The Real Dr. Miami

An interview with the Snapchat surgery phenomenon

by Miles Cooper

A body lies on an operating table. Everything but the breasts is obscured by blue cloth. Fetty Wap croons over the speaker. A scalpel comes into focus, smoothly cutting clockwise around the nipple to expose the fat beneath. Skin is sliced away from the areola. Fat is removed, a cavity is formed and a gloved hand slides a clear saline pouch into the cavity. The image jostles as the iPhone presumably changes hands. A needle plunges into the skin and out again, tugging at the skin to pull it around the nipple, sealing the cavity.

This is an image that the average person usually never sees. Michael Salzhauer, a plastic surgeon from Bal Harbour, Florida, Snapchats this reality to the masses. He uploads two to four surgeries per day to his snap story, enabling his followers to see what plastic surgery looks like in real time.

Follow him on Snapchat @therealdrmiami.

Therealdrmiami: Hello, my name is Michael, I am a plastic surgeon. They call me Dr. Miami, and I make people feel better about their bodies (laughs). Watch me as I Snapchat my way through Monday. [It was Friday.]

Miles: Okay, so how long have you been practicing [medicine] for?

RDM: The long story short is I have been in private practice for 12 years. I graduated medical school in 1996 and then went into a surgical residency program that lasted, well, including fellowship training, seven years. So I am 19 years out of medical school.

M: You are known for your Snapchats. How long ago did you start Snapchatting personally as well as professionally?

RDM: Only since February.

M: Was your first encounter with Snapchat personal use? Or was it something that was always going to be used for your practice?

RDM: I went straight into using it for my practice; I didn’t even know it existed until I had an Instagram (1) account—sorry, a patient is calling me; I have to take this. (Runs out of the room. Comes back in the room one minute later). We had an Instagram account that had something like 90,000 followers. I was very proud of it. It had taken me several months to build it up. We were almost [at] 100,000 [followers]. Then I woke up one morning and it was deleted.

M: Whoa.

RDM: I know, right? I immediately contacted every connect I knew at Facebook and Instagram trying to figure out how to get it back. They were like ‘No, dude, sorry. Just try again its no big deal, it’s just 100,000, it’s not like a million.’ I told my daughter, who at the time was 15, and she said, ‘Well, why don’t you try Snapchat?’ and I said, ‘What’s Snapchat?’ I mean, I kinda knew what it was, but I had no idea how to use it. I downloaded it and the next day I just started shooting the procedure. When I came home and showed my daughter, she said, ‘Dad, you had 2,000 people watching this today.’ It got to about 75,000 people watching it everyday. Then (2), one of their writers did an article about it, then Buzzfeed (3) did one, and then it went up to 200,000. We average between 250,000 to 300,000 viewers per day now.

M:  Wow, I have to ask, do you remember that first surgery you Snap’d? What was going through your mind? ‘Are people going to watch this?’

RDM: I had no idea! (laughs). The Instagram was easy, you just did before and after pictures and funny shit we did in the office. It was pictures…much more like a show, more of a continuous story. I had no idea how people were going to react to the blood and the guts. Some of the first messages we got were like ‘Coool’ or ‘I am sick to my stomach. I can’t watch this.’

M: You call it a show; do you think of this as your medium? An art form?

RDM: Yes, I think of it as my art form. Snapchatting for me is what writing for Cipher is for you.

M: What was your outlet before social media?

RDM: Just human bodies. I play the piano, but piano wasn’t nearly as creative as this. When I was in medical school I was the class volley, and this Snapchat is the most fun I had had since then, 20 years ago.

M: I have been following you for sometime now, and you seem to Snapchat a lot of your life, your vacation to Israel among other things. How do you find balance? It’s your art form, but where do you draw the line?

RDM: It’s not easy to balance. I’ll probably look back on this in five years and think ‘What the hell were you thinking?’ but for now it’s enjoyable and I don’t mind it. It’s a hobby.

M: Has Snapchat become the main way you use social media?

