"The first time I did a rhinoplasty, I got diarrhea all morning from the stress."
It's an awkward admission to make in the midst of surgery, but Dr. Michael Salzhauer is speaking to a captive audience. His patient — a ballerina-thin young woman named Joanna Gonzalez — lies unconscious on an operating table beneath giant flood lights. A plastic tube snakes down her throat and pumps oxygen into her tiny lungs. Her face has been smeared with iodine, leaving her looking like an Oompa Loompa.
Besides, Salzhauer's first nose job was more than ten years and 10,000 patients ago. Since then, he's augmented, reduced, reshaped, or rebuilt body parts for famous actors and aspiring models, porn stars and professional athletes' wives. His rhinoplasties, in particular, are so good he has been dubbed Miami's "Dr. Schnoz." Salzhauer wears the moniker like a heavyweight title belt.
This morning, the 40-year-old's angular features are hidden behind a surgical mask, his short dark hair covered by a medical cap. All that is visible are his deep-set eyes gazing at Gonzalez as he raises a stainless-steel scalpel to her orange face.
Salzhauer slices a one-inch cut into the bottom of her chin. There isn't much blood. An assistant removes a clear silicone disc from its sterile packaging, dunks it in iodine, and hands it to Salzhauer. The doctor deftly slips the implant under the muscles like a chef stuffing a Cornish game hen. He hums classical music to himself as he eyes his work from several angles. Satisfied, he sutures the implant into place and closes up the wound with catgut. "Oh yeah, she looks a lot better," a male anesthesiologist says enthusiastically.
Next, Salzhauer moves on to his specialty. "We call this 'unzipping the nose,'" he says, snipping the tissue between the nostrils and peeling back the nose like a satin evening glove. A bloody stump of cartilage glows strawberry red beneath the lights. His assistant hands him a footlong metal rasp and Salzhauer goes to work, filing down the bump on his patient's nose with a carpenter's zeal. From time to time, he stops to cauterize a gushing vein or two. "It's like barbecue," he says nonchalantly. "You've got to get used to the smell of burning flesh to be a surgeon."
Finally, Salzhauer decides Gonzalez's nose is still too wide. He holds what looks like a crowbar to her nasal bone as his assistant taps it with a metal hammer. The tools clink together loudly until Gonzalez's nose breaks with a sudden crunch. Blood pours from her nostrils. A few minutes later, however, the bleeding has stopped and her now considerably smaller nose is back in place.
The procedure is routine, except for one small detail: the TV crew in the corner of the room. A week earlier, Inside Edition producers had called to ask if they could film him doing a chin implant. Salzhauer didn't have one scheduled for weeks. So he called Gonzalez. "How would you like a new nose and chin for free?" he asked.
Trading free plastic surgery for publicity might sound sketchy, but it's Salzhauer's specialty. In the past four years, he's racked up more controversies than Lindsay Lohan. When he wrote a children's book about plastic surgery, parents cried foul. When he held a runway show for his patients, critics were aghast. And when he created an iPhone app so people could envisage themselves after a nip or a tuck, critics flipped out.
Then, in February, he reached new heights of flagrancy by commissioning a music video called "Jewcan Sam, a Nose Job Love Song," featuring a Jewish teenager trying to impress a girl by getting nasal surgery. The video went viral, but so did the outrage. The Anti Defamation League accused him of exploiting Jewish stereotypes. The American Society of Plastic Surgeons (ASPS) launched an investigation.
For many, the video made Salzhauer into a pantomimic villain: the flashy, heartless, obscenely wealthy Miami plastic surgeon. Salzhauer hardly tried to counter the image. Instead of backing off, he's doubled down with increasingly outrageous videos, openly pushing for ever younger patients to go under the knife.
But in a city of contradictions, he's a much more complex man than the character portrayed on YouTube. Behind the persona is a deep personal belief that plastic surgery is an answer to teen bullying, a key to adult happiness — even a divine calling. Spend an hour with Dr. Schnoz, and you'll begin to believe in him. Spend a day with him, and you'll be a convert. After a week, your new best friend will be shooting Botox into your forehead.
"Looks good, right?" Salzhauer says as his assistants snap photos of Gonzalez's new face. By the surgeon's calculation, the chin took just 23 minutes, the nose 36. A woman's voice squawks over the intercom to announce that his 1 p.m. Brazilian butt-lift is waiting.
