"Most of the younger patients, who are of the Snapchat generation, they're like, 'Cool! My friends want to watch. They want to watch my surgery as it's happening.'"
Open up @therealdrmiami's Snapchat story and you'll find yourself inside an operating room as a gloved hand makes small incisions on someone's sliced-open abdomen or face while hip-hop thrums quietly in the background. Watch long enough and the screen will fill with blood and lumps of fatty tissue and jiggly silicon implants as the doctor makes his careful snips to rearrange the shapes of his patients' bodies. This isn't some kind of performance played out on Snapchat—this is a real operating room, with a real person under the knife, and a real surgeon calling the shots.
That surgeon is Dr. Michael Salzhauer, a board-certified plastic surgeon at Bal Harbour Plastic Surgery in Florida. He's also a social media freak, better known by his screen name, Dr. Miami. He seems to take his phone wherever he goes, creating a trail of tweets, Instagrams, and Snapchats that chronicle his entire workday—surgery included. His Instagram feed is filled with before-and-after photos, pictures of his hot clients, and, naturally, the occasional inspirational quote. He calls his patients #beautywarriors; recently, he ran a "meme contest" on his Instagram, for which he received over a thousand submissions.
When I first saw Dr. Miami's Snapchat story, my stomach lurched. Watching a stranger get a tummy tuck in real time was completely disturbing to me—but it was also intriguing. I mean, who the hell was this surgeon-turned–social media king? I called his office to ask him myself.
VICE: What does an average day look like for you?
Dr. Michael Salzhauer: I get into the office anywhere between 7:30 and 8 AM, and lately I leave between ten and midnight. It's intense.
During that time, you're constantly posting to social media.
Yeah. This is the most fun I've had since medical school. You know, in medical school, that's the last time most doctors get to make a joke. So the social media allows me to express my creativity, to reach out to patients, to connect to them on a human level, and not so much the buttoned-up, white-coat, I'm the doctor sort of thing.
Would you say that's part of your personality, or is it mostly for marketing your business?
It's like this: I don't think I would've had the social media success or influence if I wasn't at this stage of my career. In other words, it's taken 19 years in practice and training and 10,000 patients to get to the level of skill and consistency with results and expertise to where I can show off a little bit on social media. This wouldn't work for me if I was just opening up my practice. It just wouldn't. But, of course it's had an effect on the business. I was pretty busy anyway, but now I'm crazy busy. I'm booked until the end of next May. Every single day. It's like, a thousand people, paid and signed up for surgery for the foreseeable future.
And that's all because of your social media presence?
Look, anybody could go online and have an Instagram and all that stuff, but I think it's the way I'm able to show my results as they're happening. You can look on Instagram or Snapchat and you can see what I do [in real time]. You can see me talking to the patients before and after surgery, and you can really see the whole process. It makes people say, "I can put my face in this person's hands."
The videos on your Snapchat story are... kind of stomach-turning. I mean, there's really gory operational footage.
There is. My Snapchat story is basically my whole day. You see me walk into work, you see me talking to the staff, you see me—if the patients allow, and only about half of them allow it—doing the operation. Most of the younger patients, who are of the Snapchat generation, they're like, "Cool! My friends want to watch. They want to watch my surgery as it's happening," which I think it's cool. It really demystifies the whole process. Yes, they are gory, but nobody has to watch it. It's not like it's being broadcast on TLC or something. You have to actually hold your finger on the screen if you want to see it, and the people who follow my Snapchat story, they know what's coming.
So you have a conversation with all of your patients where you say, like, "Hey can I Snapchat your operation?"
Oh, of course. All the patients that you see have signed consent forms for that, for social media. The majority of them want their face covered, or tattoos covered, but some of them are like, "No, I would like you to write my boyfriend's name on my back, and shout out to this person, and I would like you to play this type of music during the surgery..."
Wait, you actually get requests for how to take the Snapchat?
Absolutely. I mean, look, I'm 43. People of my generation would be horrified [of having their operation Snapchatted]. This would be shocking to them, because of how my generation views privacy and online security and all that. But kids today—and really, anyone under the age of 25 or 30—they see the world through a completely different lens. Not only is it not shocking to them, they're like, "Yeah, cool. Can you do that?"
Kids these days are so thirsty.
