Dr. Miami & The Twilight Of The BBL

It’s 5:45 p.m. on a scorching Friday in Miami, and cosmetic surgeon Michael Salzhauer is in a race against sundown. He’s en route to Lincoln Road, where he and his social media manager, Santina Rizzi, plan to film a series of vaguely Billy on the Street-inspired interviews with strangers. Their topic? The scourge of artificial bodily enhancement.

But Salzhauer, better known as his bombastic persona Dr. Miami, has realized he doesn’t have any poster board to make signs for the protest — though there might be an easy fix. “We could stop if we pass a CVS,” he says, scanning the horizon from the front passenger seat of the Lexus SUV.

“No!” says his sister-in-law and practice manager, Rosy Zion, from behind the wheel. “We have no time. Zero.”

The doctor is dressed — or, rather, disguised — in glasses, a backward baseball cap, and a black T-shirt that reads “STOP PLASTIC SURGERY.” It’s the first time Rizzi and podcast producer Megan P have seen their perpetually scrubs-clad boss in jeans, and they’re both shocked to learn that he even owns a pair. Megan, who sits next to me in the back with a lapful of recording equipment, studies him and says, “I don’t know who that man is.”

That Man is an Orthodox Jewish father of five who needs to be home before the start of Shabbat. But he’s also a compulsive showman and TikTok star with a passion for spectacle, and he can’t help but brainstorm more gimmicks even as the window for their execution is narrowing. He suggests he, Megan, and Rizzi sit down in mock protest amid the foot traffic, arms linked, and pretend to block pedestrians, then speeds to the next idea. “I should handcuff myself to someone,” he muses, “or something.”

Salzhauer is a savant when it comes to publicity stunts. He’s courted and received more sustained media attention than any other plastic surgeon in the country and probably the world. (He says Miami tour guides tell groups that he lives on tony Star Island, alongside A-listers like Jennifer Lopez and P. Diddy. But actually, that honor belongs to Lenny Hochstein, a plastic surgeon formerly married to a Real Housewife. Dr. Miami’s name is just more recognizable — or else the guides don’t know they’re two different men.)

The trajectory started around 2008, when his children’s book, My Beautiful Mommy — a picture book that outlines plastic surgery, from consultation to healed results — landed him on the Today show, and local stunts like a 2009 “plastic surgery fashion show” earned him write-ups in the local news. But in 2015, when he started sharing his surgeries live on Snapchat, the popularity and shock value of his streams attracted a brighter national spotlight, so by 2017, he had been profiled in Vanity Fair, Buzzfeed, and Complex, and filmed a six-episode season of a We TV-produced reality show titled — what else? — Dr. Miami. In 2020, Canadian director Jean-Simon Chartier released They Call Me Dr. Miami, a documentary about Salzhauer and his family that followed the doctor at his home, office, and synagogue.

For years, Dr. Miami’s shtick was performed for a judgmental general public that was ambivalent about plastic surgery at best and shaming to the point of cruelty at worst. Fans online loved him and flocked to his practice, but his outrageous conduct was offensive to a bourgeois propriety that saw his enthusiasm as gauche and unprofessional, even though the popularity and profitability of cosmetic surgery grows every year.

Since COVID, demand has sky-rocketed; after a year of closed clinics and canceled appointments, surgeries increased by 54% in the United States in 2021, with “body procedures,” like those Dr. Miami is known for, making up the bulk of the demand. By 2022, almost 30% of cosmetic-focused plastic surgeons said their business had at least doubled from before the pandemic, according to an American Society of Plastic Surgeons study. And patients have never been more willing to announce, document, and even mock their own cosmetic work online. Even Kylie Jenner has finally copped to getting breast implants. The culture may finally be catching up with the doctor.

Earlier that day, I had arrived at Dr. Miami’s office tower with the expectation of accompanying him on appointments with current and prospective patients, but when a receptionist sent me from the top floor down to the third — a staff space clearly not intended for clients — I realized I’d be watching him perform a different type of cutting and stitching.

