What went on in operating rooms used to stay behind closed doors. Unless you were a doctor, nurse, or physically in the room (and conscious) during a procedure, you relied on TV shows for an inside look — and, even then, the majority of content was edited or G-rated. Now, that’s all changing as more and more plastic surgeons gravitate toward Snapchat to document Brazilian Butt Lifts, breast augmentations, and tummy tucks. And if you’re privy to this new wave, you know there’s no censorship involved. (Seriously, Grey’s Anatomy’s got nothing on these guys.)
Michael Salzhauer, MD, or Dr. Miami (@therealdrmiami), is at the helm of this recent movement. He started experimenting with the platform after Instagram began taking down pictures from his account (an act for which the social media platform is infamous). He joined Snapchat in February of last year after a recommendation from his daughter, and has been skyrocketing to internet fame since. He can’t pinpoint his exact milestone moment, but he thinks it was once he hit 50,000 views.
“People weren’t just watching, but also sending us good questions and following day-by-day like a soap opera,” he reflects. “And not just the surgeries, but the girls in the office and the little shenanigans that were going on. That's when I knew we had something…and it just kept growing and growing.” The next notable marker was when his Snapchat video views doubled. “People were coming into the office just off the street — not patients, just people who were watching Snapchat — just to meet us and say hi,” he says. “When we did our first labiaplasty, we got like 10,000 screenshots of the before and after.”
Now, a year and a couple of months after joining the platform, he racks up an average of 1.5 million views per snap. Generally, his stories involve shout-outs to fans, rundowns of his cases for the day from his assistant Tati, guest appearances, and the real draw: very graphic surgeries.
After seeing Dr. Miami’s practice take off (and a failed attempt at trying to make Periscope happen), Matthew Schulman, MD, NYC board-certified plastic surgeon (@nycplasticsurg), also decided to give the Snap a try. “I was looking for a platform to show videos where I didn't have to worry about hiding a nipple or worrying about having to stay within specific time constraints,” he says. “At the time, I really didn't know that we were able to post stories. Like most people, at the beginning of the Snapchat days, I thought it was just a way to send naked pictures.” Now, his videos garner around 500,000 views each, and he’s up there on "best Snapchat accounts to follow" lists next to Dr. Miami.
Dr. Schulman's Snap stories show him working on cases similar to his colleague's, but with way fewer jokes, shout-outs, or music — a deliberate move. “We're not putting on a show, we're trying to present the surgeries,” he says. “I'm trying to educate people, and I'm trying to do it in an entertaining way so that people aren't bored, but I'm not dressed up in costumes, we're not dancing around.”
Both Dr. Schulman and Dr. Miami say the educational aspect is the reason a majority of their viewers tune in. “A good percentage [of those watching] are people either in the medical field or interested in pursuing careers in medicine — maybe 30%, based on the messages we get,” Dr. Miami says. “Another 30 to 40% are people who are thinking about having surgery, either immediately or sometime in the future.” The rest of the audience? Viewers fascinated by the gory and NSFW clips from the surgery room.
In one recent Snapchat, weird social media worlds collided as Dr. Miami was shown extracting pimples and blackheads from his staff members' skin: something Sandra Lee, MD — a.k.a. Dr. Pimple Popper — has become infamous for. Chances are, if you fall into the voyeuristic-viewer category, you’re already familiar with her stomach-churning (or intriguing, depending on who you ask) Instagram videos. Dr. Miami would describe them as vomit-inducing, but mostly because of his history with the act. “I remember doing a lot of those lesions, cysts, and popping stuff as a resident. And the thing people don't realize is that they smell,” he says. “You don't get the smell through the phone, so when I see [the videos], I remember the smell and I get a little queasy. Isn't that weird? I'm a surgeon, but that makes me queasy.”
Society's Weird Obsession
For those who have their nausea in check, these videos are incredibly addictive, explains John Suler, PhD, a psychologist and author of Psychology of the Digital Age: Humans Become Electric. “It's the ‘gawker’ or ‘rubbernecking’ phenomenon, where people can't resist looking at disturbing things,” he says. “What the internet has done is made all these previously unusual and observable situations easily available to everyone... It has become a cultural addiction, with one symptom of addiction being increased tolerance. People need to see higher levels of unusual, and even disturbing, things in order to get a ‘high’ from it.”
