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The Dr. Miami Effect: How Plastic Surgeons Are Grappling With Snapchat

It's a tale of intrigue, conflict, and, yes, butts.

I'm a plastic surgeon and I make people feel better about their bodies." If you're one of the millions of people who follow Dr. Miami, aka Dr. Michael Salzhauer, on Snapchat, you'll recognize this message as his cheerful daily greeting.


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Dr. Miami, who is 44 years old and has basically eschewed his given name in favor of his social media handle, is the Kylie Jenner of plastic surgeons. His huge Snapchat following and operating room antics have earned him steady media coverage over the past year.  This month alone, both Buzzfeed and Vanity Fair published in-depth profiles on the surgeon within a day of each other.

The attention has paid off, because Dr. Miami is booked for the next two years. According to RealSelf, an online forum that is a combination of Yelp and Reddit for aesthetic procedures, pageviews to Dr. Miami's profile on the site increased by 150% when comparing the first quarter of 2016 to the first quarter of 2015. Pageviews to other doctors on the site only increased by 37% over the same period.

The Dr. Miami origin story goes something like this: He wrote a children's book about plastic surgery called My Beautiful Mommy and ended up on the Today Show in 2008. He got into some hot water with the American Society of Plastic Surgeons when he collaborated on a pseudo punk rock song about nose jobs in 2012. He's also an observant Jew who keeps kosher. He's married with five kids, and he would not-so-secretly love to be a rapper and hang out with DJ Khaled's crew. After Instagram started removing pictures from his practice's page without explanation, his teen daughter introduced him to Snapchat and the rest is history. He was just nominated for a Shorty Award as Snapchatter of the Year, which he lost to DJ Khaled.

Photo:

Two full time social media staffers handle his accounts, and they show up frequently in his snaps. A typical Dr. Miami Snapchat story features bad jokes, a king costume, and a rotating roster of guests set to a hip-hop soundtrack. The money shots, though, are the graphic live surgery snaps like those showing him putting fat into people's butts during the popular and painful-looking Brazilian Butt Lift (BBL) procedure, or removing nipples during breast augmentation.

Crowd favorites, according to Dr. Miami – this data is based on how many screenshots he gets – include before-and-after shots and post-tummy tuck photos. "They always screenshot those goofy pictures of us holding up the fat. That's why I do it after every tummy tuck. People like it," he tells Racked on a recent phone call. "There's somebody somewhere with 400 pictures of me and [assistant] Jerome holding up fat in our gangster poses."

Labiaplasties also garner plenty of screenshots. "I don't know if that's just 14-year-old kids who have never seen a vagina before," Dr. Miami laughs. "But you don't [often get to] see that kind of surgery.  A lot of women maybe take that to compare, contrast, to show their lover or husband or whatever and talk about it."

Dr. Miami doesn't know how many followers he has, but he recently reached a new  personal high of 1.9 million views on a story, which he commemorated by taking a screenshot of the stat. "The numbers are mind boggling, to the point where my wife and I went to my 20th med school reunion in St. Louis. I was just walking through the zoo not dressed like a doctor, just dressed like me, and a whole bunch of high school and college kids were yelling, ‘Dr. Miami!,'" he says. "That's kind of a different level for a plastic surgeon." (He snapped these interactions, obviously.)

Other plastic surgeons have taken note of Dr. Miami's success and have started using Snapchat for engagement. "Several [younger] people in my office said, ‘Hey, did you see this guy Dr. Miami?' I was intrigued," says Dr. Otto Placik (@bodysculptor), a Chicago-based plastic surgeon in his 50s. "I don't know where it's going, but I'm frustrated with some of the other avenues of social media."

"I'm frustrated with some of the other avenues of social media.

The thing that makes Snapchat most compelling for plastic surgeons is that Instagram isn't the most ideal platform for marketing their practices anymore, though many use it. Never mind free the nipple; Instagram is definitely not going to let you free the labia. The platform often removes pictures from surgeons' pages without any explanation, possibly (probably) for being graphic or too naked.

"I have that problem all the time. I've had maybe four to six images pulled in the last two weeks," Beverly Hills-based plastic surgeon Dr. Sejal Patel (@mydrsej), 40, says on the phone.  He says he has also been accused by Instagram followers of photoshopping his results, an accusation which infuriates him, since before and after pictures are essentially a surgeon's portfolio.

Dr. Matthew Schulman (@nycplasticsurg), a New York City-based plastic surgeon who is probably the second most-viewed plastic surgeon on Snapchat after Dr. Miami (his snaps garner about a half million views), thinks there might be something more sinister at play on Instagram.

"I found recently there's a group of plastic surgeons who are having problems where pictures are constantly being taken down, even pictures that don't violate any of the terms of agreement. I think there are competitive people within the industry who are trying to purposely sabotage other people's accounts," Dr. Schulman, 42, says on a call, acknowledging that it's just a theory and he has no proof. "I think there are probably companies out there who are doing it on behalf of surgeons to try to knock down the popular plastic surgeons on Instagram."