RDM: Definitely. I mean Instagram is always there but, well, this is a lot more fun. Not only that [Snapchat] is a lot more interactive but because people can Snapchat us back instantaneously. Look, if it was just me and I didn’t have Brittany and Ashley [Social Media Coordinators/Assistants for Dr Miami] I couldn’t do it. I couldn’t respond to all the messages and also work. (Turns around). Thank you, Brittany! It’s become a nice way to communicate with the viewers. A lot of them are medical students and nurses or just people who have no idea about plastic surgery and want to ask questions about what is happening or there are just fans who want to say ‘hi.’

M: You’ve branched out from just being the plastic surgeon to creating a character, a mythos, this idea that you’re not just Michael, but you are The Dr. Miami.

RDM: (Laughs). I like that. Maybe a superhero. I could go to the next Comic-Con. I feel like therealdrmiami has become larger than myself for sure, it’s cool, it’s inspiring kids to give a crap about school. I have five kids, and I know how difficult it can be to engage them, for whatever reason, even if it’s just teenage boys tuning in to see boobs, but it has seemed to kind of go beyond that. Hopefully I can use my superpowers for good.

M: You joked when asked about why you were making these clubs that it was so you could get an extra cookie from some doctor you inspired when you’re in the old folks home. Jokes aside, what spawned this idea of therealdrmiami club?

RDM: It was a few weeks ago. I was doing a Periscope (4) session in my bathroom like I sometimes do on Saturday nights when everyone is asleep. xftecWe half-jokingly played around with the idea and everyone was like, ‘Yeah, it’s a good idea,’ and I brought it to Brittany and she said, ‘We have been meaning to make something like that,’ so I brought up the idea to the Snapchat community and people seemed to want it.

M: You mentioned Periscope. Do you think that or something else could replace your Snapchatting?

RDM: I don’t think so, Periscope is limited. It’s good for short chat sessions but if you try and do it throughout your whole day or even a surgery it’s too much and it becomes frustrating.

M: The conversation about plastic surgery in America is that it’s excessive and not something normal; beauty should be ‘natural’ and not ‘fake.’

RDM: My opinion is that the media…tends to be wrong.  [With regards to] South America, I have literally had my patients tell me that they see their plastic surgeons more than their primary care doctor when they go back home to South America. If you are a young healthy person in your 20s or 30s it makes sense, whereas here because of what the media has done with shows like Botched (5) got green lit because it fed into mainstream media’s vision of what plastic surgery is. They only want to show it when it’s ‘botched;’ they don’t want to show how for a majority of people it helps them. Rarely do they show how plastic surgery helps, and if they do they spin it. That girl who got bullied and a plastic surgeon offered her plastic surgery for free was painted as,  ‘She had to resort to plastic surgery to fix her ears that stuck out, which made her get picked on’ when the story should be, ‘Why is it any different than getting braces?’ If her teeth where sticking out of her face, her parents would be arrested for negligence, but for some reason plastic surgery has gotten this negative connotation.

M: What about in South Korea, where surgeries are done to anglicize people, with double eyelid surgeries?

RDM: To be honest, I don’t know enough about South Korean culture or what is happening to give an informed answer, but the point is that plastic surgery is to make someone feel better about themselves. Standards of beauty change country to country and within countries, generation to generation. When I grew up in the 80s, you had to be skinny as a stick to be beautiful and if you had a big butt, people would liposuction it away; now that’s completely flipped around. I don’t think there is anything wrong with anyone trying to look a certain way if it makes them feel better about themselves. If you want a big nose, have a big nose; you want a small nose, have a small nose, you want a big butt, then have a big butt. That’s up to you.

M: Do you think that it’s going to become more normalized and commonplace in America? Or is the trend going away from plastic surgery?

RDM: Yes, I think this current generation, because of social media and access to the Internet, is able to cut through bullshit much easier and see the realities about plastic surgery unlike older generations, taking the good and leaving the bad. The media only wants to show the bad, and I think people realize this and can see through it. There is a website called; it’s a huge site with three to four million visitors per month, where people who have undergone plastic surgery post their results and experiences. It’s not quite as graphic as what I’m showing, how the sausage is made in the kitchen so to speak, but a realistic view of what plastic surgery is. You know nothing is without risk, but the technology is always getting better with everything. I do think that 50 years from now they will have techniques that are beyond surgery, manipulating how genes express themselves, having fat cells burst apart, all without having to cut anything. I do think there will be a time where what I do will become obsolete, which I look forward too, because all I want in the end is my cookie. (Laughs).