"I only do half the work," he says with a smile, peeling off bloody gloves and tossing them into the trash. "God does the rest."
Miami is a massive showroom for plastic surgery. Everywhere you turn is a pair of fake boobs big enough to put your eye out. We have booties that defy the basic laws of physics, and septuagenarians with skin so tight you could use it as a drum. In fact, our sexy, sultry, superficial city is second only to Beverly Hills in terms of plastic surgeons per capita.
Nationwide, patients dropped $10.4 billion on cosmetic procedures last year, according to the ASPS. A good slice of that was spent in Miami. Of the 1.6 million people who had plastic surgery in the United States in 2011, more than 100,000 reinvented themselves in the Magic City.
The trend began after World War II, when Mount Sinai Medical Center opened in Miami Beach, says historian Paul George. Nowadays, the local plastic surgery biz is propped up by a steady stream of Latin Americans in search of Miami's more than 200 surgeons to install their new body parts. Many go under the knife in Bay Harbor Islands, a tiny town to the west of the posh Bal Harbour Shops. Here, 96th Street becomes Kane Concourse, but it might as well be called Silicone Alley. Half a dozen plastic surgeons wield their scalpels on a two-block stretch of sleepy cafés and office buildings.
None is better known — or more controversial — than Dr. Michael Salzhauer. But unlike surgeons who get into hot water over botched operations, Salzhauer isn't infamous for malpractice suits. His record is spotless. Instead, his troubles are of his own making, and they are going viral — all according to his plan. "Marketing makes the world go 'round," he says.
That attitude is front and center at Salzhauer's small, two-story Kane Concourse office, where a squadron of nubile women staffs the front desk. They answer phones and usher in patients while wearing tight baby-blue windbreaker pants and black T-shirts that read, "Bal Harbour Plastic Surgery." Checking in feels like interrupting cheerleading practice.
Two days before Joanna Gonzalez's on-air surgery, Salzhauer is in constant motion — a satellite in scrubs orbiting around a half-dozen brightly lit consultation rooms. In one, a middle-aged Israeli woman demands that Salzhauer fix a freshly stitched cut so it won't scar. (He can't, saying later: "I went to medical school, not Harry Potter's school for wizards.") In another, a younger patient is having problems with her new double-Ds.
A week earlier, the ASPS had released new statistics showing that chin jobs are the fastest-growing procedure in the nation, with more than 20,000 people beefing up their chins last year. That prompted Inside Edition to ask Salzhauer for video of the procedure, and the doc to offer a free surgery to Gonzalez so he could get on TV. He'd recently given her a breast augmentation and knew she couldn't afford anything else.
"She needs a chin and a nose," Salzhauer says matter-of-factly, staring at a computer screen on the desk in his quiet personal office. As he talks, he uses photo-editing software to enlarge Gonzalez's jaw. He lops off the ridge on her nose. "Then she would look awesome."
The television show is a welcome distraction for Salzhauer, who for the past month has taken a beating in the media for his "Jewcan Sam" stunt. The idea struck Salzhauer at a party. He found himself sitting next to the producer for a group of Jewish punk rockers from New York called the Groggers, who told him that the lead singer was from Hollywood, Florida. The next day, Salzhauer called and asked the band to write a song about nose jobs.
The result is "Jewcan Sam," which manages to insult nearly every race, color, and creed in just over five minutes. Groggers lead singer L.E. Doug Staiman plays a yarmulke-wearing high school geek with a large nose and a crush on the popular girl. When she tells him she dates only guys with "perfect" noses, he gets rhinoplasty. But even after the surgery, she still won't go out with him.
Salzhauer likes to point to the plot twist as a message that people should get cosmetic surgery only for themselves. But then there's the video's final scene, in which the nerd's hot teacher gives him her number. Score one for surgery!
The video is littered with stereotypes, including the casting of a white man in blackface as Oprah. And, originally, it offered a free nose job to whomever made the best video promoting Salzhauer's practice. The doctor called it a parody, but not everyone got the joke.
"It was distasteful and offensive," said Andrew Rosenkranz of the Anti-Defamation League (ADL). "Historically, Jews have been caricatured in a negative way by showing them in cartoons with a hook nose. This video plays into that stereotype."
