Once, plastic surgery was taboo.
These days going under the knife is like getting a (very expensive) haircut (with side effects).
And now, a soaring number of patients is letting the world watch their procedures – on Snapchat.
The past two years have seen the rise of the ‘Snapchat Surgeon’: doctors who livestream their operations on social media to millions of viewers.
At first, the plastic surgery industry dismissed the few accounts as salacious fads which would die out.
They were wrong.
Earlier this year the trend reached such a height among board-certified surgeons that the American Society of Plastic Surgeons (ASPS) was forced to publish guidelines on how to use social media in the operating theater.
Some medical schools even offer Snapchat lectures for trainee surgeons.
It remains controversial. The most famous account, Dr Miami (or rather, Michael Salzhauer), was recently slammed by the board for rapping, dressing up and fooling around in the OR during operations, forcing him to scale back. Other professionals claim they cannot see how Snapchat benefits anything other than the surgeon’s business. And yet, no one can deny it is giving all clinics a promotional boost as plastic surgery enjoys an unprecedented boom.
As the industry grapples with ethical boundaries, Daily Mail Online took a look behind the scenes with Dr Matthew Schulman, the most successful in the field alongside Dr Miami, as he performed a Brazilian butt lift (BBL) on a 25-year-old patient from Queens, New York.
The New York City board-certified surgeon joined the social media platform two years ago.
Before, he had built a name for himself as an expert in the BBL field. But that is now a footnote to his celebrity.
Today, he is pushing five million viewers on his account @nycplasticsurg – and 95 percent of his patients already follow him on Snapchat.
Behind the filter: Dr Matthew Schulman, a New York City board-certified surgeon who joined Snapchat two years ago, is one of the pioneers in the field. He now teaches student surgeons at Mount Sinai how to use Snapchat in the operating theater
He has 4.5 million viewers on his account @nycplasticsurg – and 95 percent of his patients already follow him on Snapchat
Daily Mail Online went behind the scenes with Dr Schulman and his team to watch him perform – and stream – his signature procedure: the Brazilian butt lift
‘I FELT LIKE I KNEW HIM’: PATIENT, 25, DESCRIBES WHY SHE APPROACHED THE SNAPCHAT SURGEON TO PERFORM – AND FILM – HER BUTT LIFT
As Henny reached her final year of graduate school last September, she decided she wanted to get a BBL, a specialized procedure which pumps up the buttocks and reduces the size of the waist.
The bubbly 25-year-old from Queens, New York, said she had been thinking about it for years. Finally, she decided she would get it as a graduation present for herself.
‘I spent months searching for the right person. I had three other consultations before I met Dr Schulman – one of them wasn’t even a surgeon. I ran straight out the door when I realized.
Henny, a bubbly 25-year-old from Queens, New York, was already a fan of Dr Schulman’s on Snapchat when she decided to become a patient. She said she liked that she already knew him, and her mom felt reassured that she could check up on how she was doing throughout the procedure
‘But as soon as I met Dr Schulman, I was sure. He was exactly the same in person as he was on his Snapchat. He knew what he was doing, and I’d seen him do it. I felt like I was in safe hands, and he was familiar.’
She added that her mother was reassured by the fact that she could watch her during the operation.
‘She didn’t want me to do it at all. But once I told her I was doing it, she was happy she could watch it.’
And so she booked herself in to go under the knife on July 11, 2017, at 8am – with her family ready at home to watch along.
According to Dr Schulman, that is a typical scenario.
‘Most of the patients that come to see me now are already actively following me on Snapchat, so they’ve already seen me do the surgery that they’re interested in,’ he explains.
‘They’ve seen the results, they know my team. So they’re coming in confident, and they’re coming in already having me pre-selected as their surgeon.
‘It makes for a nice practice where people are coming in that want surgery with me and they already have seen the surgeries.’
Every patient starts with a private consult, that does not make it onto Snapchat (‘I want to be able to answer all the questions without worrying about the person censoring themselves because they don’t want it to appear on Snapchat’).