Follow on snap... Username is mydrsej

A photo posted by Shaped Extra Juicy ~ Dr S E J (@drsejmd) on

Dr. Patel, who is often called Dr. Sej (pronounced sage) by colleagues, turned the first three letters of his first name into a social media friendly acronym which stands for "Shaped Extra Juicy," a reference to the frequent BBLs he performs. He's been on Snapchat for about six months, and says his snaps get about 50,000 views. He's handsome and charismatic, and tends to show his goofy side only outside of the operating room, like when he went shopping for traditional Indian garb with his mother.

"Initially I was a little reluctant because I didn't know how people would react to seeing the graphic images of the operating room," he says.  "But when I started doing it I realized it was really powerful because it made everyone see that what was going on was real. That solidified what I was doing in a lot of people's minds and it did really help out our business."

"For me [plastic surgery] is a serious academic discipline and there's real gravitas when it comes to giving people good outcomes," says Dr. Lara Devgan, a 37-year-old New York City based plastic surgeon. "For me a good post is one that explains that. Another set of posts that's been very popular on my account is whenever I post about my journey as a woman in a male dominated field or the fact that I have four young children as well as a full-time career as a busy plastic surgeon." She has been using Snapchat for a few months and gets several thousand views on her stories, which never feature snaps during surgery. Her patients rarely consent to being on camera.

Many of these surgeons' patients do consent, however, which may be mind-boggling to those of us who can't imagine having our bare asses with all their pre-op lumps and bumps shown to the world. All the surgeons interviewed here say they use a written consent form which states they will try to protect a patient's privacy while on camera.

You don't often see face lifts on Snapchat. Most patients who are willing to be filmed usually get some sort of body treatment like a BBL, liposuction, or breast implants. "My patients are a little bit younger, anywhere from 18 to 40, so I have the millennials and also patients who understand technology," says Dr. Schulman. "Probably 80% of the patients that come to see me for a consult have already been following me on Snapchat. So it's easy for them to be willing to appear." Occasionally patients do ask to be deleted once they're on Snapchat, but it's rare.

"Probably 80% of the patients that come to see me for a consult have already been following me on Snapchat."

Dr. Placik saw the appeal of having control of his message and image and now snaps daily, though many of his patients won't consent to be recorded. His snaps garner "not quite a thousand views," and he still seems to be figuring out how to approach the app, though he says he's channeling Bill Nye the Science Guy. He shows before and afters and will talk about anatomy in laypeople's terms.

"I'm not a rap singer. I'm not going to be singing Fetty Wap. I'm not going to get dressed up in a king's outfit," he says, sounding somewhat resigned. "Dr. Miami's a very intelligent guy, but I don't think I mesh with that patient population necessarily. I don't think I could keep up with him."

If you do want to keep up with Dr. Miami, however, he'll help you – for a fee. "We do social media training and surgical training is part of it. I think the marketing fee is $2,500 per month," he says. "But then we offer training in our BBL style and social marketing stuff and how to make a Snapchat pop. Those are additional one-time fees for training." (It's $15,000, according to the Buzzfeed article.)

That explains why you'll see before-and-after photos from doctors with handles like DrBBL, DrDallas, and DrBfixin showing up occasionally on Dr. Miami's Snapchat. "We pick people who are good and also we pick people who have a similar kind of personality," he explains. "They have to have a sense of humor and they have to be able to relate to audiences in their area. We decided to limit it to ten people total around the country and we've got five or six a that have already signed up in different cities." He likens it to his beloved rap community. "It's a marketing social media alliance. Like East Coast/West Coast rappers."

Dr. Miami also made a short-lived foray into franchising, but quickly gave it up after figuring out how logistically difficult it would be. "We realized that we don't really need to run anybody else's practice or have our hands in their cash register so to speak, like McDonald's," he says.

Dr. Christopher Balgobin (@drbbl), a 41-year-old surgeon in Minnesota, was Dr. Miami's first franchisee. His work shows up frequently on Dr. Miami's Snapchat and he even travels to Miami to do injectables like Botox and fillers once a month in his office. He says that even with Dr. Miami's guidance, Snapchat has been difficult, which is a sentiment echoed by other surgeons here, too. "Snapchat is hard in that the people who follow you are now looking for Dr. Miami," he says. "They're looking for what he provides everyday, which is funniness and quips and surgeries. For any normal practice, that's very difficult." Most of his patients do consent to be on his Snapchat, and he's now considering hiring a social media employee to help out.

drmiami, drsej, drbbl, bodysculptor Snapchat

"You've got to do stuff everyday," agrees Dr. Patel. "I've spent hundreds of hours trying to develop content and post content.  We Snapchat every day and that adds time to surgery. That costs money."