The ADL wasn't alone in condemning the video. After national media picked up the story, the ASPS announced it was probing whether Salzhauer had violated his pledge to "uphold the dignity and honor of the medical profession." The association threatened to kick him out.
Before Gonzalez's surgery, Salzhauer laughs off the threats. "It was pretty good marketing," he says with a shrug. "I now have people calling from literally all over the world. And CNN called me 'Dr. Schnoz, the nose king of Miami.' That's something."
Yet the story left many Americans with an impression of Salzhauer as one of the soulless bastards from Nip/Tuck, with their mega-money, fast cars, and loose morals. The truth, however, is more complicated than a butt-lift/boob-job combo.
Salzhauer's enigmatic text message arrives late on a Saturday night: "I've got another interesting aspect for your story if you are available Monday morning around 7:30 a.m.," it says. "It's a part of my professional life that no one knows about."
In his early-morning operating room, Salzhauer is surrounded by rabbis rocking back and forth and mumbling prayers in Hebrew.
Uri, a young man with a goatee, gold chain, and black yarmulke, lies on the operating table. A sheet prevents him from seeing the men hovering over his groin. One of them is Rabbi Yaron Amit, an enormous man with an unruly white beard who, in his apron, looks like a butcher. The rabbi deftly lops off a sizable chunk of Uri's anesthetized manhood and places it on a steel tray. The foreskin will later be packed in a medical tube and taken to Israel to be ritually buried.
"Mazel tov," Salzhauer says, already stitching up Uri's penis.
That's right: Miami's most notorious plastic surgeon, a man labeled an anti-Semite by his critics, is a devout Jew. And an orthodox one, at that. Under his ever-present surgical cap lies a yarmulke. For Salzhauer, Judaism isn't just compatible with being a plastic surgeon; the two go hand in hand. He believes he has a religious calling to help others feel better about themselves, even if that means boob implants or a butt-lift. He has such faith in his profession, in fact, that he's had cosmetic surgery himself.
Detractors say Salzhauer uses his religion as a shield from criticism. "Anything that plays an ethnic card to drum up business is particularly vulgar, even if someone belongs to that ethnic group," argues Kenneth W. Goodman, director of the University of Miami's Bioethics Program.
Yet it's little wonder that Salzhauer feels inoculated from accusations of anti-Semitism. His family story is a Talmudic tale of exile and suffering. His grandfather, Jacob Koppel, was only 6 years old when World War I broke out. His family fled their town in the Ukraine, only for a Cossack horseman to club Jacob's father to death on the side of the road. Jacob found refuge in Vienna and then Berlin. But in 1933, the 24-year-old was forced to flee again when Adolf Hitler came to power. This time, he and his wife settled in Palestine.
Salzhauer's father, Tzvika, was born two years later in Tel Aviv. He was a clever boy but had no patience for school. Unlike his parents and teachers, he spoke both Yiddish and Hebrew. When he was 16, he ran away from home and joined the newly formed Israeli army. But after Tzvika's cousin was killed during an air force training exercise, the government realized the scrawny tank commander was the only male in his family not murdered in the Holocaust or martyred defending Israel. He was shipped off to New York in 1958.
Tzvika used his military background to begin a demolition business. But clients wouldn't award contracts to a Jew, so he started a printing company. One night while he was eating in an Upper East Side diner, 16-year-old Linda Martin wandered into the deli and took a liking to the Israeli war veteran. They were married a year later and soon moved to the Jewish suburb of Orangeburg near New Jersey.
Michael was born in 1972, during the Cultural Revolution, but it was obvious to his parents that he wasn't destined to be a hippie. The 4-year-old wanted to be a doctor so badly he begged his father for a stethoscope. Michael would fall asleep at night to the sound of Tzvika's beating heart.
"He was Mr. Republican," his older sister Eliana remembers. "He was very interested in money from a young age. He was reading that How to Win Friends and Influence People book at 14."
Michael and his three siblings attended Jewish schools, but their family wasn't very observant. They ate kosher at home but scarfed down whatever they wanted with friends. The Salzhauer kids' bubble of Jewish school, family members, and friends burst only when Michael insisted on attending a public high school so he could swim competitively his freshman year.