The length of the videos (usually a few seconds) makes them even more appealing to viewers, says Franklin Nii Amankwah Yartey, PhD, a communications professor at the University of Dubuque in Iowa. “The fleeting nature of the content that social apps like Snapchat have...provides an incentive for the public to consume content at a very fast rate... Some of us would rather watch short, entertaining snippets of content because we are in a hurry to watch the next viral video or snap. Thus, from the comfort of our homes and surroundings, we can consume the lives of others for entertainment, which may or may not have educational value,” he says. “For those that have access and the literacy to navigate these technologies, the high interactivity that these social apps offer keeps some audiences interested and glued to their screens.”
The fact that the bits of the procedure shown to the public are short and disappear after 24 hours is also a big selling point for clients, says Dr. Schulman. Both he and Dr. Miami mention that about 75 to 90% of their patients agree to have their surgeries shown on Snapchat (they all sign consent forms), and that most of their clientele discover them through the app. “Most of the time, people don't even think twice [about agreeing to be on Snapchat], because they know that that's what I do…and it's also because they found Snapchat to be such a useful tool in their search for plastic surgeons, or their preparations for the surgery, that I think people kind of feel an obligation, or at least a desire, to pay it forward,” Dr. Schulman explains. “These are people who already know who I am, know what I'm about, know what I do, know my staff, know my nurse; they're totally comfortable with my team before they even come into the office.”
A majority of patients do typically request that their names and any identifiable markings on their bodies be covered up, Dr. Schulman says. But then there’s the bunch that's seeking internet fame. For those who request it, Dr. Miami will often plug their Snapchat names (i.e. write them out) before the procedure for good viral measure. “Some people are really into it, it's like performance art for them,” he says. “They're like: 'I want you to write the name of my favorite band on my back, play some songs, and shout out my sister in Kentucky.' It's a little weird, but it works.”
Of course, with great internet power comes great responsibility — and critics. Daniel Maman, MD, of 740 Park Plastic Surgery is one of them. “To some degree, there's an educational component to [these videos] but the intention and the reason that people jumped on the bandwagon is for marketing purposes,” he says. “I think the appeal of these Snapchat accounts is that they're talking about non-surgical issues, are cracking jokes, wearing sunglasses, or wearing costumes in the [operating room]… I think that these surgeons have gone beyond what's ethically acceptable in the practice of safe surgery.”
The biggest qualm that many people have with this new trend: the doctors being distracted during surgery. But Dr. Schulman explains that surgery-snapping isn't any different from teaching his medical students.
“I teach plastic-surgery residents, and as I'm teaching a resident how to do an operation, I'm talking them through the steps. So, doing that for the camera is no different,” Dr. Schulman explains. “I promise that I know how to walk and chew gum at the same time.” In fact, he makes the argument that being able to talk through the steps is reassuring to those going under the knife (and those watching) because it reinforces that he knows what he’s doing.
Despite these justifications, rules might be put in place as to how surgeons can conduct business — and soon. Dr. Maman hints that the American Society of Plastic Surgeons will eventually come out with guidelines as to what’s ethically acceptable when it comes to broadcasting surgeries live.
Although Dr. Miami doesn't advocate for stricter rules, he says that he’s willing to get on board as long as the limitations are legit. “Obviously, a guideline would be: a) Patients need to have written consent, b) Patients should have the right to delete or remove content posted online that they change their minds about. That's all fair and reasonable,” he says. “If they say you can't be funny on your Snapchat, I think that would be unreasonable. If they say you can't show your staff on your Snapchat, that would be unreasonable. If they say you can't promote your practice, that would be unreasonable — and I would disagree with them vehemently.”
Until the stipulations are implemented, Dr. Miami says he’ll continue to cater to his clientele's desires, whether or not the ASPS approves. “I'm past the point of thinking about how it looks to the establishment. I'm more interested in taking care of my patients and how my patients feel about it,” he says. “If my patients didn't love it, I wouldn't do it. If my patients weren't responding positively to it, I would stop immediately. But they don't — they love it. They're cheering me and other surgeons on. They want to see more, not less. They're the people I answer to first and last.”
They — along with the viewers — are the ones writing this new chapter of social media. More plastic surgeons are gravitating toward Snapchat to document their work, and there don’t seem to be signs of inside-the-operating-room fatigue. “At this point, it's only growing — it's on the up and up,” reflects Dr. Miami. “Clearly, there's an audience. In this country, if the market demands something, if there's an appetite for it, it'll find a way to manifest.” And those holding the scalpels — and the phones — will continue to give the people what they want, as long as they still want it.