The first time fans meet one of the patients-to-be is shortly before the procedure, when Dr Schulman posts some before photos of their body, covering their face and any identifying features they want to obscure, such as tattoos. Dr Schulman then talks the viewers through the procedure, and anything particular about their case.
But before that, during the consultation, he asks them what they are looking for.
According to Dr Schulman, all of his patients bring in the same ‘wish pics’ from Instagram.
‘They’re all 18-inch waist, big tight round butt.
‘Yes that’s why they call it a “wish pic”. But that’s not realistic and I tell them that from the start.’
IS IT ETHICAL?
The industry has been toying with the issue of ethics for years, and it this year it reached a height.
Previously, the ASPS code of ethics prohibited surgeons from promoting their practice for business game, and from doing anything that could put the patient at harm.
But now, the board faces a conundrum: more and more surgeons are seeing the benefits of Snapchat to court patients – there is @bodysculptor in Chicago, @drsejmd in LA, and Dr Schulman in New York. It is also helping to fuel the current trend plastic surgery becoming less taboo.
The ASPS has always offered room for education – and Dr Schulman has capitalized on that. While his Snapchat shows the same procedures, he vociferously promotes an image of himself as ‘the educator’ in the field
Added to that, they face the issue of the ‘Dr Miami effect’. Dr Miami is credited with creating the Snapchat surgery trend. The eponymous surgeon is so prolific he was nominated for a Shorty Award as Snapchatter of the year, but narrowly lost to DJ Khaled. In the last year, his viewership has grown by 150 percent at least, and he is now booked up until 2019. But his style that has won over so many fans is controversial. He dresses up in funny costumes, plays hip hop music, holds up a patient’s fat to the camera, and brings in a reel of guests.
Several months ago, the ASPS came out with a set of guidelines. Publishing them with an editorial, the board leaders slammed high profile Snapchat accounts that make light of the practice (and many took this to be a direct dig at Dr Miami).
‘I think he’s toned it down because he’s seen that people he respected were critical of his methods,’ Dr Daniel Maman, a board-certified surgeon who does not use Snapchat, told Daily Mail Online.
Dr Maman, of 740 Park Avenue Plastic Surgery, said he can see the benefits of it, but like many in the field he is conflicted.
‘It’s a double-edged sword. There are some great things and not so great things. It helps to educate the public about our work and spread awareness about the kind of procedures we do – they become more aware of the good and the bad and our field.
‘But a lot of people are taking it to a level were it sensationalized everything. That just detracts from the importance of what they’re doing and detracts from patient safety. There is a fine line between trying to please and trying to entertain.
‘You wouldn’t want your cardiac surgeon changing your heart valve while rapping. One wrong move or inattention can cause severe bodily harm if not death.
‘There are certainly surgeons – good ones – that do it in a very tasteful and ethical way. But I think it was very important for the ASPS to come out with guidelines and say that they were extremely critical of some of the behavior.’
Amid the furore, Dr Schulman has taken a clear – and useful – stance: ‘it’s all about education’.
The ASPS has always offered room for education. A surgeon can promote their practice if their primary focus is to educate aspiring surgeons and the wider public about the practice, to enhance the field.
Dr Schulman’s Snapchat is no less salacious and stomach-churning – with butt lifts and breast augmentations galore – and his business is benefiting from his celebrity.
However, he vociferously promotes an image of himself as ‘the educator’ in the field. Aside from lecturing at Mount Sinai, he has started offering fellowships to fans of his Snapchat, who come to shadow him for one or two days at a time.
‘I think it’s kind of a way to pay it forward,’ he says.
INSIDE THE OPERATING THEATER WITH DR SCHULMAN – AND HIS SNAPCHATTING ASSISTANTS
At 7am, the surgical team is quietly setting up the theater; Dr Schulman is buzzing.
‘Are we ready guys?’ he chimes, powering through the clinic in his black scrubs.