"I had a bump on my nose, but it had never bothered me until then," Salzhauer says. "Suddenly, I was picked on for my nose and called names. It was the first time I had ever experienced any real anti-Semitism."
Michael shelved his dreams of Olympic glory as a swimmer, returned to Jewish school, and focused on his grades. But he hated the constant prayers and strict dress code, so he skipped his senior year and enrolled at Rockland County Community College. Ever ambitious — with a 4.0 GPA and a nearly perfect SAT score — he was then accepted to Brooklyn College's seven-year BA/MD program, at only 17 years old.
Like his father, Salzhauer was eating when he met the love of his life. Eva Zion was a beautiful brunet psychology major who sat at his table in the Brooklyn College cafeteria. The two began dating, and when Salzhauer transferred to Washington University in St. Louis, she followed. Their 1995 marriage was announced in the New York Times.
Eva persuaded her young husband to do his medical residency in Miami. The hours at Jackson Memorial Hospital were grueling 48-hour shifts of nonstop gunshot and car crash victims. Occasionally, however, Salzhauer saw firsthand cases that needed a good plastic surgeon — usually because an amateur had botched the job. Debriding a patient's buttocks — literally, tearing the person a new ass — was gross, but it indulged his creative impulses.
Salzhauer had another revelation during his residency. The marathon days of saving dying people had desensitized him and inflated his ego. He had begun to see his patients not as people but as problems he could fix. So when a young Orthodox Jewish woman arrived with a serious infection, Salzhauer made it his mission to save her. He checked on her obsessively, devoting extra hours and concocting elaborate treatments. In the process, he grew close to her husband.
When she died a few months later despite his efforts, Salzhauer was deeply shaken. Yet the woman's husband and family seemed miraculously prepared and at peace.
"They had this simple faith, this spirituality that was missing in my life," he says. Salzhauer began attending the shul on Collins Avenue in Miami Beach, an orthodox temple where the sexes sit separately and men wear black boxes inscribed with Torah verses on their heads during prayer. "I realized that I wasn't in charge," he says of his epiphany. "No matter how smart or diligent or good I was, there are some things that are out of my control."
Dr. Schnoz had found God.
Linda Salzhauer shrieked at the sight of her son. Dr. Michael Salzhauer had just finished a shift at the prestigious Cleveland Clinic Florida in Weston. But when he slipped into her car, his face was covered in bandages like that of a burn victim. For the past year, he had honed his skills alongside the clinic's finest cosmetic surgeons. He was remarkably young for a doctor and undoubtedly talented, with a multimillion-dollar career ahead of him. But the taunts from high school had stuck with him. And as he learned how easy it was to change someone's face, he decided to change his own.
His colleagues did it for him as a graduation present. They filed down the knot in his nose, boosted his chin with a silicone implant, and liposuctioned his love handles. His mom was in shock. "I would never, never have told him to do that," she stammers a decade later. "I thought he was perfect the way he was."
Salzhauer's own plastic surgery was both a personal decision tied to memories of abuse over his nose, and a business move, because who wants plastic surgery from a guy who hasn't done it himself? But the surgery would also have a more lasting impact on his side career as a professional shit-stirrer.
Until he returned home, Salzhauer had kept his plans from his daughter. "Is Daddy going to die?" 4-year-old Aleah wailed when she saw her father's bandaged face. Realizing the trauma his surgery could inflict on her, and trying to explain his operation, he had an idea: Why not write a book to help other parents explain their operations?
My Beautiful Mommy hit bookstores on Mother's Day 2008. In bright illustrations, it tells the story of a young girl whose mother gets a tummy tuck. Dr. Michael — Salzhauer's superhero-like stand-in with broad shoulders and a square chin — also gives the mom a nose job. By the end of the book, when Mommy's bandages come off, she is a veritable cartoon cougar.
Public reaction was fast and furious. Bloggers nationwide accused Salzhauer of selling plastic surgery to little kids and, even worse, sowing inadequacy. "That's an excellent message to send to your daughter," wrote Jezebel's Jessica G. "Isn't she going to think that her nose is inadequate too?"
Child psychiatrists also sounded alarm. Elizabeth Berger, author of Raising Kids With Character, told the Daily Beast that Salzhauer was right to tell parents to talk to their children about surgery, but that it was dangerous to raise body image issues with girls too young to understand them.