M: What’s your opinion on the term ‘plastic surgery’?

RDM: Yeah, I think it’s a bad name, but it’s been with the practice for 100 years now and when it was coined plastics w new. (Laughs). Like, ‘Ooooh its made out of plastic that’s great!’ You know though that plastic comes from the Greek word plastikos, which means ‘change;’ it doesn’t mean something is fake, or use plastic in the surgery. The practice came into being after World War I when plastics were new and sounded cool, but in this day and age plastic is seen as a negative thing, a resource that doesn’t degrade and a waste on the planet, that it’s fake. You know the only time I use anything fake in my procedures is with breast implants, everything else, with noses or butts, I am just shaping or moving people’s own fat around.

M: In your Vice interview you mentioned that you don’t like doing facelifts.

RDM: I don’t like operating on old people; it’s a little more dangerous. I know this is going to sound weird, but I feel like plastic surgery is wasted on the old.

M: Interesting.

RDM: I feel that and I think the reason that people associate plastic surgery with old people is that old people have money, and that plastic surgery used to be a very limited resource. Only people that had money could afford to go get plastic surgery, so you had this thing where doctors on Park Avenue could charge 25,000 dollars to people who could afford 25,000 dollar surgeries to have their faces lifted or look frankly, weird (Laughs).

In my opinion, the earlier you have whatever bothers you changed—your ears, nose or breasts—the bigger area under the curve of enjoyment that you will have will be bigger. I have people in their 30s come to me to get this weird mole that’s been growing out of their cheek for years and all I can think is, ‘Why did you have to wait till now?’ A simple operation could have changed who they married, whether they got hired for a job and how they feel about themselves; whether they look someone in the eye. Changing someone’s self-esteem changes the whole trajectory of his or her life. It’s one thing if a 60-year-old wants to look like they’re 50, but it’s just that old people don’t want to look younger, they want to be younger, and I don’t have a time machine.

I’ll tell you when I first opened my practice, I did 65-80 facelifts a year, a lot of facelifts on old people, so I have experience to which I speak about here and you know they are never as quite as happy as a 20-year-old girl who is an A-cup and can now fill out the clothes she likes and so forth. It’s true you know most guys just think, ‘Haha, how silly.’ But it’s true for the teenage girl who cries at night because she doesn’t like her nose. It’s not shallow, it’s real tears. Your self-esteem can really impact your whole future. Gosh, I talk a lot don’t I?

M: Don’t worry about it. Do you get men coming into your practice?

RDM: I do. It’s about 10-15 percent men that I get. I think women are more comfortable with the idea [that] it’s on my Facebook and Instagram. ‘Beauty is power,’ and I think women have always known that. Men don’t realize it but [beauty is power] works for men as well, it’s actually—well there is a book called Erotic Capital, which, if you have time and ten bucks it’s a good read—but it says that men generally get more bang for their buck in terms of attractiveness than women tend to. I think it’s because men care less [about being beautiful] than woman do so the ones that do stand out more.

M: What is the most common surgery you do for men and women?

RDM: For women right now, it’s the Brazilian Butt Lift, breast augmentation and then rhinoplasty. Mommy Makeovers—you know, tummy tucks and breast augmentations. For men it’s rhinoplasty, Liposuction, chin implants, but I have had some men get some butt lifts as well; I get at least five a year.

M: You talk about young people. A big part of your fame comes from the fact that you play a lot of trap music in your surgeries.

RDM: I can promise you I’m not the only doctor who plays trap music during surgeries! I’m the only one you get to see in the operating room, but I am not the only doctor playing trap!

M: How long have you been listening to rap and trap music? Or is it just a part of your show?

RDM: Probably since the Beastie Boys—1987 was when I started listening to rap. You know it’s a democracy in the operating room, so if Brittany likes something or Jerome (another surgeon) turned me on to Soca7 music, you know, and I have never really heard about Soca music, I knew regular reggae but Soca is very new to me. My musical tastes are eclectic because of what I listen to in the OR.

M: If tomorrow were going to be your last surgery what music would you play?

