"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.