Henny was sedated, then lain on the operating table, hooked up to various IV drips keeping her anesthetized and keeping her heart rate stable. While she was being set up, Dr Schulman stood outside snapping his introduction. He explained to his fans who his patient was (a 25-year-old girl who is not overweight), and what she wants (a heart-shaped butt).
Once inside, he stood over Henny, who was completely covered aside from her midriff. He snapped another intro, showing fans her body, and turning the camera to a screen, which shows her ‘before’ pictures. He then set the iPhone 6 aside, and started drawing marks on her body where he would be removing fat.
Lights! Camera! Suction: This is a shot of Dr Schulman’s operating theater when there is no surgery going on. The set-up is well-oiled, and primed for visitors like fans or media. There is space for at least nine people, with bright lights for shooting
Order of service: A large white board in the corner lists the essentials – the procedure, the timings, and if Snapchat is on
Before: Dr Schulman keeps Henny’s before pictures permanently displayed in the room as they morph her body
The set-up is well-oiled, and primed for visitors like fans or media. Everything covered in blue sheets is ‘off-limits’. There is space for at least nine people, with bright lights for shooting.
The entire procedure would be three hours long – one hour of liposuction on the back, one on the front, and an hour to re-inject all of that fat into her hips and butt while shaping it into place.
Dr Schulman is relaxed and confident, flanked by an anesthetist, a physician’s assistant and a registered nurse. There is also a student in the room, 18-year-old Matt from Chicago, who is an aspiring surgeon and an avid fan of @nycplasticsurg.
‘We usually play music in here but I won’t today. Stay serious,’ Dr Schulman says with a smirk.
STAGE ONE: LIPOSUCTION ON THE FRONT (1 HOUR)
Liposuction is a broad term which refers to the removal of fat from any part of the body – commonly the tummy or the thighs. In a standard liposuction procedure, the fat is then discarded. In a BBL, it is ‘processed’ then injected back into the body, all into the butt and hips.
There are various ways to perform liposuction. Surgeons can use a ‘tumescent fluid’, inserting a mixture of salt water, numbing medicine and epinephrine into the body before the fat is removed. This is designed to minimize the amount of bruising afterwards. Other options can involve using a laser-powered cannula or an ultrasound-powered cannula, which emit energy to melt the fat before it is removed.
Dr Schulman does none of that in a BBL. He uses another classic technique: using a power-assisted cannula which vibrates to tunnel into the fibrous tissue and remove the fat.
He makes small incisions around her abdomen, in her belly button and just below her breast line. Then he starts extracting. The cannula makes a buzzing noise as he forcefully pumps the tool back and forth into her body, while feeling around for fatty spots to target.
The cannula is connected by a clear tube to a large plastic jar, and the fat splatters into it. As he moves around her body, Dr Schulman has white cloths to wipe up residue from the incisions. By the end of the process, these cloths are a deep yellowy-red.
He takes out much more fat than other surgeons normally would.
That is a feature of his trademarked signature style, called the SCOOP Lift, which is a play on the upside-down heart shape.
By taking out far more fat, and injecting far more fat, he makes a smaller waist, and has more to ‘work with’ to contour the butt creases and create a smooth transition to the legs.
There are long stretches of silence, with each of the team pottering away at their work.
Now and again, the registered nurse Jay will pick up the phone from its designated table, and tell Dr Schulman ‘let’s do another’.
She snaps as he continues plugging away, chatting to the viewers. ‘I know her family are watching! It’s all going very well,’ he effuses.
Jay then puts the phone back down and busies herself with making some notes on the white board as the physician’s assistant Tami quietly checks the jar of fat and anesthiologist Dr Douglas Kornreich, a long-time associate of Dr Schulman’s, stares at the heart monitor.
At times during the three-hour operation conversation flourishes.