RDM: When I was a teenager I listened to rap, when I was in college I listened Depeche Mode and The Cure, when I was 14 I loved Iron Maiden and Metallica. You see the hard part about these clubs is there are so many getting made that it’s hard to keep track of all the data.

M: I’ll wait before I start one at CC then. I’ll give you some time to think about the playlist.

RDM: (Laughs) No man! I know you; you’re at the top of the list!

M: Okay, so I am curious about your thoughts on Medicine and Medical School in the United States. Especially how hard it is for people to get into medical school and the cost of medicine in the United States?

RDM: There is no reason that people need to be cookie-cutter; we called them ‘gunners’ in medical school. People who just study all the time, don’t work well in groups, people who rip pages out of textbooks—well they don’t do that anymore because you guys don’t have books like we did. In my day a real gunner would go to the medical school library and pull pages out so that other people couldn’t study from them. But that, the competiveness, has been going on for a long time and it does not breed excellence and it does not breed creativity. I would be for anyone with an average GPA and MCAT score just gets put into a pool and then sort them out there. If you only go by numbers you end up with a really bland group of people.

M: Is there anything in particular you would give as advice to undergraduates interested in the field?

RDM: You know, gosh, I went to medical school 20 years ago and there is a lot more to know now (Laughs). When my professors went to medical school it was like ya know, ‘this is the liver, now we don’t know what it does but something is happening inside there.’ Nowadays there is a lot more to know. If I had to talk to me going through school I would have said ‘don’t take so many science classes.’ You should focus on those subjects to learn that won’t be available to you after you grow up. I would say develop yourself as a person over your GPA. I mean you need a good GPA to get into med school, so I would say take the easiest possible classes that you need to get the grades in the basics and then after that take stuff that actually interests you. People always seem to say, ‘Noooo I got to be a neuroscience major or else they wont take me seriously!’ I say trust me, they will take you seriously and study hard for you MCAT because that is something that they look at and it does weigh very heavily on your chances of getting in, ya know. Whatever any of that means.

M: What about medicine in general though? What made you make the switch from public to private?

RDM: I went straight out of residency; I knew I wanted nothing to do with academia. I knew from those seven years I didn’t want that. I am not a very political creature and if you want to be in academia you have to have that political gene, who to curry favors from, so you can get your grant or your favor. I never wanted to be that. I did research during those seven years and I found that a majority of the stuff that’s published is worthless; it’s just taking up unnecessary trees. (Laughs). Ya know? It may be different now but I knew I didn’t want to be in that, if I had an idea that could help people I would go back but I haven’t had that idea, so no.

M: I go to Colorado College, where the ethos tends to be that natural is always best. If you had to talk to students at Colorado College who by and large would see plastic surgery as negative, what would you say to them?

RDM: (Audible silence). I would say this: Do not confuse natural with good—I mean Ebola is natural, hemlock is natural. Just because it comes out of the ground and exists in a natural state doesn’t mean its good. If we thought that way about everything we would be living in caves still and riding horses instead of driving cars. Think of [plastic surgery] as the natural progression of technology to enhance what already exists in nature, which is that people are attracted to people based on the way they look, and how they feel about how they look affects the way they present themselves to other people. I just think that [plastic surgery] is just another way of making your life better. The natural thing is like a red herring. ‘It’s not natural!’ So what? The plague is natural.

M: So it’s just people taking more control of their lives? Would you say getting a new nose should be like getting a new pair of jeans?

RDM: Yes, exactly. I think we need two to three times more plastic surgeons than we currently have. That’s my honest opinion—we need more plastic surgeons. There is big demand but not enough supply, and the price would come down and it would be more accepted, people would be more productive. People spend enormous amount of time to look good to each other. I think we need more surgeons in the world, period.

1. Instagram is a mobile platform that offers photo and video sharing as well as social networking.

2. is a news outlet which could be described as the love child of Hunter S. Thompson and Walter Cronkite.

3. Buzzfeed is a news website but lends itself more toward quizzes like “What kind of Eastern European dessert are you?” and “What late 90s thing are you because you’re a late 90s kid?”

4. Periscope is an app through Twitter that offers live streaming services, truly the ideal platform for the voyeurs of the 21st century.

5. “Botched” is an American Reality TV show on E! You can start watching in April, Sundays at 9 p.m.