This generational thing—I can see it in my own practice. If a woman comes in and she's over the age of 40, I can tell you for sure, she's going to have trouble with Snapchat or having her pictures go up. But the younger generation, they're out there. You know what the difference is? They're not ashamed. They're not ashamed to talk about their bodies, or discuss their insecurities... I think it's a good thing.
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Would you also say that the images you share on social media do a service in showing what the plastic surgery experience is really like?
Yes, exactly. That's what draws people to it—it's very genuine. I mean, you see the bruising. I tell you right there in the comments, "Yes, this looks like it hurts, because it does. This scar looks long, because it is a long scar. And yes, that scar will be there forever. And yes, she'll be out of work for two or three weeks." This stuff is not like getting your hair cut. I don't sugarcoat it in any way. If you want to see how it's actually done, go onto the Snapchat, and you can see. I've got, on any given day, between 50,000 and 75,000 Snapchat viewers. And they're from all over the world.
How do you keep up with that?
I've got two full-time social media assistants who do the actual snapping and responding to people. There are people from all over the world—a lot of them are medical students, nursing students—and they ask questions about the anatomy, and why I'm doing certain things. It's cool. Really, it's fun.
You have two full-time social media assistants. Do they just, like, follow you around and document your workday?
Yeah, pretty much. You can see them on the Snapchat story—Ashley and Brittany. They also answer inquiries. I've got like, 100,000 followers on Instagram, so I get a lot of direct messages. I'll have other surgeons' patients send me questions, like, "I had a breast augmentation three days ago, and this hurts, is that normal?" And they don't feel comfortable, for whatever reason, asking their doctor, so they hop online and direct message me, and then Ashley and Brittany will answer it. I'll be operating and they'll say, "What do you think about this?" and they'll type back direct messages.
So your social media interactions are the same conversations you might have in a doctor's office, except instead, they're happening on your Instagram.
Right, and directly to me, which is kind of cool. Obviously there are surgeons who are more experienced than me, but there are a lot of surgeons who are less experienced than me, and they have patients everywhere. So literally, a person in Dubai can send me a direct message that says, "I had a rhinoplasty four weeks ago, what do you think of this?" Then I can click on the picture, look at it, message back to her. They can get a second expert opinion instantly, from anywhere in the world. Technology is amazing.
I've seen you post things on Instagram saying, like, "I'll be offline for a few days, so don't send me any DMs, because Instagram has a limit on how many can stay unanswered in your inbox." How many of these messages are you getting?
It's nonstop. It's like drinking out of a fire hydrant. There's no way to explain, unless you're sitting here watching my phone blow up. You have no idea how many messages I get between the Snapchat and the Instagram. It's hundreds upon hundreds each day. In the beginning, I tried to do it all myself. Then I hired one person, and then I realized this was more like a two-person job, literally all day long. I'm a little bit of a perfectionist, so I don't like any messages going unanswered, so I try to get to all of them. But that's difficult, because there are hundreds upon hundreds each day.
Your posts seem to have adopted this teen vernacular—Emojis and all. Like, I'm looking at your Instagram and there's a post that says: "Mommy Makeover On Super Fleek." Is that you or your social media people?
No, no, that's all me. I'm not [a millennial], but I've sort of been drafted into it. I have a 15-year-old daughter, who actually introduced me to Snapchat, and I also work with a lot of young people. In my office, I've got a whole bunch of millennials, and I hear how they talk. I see how they text message each other and me. I'm a real informal kind of boss, so they can let their hair down a little bit, and I've realized that those are my ideal patients. That's sort of how we got into this. Like, my practice is completely limited to patients under the age of 50. If you're over the age of 50, you can't even see me.
I decided a few years ago that I only want to operate on the patients that I like and doing the operations that I enjoy. I don't enjoy doing facelifts, so I don't do them anymore. I like doing breast augmentations, tummy tucks, Brazilian butt lifts. Those operations work best in younger patients in general. They're also safest in younger patients. I mean, think about Kanye's mom, who tragically died because she had a heart condition and she wanted plastic surgery and she shopped until she found a plastic surgeon who would do it for her, even though she wasn't fit. So you're going to have more and more of those types of patients over the age of 50, so because I limit my practice to people under 50, I find my days go by beautifully. I'm doing the operations that I like, on the patients that I like, who are the least risk, and they look great. To reach out to those patients best, you really have to use social media.
Follow Arielle Pardes on Twitter.