Dr. Schulman says other practices reach out to him for social media advice "constantly, every day. I tell them your primary responsibility is to educate and spread knowledge because I think if you do it the right way, everybody in plastic surgery benefits," he says. "You destigmatize plastic surgery when you show what really happens, and it's good for everybody. You should be engaging and entertaining but not over the top and not cheesy and unprofessional." The most gimmicky thing you'll generally see on his snaps is him wearing a wildly patterned surgical cap.

Speaking of unprofessional, not everyone agrees with Dr. Miami's approach. Dr. Daniel Maman, 38, a plastic surgeon with a Park Avenue practice in New York City, supports plastic surgeons' social media marketing efforts, but not some of the methods.

"My biggest concern would be that when you're physically in the operating room and operating, the only thing I'm thinking about is the patient and what I'm doing surgically," Dr. Maman says. "A lot of these guys who have big Snapchat accounts, they spend half the time cracking jokes and dressing up and chatting with viewers and I think that's a distraction and certainly not the standard of care when it comes to surgery."

He continues, "The demographic they're targeting on these Snapchat accounts are not well informed patients who are doing their research. I think it's all money driven, and certainly not patient care driven, that's for sure. If Snapchat is done in an academic and professional manner where it's for educational purposes, I can't see anything wrong with that. But for the ones I've seen, it's sensationalized jokes that puts these patients lives at risk." He also questions whether or not some patients really understand what they're consenting to when they agree to be filmed for social media.

"I think it's all money driven, and certainly not patient care driven, that's for sure."

Dr. Maman speculated that new ethical guidelines related to social media would be forthcoming, likely spearheaded by the American Society of Plastic Surgeons (ASPS), the main certifying body for plastic surgeons. (All the surgeons interviewed here are members, with the exception of Dr. Balgobin, who is board certified in family medicine.) A representative for the ASPS confirmed to Racked that the organization is indeed drafting new guidelines, but there is no information about when they'll be released.

"The Ethics Committee is working on a revised code for our members," the representative wrote in an email. For now, this is the only official statement from the ASPS on the matter: "Regarding the broadcasting of a surgery, there are so many variables to consider with each surgery location, procedure, patient, and doctor. In all cases, privacy laws and patient consent must be honored. Ultimately, any broadcast is at the discretion and consent of the facility, patient, and doctor."

Dr. Miami responds to other plastic surgeons' criticism with his usual DGAF attitude. "You should have them secretly Snapchatted in the OR. That would shut them up immediately," he laughs. "That's what surgery's all about! I'm sure it's the same thing in airplane cockpits. You have this idea that the people are focused on the controls and holding it steady. No. We are certainly able to have conversations while we operate. Most ORs listen to music. The only difference is that for about three to four minutes per operation I also talk to the camera and explain what's going on, which I would do if there were students in the room anyway."

drmiami Snapchat

Not all surgeons are so cavalier. "I'm worried that some of my societies would come down on me," says Dr. Placik. Even Dr. Balgobin, arguably Dr. Miami's most loyal colleague, remembers an incident when Dr. Miami took a flap of tattooed skin off a patient and held it up to his chest as a joke on Snapchat.  He says he thought at the time, "There are going to be some doctors out there watching this who are like, ‘Wait a minute. This is not appropriate. This is not right as a doctor to do.' The board could question him on that."

Question away, says Dr. Miami. "[The ASPS] is very good at making rules and they're generally run by academic practitioners in an ivory tower. I'm sure their rules will be quite draconian when they do make their guidelines. Hopefully by then I'll be on another different platform of social media!" he laughs.

"Look, I get their role and their job. They like to maintain the conservative, old order because it works to their benefit and I suppose to some degree it benefits everybody a little bit. However, the world is changing very fast and you have to adapt," Dr. Miami says. "Snapchat and the internet in general leads to more transparency and that frightens a lot of institutions. But there's no way to put the genie back into the bottle."

As other plastic surgeons struggle with how much to share on Snapchat and how to do it, Dr. Miami is ironically about to enter the world of old media via a reality TV show deal in the tradition of Botched and Extreme Makeover.  He can't reveal which cable network, but says it ordered six episodes that will be released by the end of the year. "It's going to be kind of like everything on Snapchat plus more patient focused stories. You get the back stories on the patients, you get to see the reveals, the stuff that you're used to in a makeover type show, which you don't really get to see on our Snapchat so much because it's focused on my typical day," he explains.  "I don't have the opportunity to go back with patients to their home and ask them why they're having surgery. You don't get that follow through, which people really ask for."

In the meantime, expect to see more bare butts and bloody flaps of skin on your Snapchat as more plastic surgeons gravitate there. "Any doctor who's willing to show you the entire fricking surgery is pretty proud of what they're doing in the OR," says Dr. Patel. "Wouldn't you want to watch that?"

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