On Friday mornings, Salzhauer checks on patients recovering at the nearby Grand Beach Hotel, where he keeps the third floor in reserve for out-of-town patients, he tells me, but then he and his team “just have fun.” They make clips for his TikTok following of 2.7 million, some of which will be crossposted on Instagram (for an audience of 1.5 million); brainstorm future content; and record his new podcast, Crime and Plastic, with co-hosts Zion and Rizzi. (Thanks to her ubiquity on Dr. Miami’s feed, Rizzi has earned an ardent TikTok following of her own, and though she told me she loves getting recognized in public, she declined an interview.) I overhear the end of two FaceTime calls with clients, one with a seroma that needs draining and another who’s struggling to keep her postsurgery belly button dry. But that’s it for medical work.

This isn’t to imply the doctor doesn’t love his official day job. From his earliest memories of growing up in Rockland County, New York, medicine was his calling, though it wasn’t a wholly self-conceived notion. “My father said, ‘You can be any kind of doctor you want,’” he jokes. He credits M.A.S.H. with his gravitation toward surgery, and during our conversation, it’s clear his love for the discipline has only grown. But for most people who know his face from social media, or for anyone whose For You page occasionally shows them a TikTok of Salzhauer splashing around waist-deep in the ocean in his scrubs, “Doctor” probably seems more like an honorific or gimmick than a serious title.

Later that afternoon, when he hits Lincoln Road in his disguise, he asks three different women, “Is Dr. Miami a real doctor?”

“I have no idea,” says one.

“I’d like to think so,” says the other.

“Considering how big he got on social, I’m starting to get a little skeptical,” says the third.

At one time, his relentless self-promotion could have been chalked up to savvily growing his business, but by now, well over a decade since he first appeared on national TV, the business is built. He owns the building that houses his practice, and uses all five stories. He opened a second location in Saudi Arabia earlier this year and plans to expand in the Middle East where, he says, the unmet demand for cosmetic work is tremendous. When Miami’s COVID restrictions were lifted, he had such a backlog of scheduled surgeries that he spent the next two years operating five days a week instead of four. He agreed with me that he could quit social media today and still be booked for the next 8.8 years — which is how long he has until he told his wife he’d retire, sort of. (“Surgeons don’t really retire,” he says.)

Though he jokes (I think) that an Emmy and a Grammy are among his remaining career goals, his online presence seems to have its roots in something other than avarice or a craving for fame. He clearly enjoys being creative, and is one of those tireless characters who always has more energy than everyone else in the room, even when those other people are 30 years his junior. Salzhauer refers to his patients’ joy as “my drug, my high,” and it’s clear that the delight of his larger, remote audience has a similar effect on him. “I want to make people happy,” he tells me more than once.

During the early pandemic, “I got to really stop and think about what makes me happy, what operations and what kind of patients,” he says. Salzhauer’s joy predilection dictated that he stop doing facelifts, though they’re “easy” and popular among older people with means, because those patients “don’t really want plastic surgery; they want a time machine.” They’re never quite as ecstatic about their results as “a young person who always didn’t like the way their ears stuck out or never had breasts.”

Male patients already made up a negligible percentage of his business, but after COVID, he stopped seeing them altogether. “If you look up people who have killed their plastic surgeons,” he tells me, “it’s male rhinoplasty patients.” When the doctor documented a Penuma penis enlargement surgery in 2019, despite its having allowed countless labiaplasty streams, Snap deleted his entire account. (While it ultimately gave the account back, he isn’t active there much anymore because everything he does “gets shadowbanned.”)