Everything covered in blue sheets is ‘off-limits’ to Dr Schulman’s visitors – either fans or media. Here, he can be seen (top left) holding a power-assisted cannula, which he inserts into the body to extract fat. The cannula is connected by a clear tube to a large plastic jar (bottom left), and the fat splatters into it. Once that jar is full, they switch the tubes to connect to the second jar (next to it)
The cannula makes a buzzing noise as he pumps the tool back and forth in her body, feeling around for fatty spots to target
Now and again, the registered nurse Jay will pick up the phone from its designated table, and tell Dr Schulman ‘let’s do another’. She snaps as he continues plugging away, chatting to the viewers. ‘I know her family are watching!’ he says
Dr Schulman pictured during stage one. By the end of the liposuction section on both front and back, both jars were full
The jars fill up with a mixture of fat, bodily fluid and blood, which will gradually separate like oil and water
Once the first jar was full, Tami moved it over and attached the tubes to the second to start filling it up
First hour done: Dr Schulman and his assistant Tami sew up Henny’s skin where they made incisions for liposuction
On to stage two: The entire team helps to flip Henny over to liposuction the back then re-inject the fat and contour it
‘We’re guinea pig sitting for someone at the moment,’ Dr Schulman tells Tami as he plunges the suction rod into Henny’s back. ‘It’s cute and stuff but it just doesn’t stop pooping. At least a hamster or something just poops in one corner. But this thing just doesn’t care.’ The room buzzes with musings about rodents and feces as Tami reassesses the fat jars.
Throughout, Dr Schulman is making notes on a blue table sheet, one column showing where he is sucking fat out, another which will show how many injections of fat he makes.
Finally, he determines that they have got the most out of the front. Tami sets the cannula aside and helps Dr Schulman sew up the parts of of Henny’s skin where they made the incisions.
STAGE TWO: LIPOSUCTION ON THE BACK AND PROCESSING THE FAT (1 HOUR)
Once flipped over, Dr Schulman takes a snap of Henny’s back, with her butt exposed. He then douses her body in antiseptic ointment, and starts the same process: making marks around her back thighs and waist where he will be extracting the fat.
Meanwhile, the fat in the large plastic jar is ‘processing’.
This process is arguably the most important aspect of the procedure.
Brazilian butt lifts have a higher death risk than most cosmetic operations – 20 in 100,000 compared with 1 in 100,000.
There are two major risk factors that can make a BBL fatal: a fat embolism (blood clots that travel to the lungs) and accidental injection of fat to blood vessel.
Starting stage two: Dr Schulman takes a snap of Henny’s back, with her butt exposed, showing his viewers the ‘before’ shot
They doused Henny’s body in antiseptic ointment, and starts the same process: making marks around her back thighs and waist where he will be extracting the fat
The team watches as Dr Schulman pauses the procedure to capture the half-way point on Snapchat
Dr Schulman, pictured marking the points on Henny’s back where he will be extracting the last bout of fat
The BBL connoisseur takes out much more fat than other surgeons normally would. That is a feature of his trademarked signature style, called the SCOOP Lift. By taking out far more fat, and injecting far more fat, he makes a smaller waist, and has more to ‘work with’ to contour the butt creases and create a smooth transition to the legs
Dr Schulman insists the procedure has little impact on his patients’ tattoos. ‘I actually think they look better after,’ he says
As he moves around her body, Dr Schulman has white cloths to wipe up residue from the incisions. By the end of the process, these cloths are a deep yellowy-red
By the second half of the surgery, another assistant had arrived to help with the surgery – and to take over Snapchat duties
Dr Schulman dismisses both of them as amateur concerns (‘if you know what you’re doing, that’s basically impossible’). But getting the fat right, he agrees, is an art.
Many surgeons use a centrifuge to ‘purify’ the fat – separating the best fat from blood and bodily fluid. Dr Schulman doesn’t; he leaves the fat to separate naturally, like oil and water.
‘Less manipulation of the fat, the better it will survive,’ he says.
