Consultant plastic surgeon Mr Ali Juma outlines why he believes all aesthetic practitioners should undergo training with the use of cadavers.
Cadavers have, for many years, been used in medical education both at undergraduate and postgraduate levels, including in specialities like non-surgical aesthetic and cosmetic surgery practices. This article aims to highlight the benefits of donated human cadavers in non-surgical aesthetic procedures, including the learning process and ethical issues that are associated with such practises.
To do no harm to the patients we treat is an important edict of the Hippocratic Oath and must be upheld for our patients’ protection.1 Training in non-surgical aesthetic facial treatments is not standardised, and often involves volunteer patients undergoing treatments administered by trainees, albeit under an experienced practitioner’s supervision. The trainee’s knowledge of the complex applied facial anatomy may be based on theory and two-dimensional diagrams in the literature, which do not have the same visual impact on the learning and practicality of three-dimensional cadaver dissected faces, supported by an appropriately trained, credentialed, and experienced practitioner.
Anatomy knowledge and teaching has played a major role in optimising a crucial stage in the training of prospective physicians, which is reflected in one of the first portraits by Rembrandt in 1632 known as the ‘Anatomy Lesson’ in which medical students study a cadaver under the director of their mentor, Dr Nicolaes Tulp.2 Hence, cadaver facial dissection provides an opportunity to better understand the facial tissues’ anatomy, the fat compartments, the structural relationship these tissues share and the relevance to surface anatomy.3
Studies have indicated that cadaver dissection, when connected to medical informatics, can expedite and enhance preparation for a patient-based medical profession.4 This is necessary for acquiring scientific skills, adding to a communicative, moral, ethical, and humanistic approach to patient care.4 The cadaver has been referred to as ‘the first patient’ during medical training and it allows the student to earn the privilege of bringing healing to the patient, i.e. the human cadaver acts as a surrogate patient contributing to the student learning process of medical healing.5 Hence, in my opinion, the interaction between cadaver and student is a ‘nodal point’ in medical education, from which evolves applying medical science to visual anatomy.6
The value and impact of cadaver training has been shown to improve applied facial anatomy knowledge for most candidates who participate in such training courses.3 It may also enhance the candidate’s confidence in performing non-surgical facial aesthetic procedures.3 It is important to add that cadaver courses and facial aesthetic training are not the only mechanism of improving safety; however, in my opinion, a structured training pathway, which includes theory of knowledge, cadaver dissections and applied hands-on learning must be contemplated. This should be followed by support from experienced and appropriately-credentialed practitioners. It is my belief that such a pathway makes for a safer patient journey.
A detailed knowledge of facial anatomy vascular framework is crucial for delivering safe non-surgical aesthetic procedures.2 A study by Kumar et al. in 2018 documents that there is currently no core consensus for the teaching of facial anatomy to aesthetic practioners. This study’s purpose was to ascertain the critical anatomical structures to avoid serious complications resulting from non-surgical treatments.2 Based on an international experts’ survey, the researchers concluded, especially following the significant increase of aesthetic courses, that a ‘Core Syllabus’ would act as a blueprint for the educators while putting a programme together.2 Although this study was not about cadavers and anatomy, it did demonstrate that standardising a curriculum will help learners to have a comparable learning experience and also help educators to methodically see as to how effective the teaching is and whether improvement is required.
With cadaver teaching comes regulations of handling cadaver’s tissue and of course the ethical considerations. The main ethical concern of cadaver dissection lies in respecting human life.7 Dissection laboratories have etiquette, including preserving dignity, respect, and limiting access to those who work there and the participating candidates.7
Also in the summary of the main points of The Human Tissue Bill 2003-04, the Government believes that this bill will; ensure that no human bodies, body parts, organs or tissue will be taken without the consent of relatives or patient. Once the coroner’s enquiries have concluded, then the organs and tissues taken will come under the authority of the Bill.8
The laboratory safety standards have to be respected and all the tissues collected from the cadavers must be disposed of according to regulations of the Human Tissue Authority, the regulator for human tissue and organs.9 Photography in the cadaver lab falls under the dissection room etiquette and must be respected. We must remember that we are not only dealing with human cadavers; we are also dealing with their relatives, hence, both must be given the respect to dignity and privacy they are entitled to.
Not everybody will agree on the use of human cadavers and teaching. The reasons may vary from personal reasons, moral, and religious beliefs; however, in my opinion in all circumstances, all those who participate in the dissection of cadavers must be from the medical profession and have a background of anatomical knowledge prior to their participation. In 2016 the Daily Express newspaper wrote that critics had said a two-day course using cadaver heads teaching non-medics to inject wrinkle-relaxing injections was labelled as abuse of the good will of those who donated their bodies to doctors and specialists which ‘beggars belief’.10 Although I don’t approve of the training of therapists in these treatments, in my opinion, cadaver dissections in the relevant settings are of profound importance in training medics. This three-dimensional visual method makes it an essential part of the curriculum adding to and improving patient safety.
The use of human cadavers and cadaver parts in non-surgical aesthetic treatment has, in my professional experience, become more popular in the last decade. This privilege has further fortified the training ladder of options to achieve a safe environment to trainee candidates, where they participate with an interactive group of like-minded individuals from an appropriate background of training, expertise, and experience.
However, with this use of cadavers comes national rules and regulations, in addition to laboratory etiquette, all of which have to be respected and implemented in order to instil not only respect from the public, but also acquiring their confidence to perpetuate the donation of human bodies and parts to allow us this precious privilege of learning.
Disclosure: Mr Ali Juma is a trainer for LMEDAC and teaches with the use of cadaver.
1. The Hippocratic Oath, (US: Medicine Net, 2018) <https://www.medicinenet.com>
2. N Kumar, Swift A, Rahman E., ‘Development of “Core Syllabus” For Facial Anatomy Teaching to Aesthetic Physicians: A Delphi Consensus’, Plastic & Reconstructive Surgery- Global Open, (2018) Volume 6 Issue3 – P E 1687.
3. Narendra Kumar and Egram Rahman., ‘Effectiveness of Teaching Facial Anatomy Through Cadaver Dissection on Aesthetic Physicians’ Knowledge’, Adv Med Educ Pract. (2017) 8: pp.475-480.
4. Aziz A M, McKenzie J C, Wilson J S, Cowie R J, Ayeni S A, Dunn B K., ‘The Human Cadaver in the Age of Biomedical Informatics’, The Anatomical Record (New Anat) (2002), 269, pp.20-32.
5. Kasper A., ‘The Doctor and Death’, In: Feifel H. Editor., ‘The Meaning of Death’, New York; McGraw- Hill. (1969) pp.259-270.
6. Pellegrino E D, ‘Educating the humanist physician: An Ancient ideal reconsidered’, JAMA (1974) 227, pp.1288-1294.
7. Shaikh S T, ‘Cadaver Dissection in Anatomy: The Ethical Aspect’, Anatomy & physiology: Current Research. (2015).
8. The Human Tissue Bill, Bill 9 of 2003-04, House of Commons 04/04, 9th January 2004 <https:// researchbriefings.parliament.uk/ResearchBriefing/Summary/RP04-04>
9. Human Tissue Authority (UK: Gov, 2018) <https://www.hta.gov.uk/donating-your-body>.
10. K Corcoran, Bodies donated to medical science used for BOTOX PRACTICE, 2016, Express, <https://www.express.co.uk/news/uk/631553/Bodies-donated-to-medical-science-used-for-BOTOX-PRACTICE>