The demographic Salzhauer connects with most seems to be moms, whom he estimates constitute 85% of his business. When the Today show introduced the world to his children’s book, My Beautiful Mommy, it seemed like a product designed to outrage and offend the maximum number of people. But in the live segment from 2008, he was incredibly efficient at winning over both Kathie Lee and Hoda Kotb to his position. He pointed out that a doctor is associated with sickness, and so it’s scary to be told nothing about why your mother is going to one or why she comes home in bandages. He knows all of this firsthand, because he once had to explain his nose job to his inquisitive then-4-year-old daughter. “I agree society in general places too much importance on external appearances,” he said, but there’s a deceptive self-righteousness in these debates; most parents wouldn’t hesitate to get cosmetic dental work done on their child. “You’re absolutely right, there might be a little bit of hypocrisy here,” Kathie Lee said. They’d only been speaking for a few minutes.

The tension between our cultural fetishization of good looks and the widespread condemnatory stance against plastic surgery is part of the reason why “tasteful work” that leaves one looking “refreshed” is tolerated and even encouraged while obviously inflated lips, tits, and asses are treated as signs of social decay. As an early adopter of the BBL, Dr. Miami is associated more with the latter, and he tells me half of his patients are people who want to look “really, really, really, really, really fake.” Some surgeons refuse to give patients alterations they ask for, not because they’re unsafe but because the surgeon finds the preferences to be aesthetically incorrect. But Salzhauer said he lets his clients decide: “I’m not paternalistic. If you show me a picture and you like this and it makes sense, I have no problem.” (When I ask about his own aesthetic preference in a woman’s body, he says “my wife.”)

The era of “really, really, really fake” may be dying out, though. Salzhauer says that this year is the first since 2005 that the demand for butt lifts “has leveled off,” though they still comprise a substantial part of his business. It’s also the first year he’s seen patients asking to make their butts smaller on a regular basis. He estimates he performed about two butt reductions in the previous five years, but within the first six months of 2023, he did five. “I think all the teasing on the Internet and social media about them being too big is having an effect,” he said.

There are not enough plastic surgeons on earth to deal with the coming demand for that kind of surgery.

He predicts that as weight loss drugs like Wegovy, Ozempic, and Mounjaro proliferate, the future of cosmetic surgery will be all about skin removal, breast lifts, and tummy tucks. “There are not enough plastic surgeons on earth to deal with the coming demand for that kind of surgery,” he says. “You’ll see it in, I think, five years.”

He’s played the Tiresias role before. When Salzhauer’s live streams became national news fodder, initial criticisms came from other surgeons, he says. But he was confident in his relationships with patients and had faith in the soundness of his approach. “When I first went on Snapchat and Instagram,” he tells me, “the American Society of Plastic Surgeons sent me some kind of [letter] like ‘We’re not sure that social media is appropriate for surgery.’ Then, within a year, they have a separate column in their trade journal about social media and plastic surgery.”

He views live-streaming (or any type of recording) as a safety and accountability measure, since it eliminates uncertainty about what the surgeon is or isn’t doing behind closed doors. Given documented incidents of surgery teams trash-talking their anesthetized patients, it’s reasonable for a client to want more transparency. Those who agreed to be streamed said it was a comfort to them that friends and families could watch, if they wanted. Similarly, Salzhauer’s penchant for making jokes and poking fun can reassure anxious patients who’d feel less at ease with someone somber.

Salzhauer has always played up his cockiness for the camera but in the car on the way to Lincoln Road, he seems — while still, admittedly, very keyed up — at peace: confident but also settled, with nothing left to prove. He has a thriving business, an incredible track record as a medical professional, and his utilization of social media has been adopted (but never duplicated) by countless other doctors. Two of his children are married, and this year marked the coming of his first grandchild. He’s practicing his Arabic and counting down those 8.8 years till semi-retirement with a custom-made monthly desk calendar. Debates about the rightness or wrongness of cosmetic surgery have never really been able to touch him, nor the industry as a whole. That’s why he can afford to turn them into a joke.

From the car’s front seat, in his normal person costume, he reads aloud to us from the notecards he’d scrawled interview questions on while in the office: “This one just says ‘plastic surgery, a crime, question mark.’”

Photographs by Mary Beth Koeth

Photo Director: Alex Pollack

Editor in Chief: Charlotte Owen

SVP Creative: Karen Hibbert