As the firestorm raged, something curious happened: Instead of shrinking from the derision, Salzhauer grew to crave it. In part, it's because the doctor thought the book's critics were ridiculous. "People see it as a sign of the decadence of Western civilization," he says. "But... plastic surgery helps people feel better about themselves. If something bothers you about your appearance, fix it. If it doesn't, then don't."
But the kerfuffle also kindled something more basic: For years, Salzhauer had been so focused on med school, his residency, and his practice that he'd never really had time to be a kid. He could perform most surgeries on autopilot, yet courting controversy was different. It was dangerous. It was fun.
Rather than move on, Salzhauer sought to start more trouble. A year later, he hosted a highly publicized fashion show for his plastic surgery patients. Ten artificially enhanced women in skintight dresses sauntered down a makeshift catwalk, fake boobs bouncing to the music's beat.
In 2010, when reality TV star Heidi Montag landed on magazine covers across the country after undergoing ten cosmetic procedures in a single day, Salzhauer created an iPhone app called "Heidi Yourself" that allowed women — and girls — around the world to upload photos of themselves and tinker with their appearance. More than half a million people downloaded it, but again Salzhauer was accused of going too far.
Yet nothing compared to the uproar over the "Jewcan Sam" video. At first, Salzhauer sent it out to a few hundred of his former patients. A week later, only a few thousand people had watched it. Then the doctor got a call from ABC News asking for permission to post the video on its site. Within hours, more than 50,000 people had clicked. The ASPS quickly announced its investigation.
Salzhauer was oblivious, however. Like many Orthodox Jews, he doesn't watch television. His children listen to songs sung a cappella in Hebrew. "My teenage daughter wouldn't even recognize Britney Spears," he says. "That gives you an idea of the type of bubble I live in."
Indeed, although Salzhauer's two-story, Mediterranean-style house is worth more than a million dollars, it's no Nip/Tuck bachelor pad. It's large and boasts plenty of marble, but the floors are littered with toys belonging to the surgeon's five kids. When Salzhauer and his wife decided to buy a second home, they chose the one behind theirs so their children could have room to play. They let visiting rabbis stay there.
Even if he had a TV set, he'd hardly have time to watch it. The doctor wakes up at 4:30 every morning, swims at a local gym for two hours, and heads to the shul to pray. By 8:30 a.m., he's in his office meeting patients. He drives his Lexus SUV home each evening for dinner with the family, and then he returns to work until 9 or 10 p.m. for more consultations. By the end of the day, his hands are black from drawing on patients' faces.
On March 14, the day ABC posted "Jewcan Sam" and the video went viral, his routine ground to a halt. That night, someone from his office called and told him to turn on the news. He crept into his maid's quarters and turned on a tiny TV set to see a local news reporter standing in front of his office building. You've got to be kidding me, he thought. After the ASPS complained, he abandoned the video contest. But the web hits kept coming.
"I had people calling me and asking me if I was going to prison," Salzhauer says.
Even that firestorm didn't sate his thirst for publicity. A few weeks later, after the "Jewcan Sam" hubbub had subsided, he stumbled upon an op-ed on the Jewish Press website in which a woman named Yitta Halberstam advised Jewish mothers to buy their daughters plastic surgery to marry them off. The op-ed quickly accumulated almost 1,000 angry comments.
Salzhauer soon added his own: "This article is 100 percent on target," he wrote. Then he made an offer: free plastic surgery for Orthodox Jews who needed it to find a match. He called the promotion "Operation Chuppah," referring to the Hebrew word for wedding canopy.
"There is a singles crisis in the Orthodox Jewish community," Salzhauer says. "There are more women than men, so the guys are being very picky."
He quickly adds, "Not that the guys couldn't use a nose job too. But something has to be done to get them together."
Call it sexist or shallow, but Joanna Gonzalez looks great when she arrives at Salzhauer's office a week after her surgery. The single mother wears a short black summer dress and high heels. Just a hint of blue remains beneath her eyes from the broken nose, and a small bandage straddles her new chin.
Salzhauer takes her face in his hands like a Fabergé egg. He inspects the features he's given her with the love and pride of Pygmalion polishing his Galatea. "You look awesome," he says definitively. She beams.
