformative’
‘Safely recommend to others, Australia too far away, ASAPS offers easy access’
‘Great, very clear, understanding pre-reading manual, excellent tutors.

2017

April
San Diego Convention Centre
The Aesthetic Meeting, American Society of Aesthetic Plastic Surgery
Thirty attendees (eleven attendees were returning for the second or third time, and one
attendee for the fourth time), and 17 faculty.
‘Good content and illustrations with excellent diagrams and explanations.’
‘Best Course I’ve taken and I’ve taken a lot of cadaver courses. Thank you, hope to be back.’

2017 – The first MAFAC Graduate Course

October 17-18
Royal Australasian College of Surgeons, Melbourne
The first graduate course was a sell-out with 32 former MAFAC graduates returning to Melbourne from the USA, Brazil, Mexico, Taiwan, Argentina, Russia, the Philippines, China, Germany, the UK, New Zealand, and Australia.
Visiting faculty including Dr Daniel Labbé from France, and Dr Giovanni Botti, from Italy.
‘Outstanding faculty’
‘Loved the Q&A’s.  From theory to direct practice it doesn’t get any better. Level of expertise is mind blowing!’

2018

April
Javits Convention Centre, New York,
At the invitation of the Aesthetic Meeting 2018, American Society of Aesthetic Plastic
Surgery.
Thirty three attendees and 17 faculty.
‘New way of learning surgical anatomy. Ground breaking! More people need to learn the deep space technique.’
‘Unique information with revolutionary approach to lower face and spaces.’

2018

October 11-13
Royal Australasian College of Surgeons, Melbourne
Thirty two attendees from Taiwan, Brazil, New Zealand, Germany, Indonesia and Australia,
and 15 faculty.
‘Great lectures all very well explained. The dissection sessions were clearly demonstrated with great tutors available.’
‘Highly recommended; the best facial anatomy in the world’
‘This course has allowed me to be more confident in facelift surgery.

2019 – MAFAC’s First Short Course

May 18
New Orleans Convention Centre, New Orleans, USA
At the invitation of the Aesthetic Meeting 2019, American Society of Aesthetic Plastic Surgery. Twenty two attendees.

This was MAFAC’s first short course, at just five hours. Feedback from attendees showed that it was one of the most successful and enjoyable MAFAC courses, although many would have liked more time. Despite the limited time, there was unanimous feedback that the course had changed people’s understanding of facial anatomy.

2019 – Upcoming – The Second MAFAC Graduate Course

October 2-3
Medical Engineering Research Facility (MERF) Queensland University of Technology. Prince Charles Hospital, Brisbane, Australia
MAFAC’s second Graduate Course will feature guest faculty Sam Hamra and Andrew Jacono, who will demonstrate their techniques using magnified, high-resolution video.

7.

REFERENCES

  1. Australia, Argentina, Bahrain, Belarus, Brazil, Bulgaria, Canada, Cyprus, Finland, Germany, Greece, Hong Kong, Indonesia, Iraq, Israel, Japan, Kuwait, Latvia, Lebanon, Malaysia, Mexico, New Zealand, the Philippines, Russia, Singapore, South Africa, South Korea, Spain, Sweden, Switzerland, Taiwan, Thailand, Tunisia, Turkey, the United Arab Emirates, the United Kingdom and the United States of America.
  2. Simon Bernard died unexpectedly in January 2011, whilst on a skiing holiday in Utah. He was 44 years old with a young family.