"It's almost like he sees it in his head beforehand," Gonzalez later says of Salzhauer. "He's a genius." Asked whether she felt strange knowing a TV crew was filming her surgery or if she was put off by the viral videos, she shakes her head. "Nowadays, it's all about the YouTube hits."
A decade into an already controversial career, Salzhauer has reached a happy equilibrium. Patients such as Gonzalez don't care about the ethical questions. The doctor, meanwhile, quieted his own conscience years ago. Let the haters hate. I'm going to make people happy, his mantra now goes. And I'm going to put it all on YouTube.
When it comes to carving new faces, Salzhauer's skills are unquestionable. His viral videos, however, are another matter. Each one is a marketing Hail Mary that will bring either thousands of new customers or national controversy. Ever since My Beautiful Mommy, Salzhauer's shameless approach has rubbed the medical establishment the wrong way. Several fellow plastic surgeons declined to comment for this article. And "Jewcan Sam" has driven ethicists insane.
"To think that someone was offering a free medical procedure in order to produce a video to build his practice, yikes and yuck," says Kenneth Goodman, the UM bioethics director. "Surgery is an ancient and noble profession designed to help other people. That does not leave room for tawdry marketing gimmicks."
Tell that to Salzhauer. Dr. Schnoz now spends several hours a week making videos to upload to YouTube. He has hired a cameraman away from local TV news. He recruits his surgical assistants and office workers for his videos. And ever since he gave a hip-hop producer a nose job, he's been in discussions to have a major rapper drop the name of his practice in a song.
Salzhauer describes his viral-video obsession as one-third geeky hobby — the adolescence that the child prodigy gave up when he enrolled in medical school at age 17. But the rest of it is business. Other Miami plastic surgeons have their own reality TV series. "I'm just trying to stay on the cutting edge among my peers," he says.
Instead of selling surgery to soccer moms who watch reality TV, Salzhauer is targeting teenagers who compulsively watch YouTube on cell phones. Roughly 30 percent of his patients are now under 25. He'd like to triple that number. And he says he routinely operates on kids as young as 15, in part because he believes surgery can help teens avoid years of bullying.
"Public attitude is changing," he says. "Fifty years ago, people thought braces were evil. Nowadays, if you don't fix your kids' teeth, you're considered a monster."
But Goodman points out that teenagers' faces continue to change until they are in their 20s, and that counseling is a much safer option. "This sends a very sad message," Goodman counters. "This is caving in to the very worst of adolescent peer pressure. We used to tell kids to stand up against bullies. This is telling them: 'Give into bullies, and we've got just the surgery for that.'"
Salzhauer dismisses that argument. "Some people languish in life," he says bluntly. "They never reach their full potential because they are unhappy about some part of their body. People always say character is what really counts. Yeah, right. Try telling that to the kid crying into his pillow every night."
There are also religious objections to Salzhauer's permissive approach to plastic surgery. Citing the Torah, some Jews consider tattoos — let alone nose or boob jobs — tinkering with God's work: "You shall not make gashes in your flesh for the dead, or incise any marks on yourselves," Leviticus 19:28 says.
Salzhauer is at peace with his religion too. "Judaism isn't like Catholicism, where the body is sacred," he says. "For Jews, the body is a like space suit for the soul. We need it to exist, but we're not unique snowflakes that can't be altered. Take circumcision. It's a commandment."
With Operation Chuppah, Salzhauer might be onto something. In late May, he gave away his first nose job to an 18-year-old high school student from a large Orthodox Jewish family in New Jersey.
"I don't think having my nose a little smaller means, oh my God, guys are now going to want me," says the teenager, who asked that her name not be published. "But it gives me confidence, which is helpful when you are dating."
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Salzhauer is gratified to hear stories like hers. But he freely admits the truth: Not even a satisfied patient compares to the high he gets from seeing one of his videos go viral.
On a recent weekend, Salzhauer calls a New Times writer to deliver breaking news with bated breath. His latest project, a commercial spoof called "Old Spice vs. New Spice," has rocketed to the top of YouTube's daily chart with nearly 200,000 views in 48 hours.
"I want to make sure that YouTube isn't playing a trick on me," Salzhauer says excitedly, asking the reporter to check the website. "We shot it yesterday morning before surgery in an hour and a half.
"That's incredible," he says, almost giggling. "I just wanted you to share in this moment."