It was easy to see when they had fully separated: there was a bubbly orange mass at the top of the jar, and a clear red liquid at the bottom. Once they reached that point, Tami put a metal bowl underneath the jar which has a tap at its base. She opened the tap and the fluid came gushing out. While many surgeons discard this, there is a growing trend of saving it, since more and more studies show it contains ‘microfats’, which can be recycled and used in other procedures, such as rhinoplasties (nose jobs).
Throughout, the fat in the large plastic jar is ‘processing’. This process is arguably the most important aspect of the procedure. Brazilian butt lifts have a higher death risk than most cosmetic operations – 20 in 100,000 compared with 1 in 100,000. Most deaths are connected to fat embolisms, caused by poorly injected and poorly processed fat. While some surgeons use apparatus to separate the fat from fluid, Dr Schulman leaves it to process naturally
Once the fat was processed, Tami put a metal bowl underneath the jar which has a tap at its base. She opened the tap and the red fluid came gushing out. While many surgeons discard this, there is a growing trend of saving it, since more and more studies show it contains ‘microfats’, which can be recycled and used in other procedures, such as rhinoplasties (nose jobs)
The useful fat is then splattered into another jar. Some of it will be used in the procedure; the leftovers will be stored
The physician’s assistant pours excess fat into a sterilized jar for storage through a funnel
Here, Tami is pictured holding the valuable microfats which came out of the jar with the bodily fluids
STAGE THREE: INJECTING THE FAT (1 HOUR)
Finally, Dr Schulman filled up the tools to inject the fat.
This procedure is delicate, and he has each injection point marked out on her body.
As he goes, he is shaping the butt with his hands, and making a tally of how many injections he has made.
‘I do it by a combination of feeling and sight,’ he explains to the camera. ‘I need to get it in the best shape possible for the fat to settle that way.’
When they’re not filming, the team silently moves through the motions of the surgery. Any sign of a camera, Dr Schulman is ready to spout out some facts about butts, fat, surgery, or the recovery process. He matter-of-factly mentions that Henny won’t be able to sit for weeks afterwards as her butt takes shape.
Eventually, he reaches a point where he deems her shape complete. Tami picks up the equipment and sets it aside, then the lights dim, a spotlight comes over the table, and she helps Dr Schulman sew up the incision points.
She is then put in a compression suit. Henny said one of the things she liked best about Dr Schulman was his reputation for using effective compression suits, which are designed to hold one’s shape after a cosmetic procedure. Once she is in her suit, the entire team flip Henny over onto a specially shaped bed which will hold her shape.
Stage three begins: The team fills up the tools to inject the fat
Dr Schulman injects more fat than most of his competitors to sculpt a fuller heart-shaped butt, he says
The needles are inserted forcefully and the fat injected fast as he pushes against the skin with his left hand
When they’re not filming, the team silently moves through the motions of the surgery. Any sign of a camera, Dr Schulman is ready to spout out some facts about butts, fat, surgery, or the recovery process
Snapchat fame aside, Dr Schulman has spent years cultivating a name for himself in the BBL community
It may be the most risky invasive procedure, but fans clamor to watch the procedure at fat splatters on the sheets
‘I do it by a combination of feeling and sight,’ he explains to the camera. ‘I need to get it in the best shape possible for the fat to settle that way’
Some of the fat from the procedure on the sheet as Dr Schulman continues the final leg of the surgery
The physician’s assistant captures the final moments of Dr Schulman shaping Henny’s butt
As he goes, he is making a tally of how many injections he has made (pictured)
Eventually, he reaches a point where he deems her shape complete. Tami picks up the equipment and sets it aside, then the lights dim, a spotlight comes over the table, and she helps Dr Schulman sew up the incision points
Dr Schulman surveys his work, filming it for viewers, with Henny’s ‘before’ pictures in the background
This is the best it will look for weeks. As she heals, it will look lumpy and bruised. She will not see her final shape for a couple of months
Compression suit: Henny said one of the things she liked best about Dr Schulman was his reputation for using effective compression suits, which are designed to hold one’s shape after a cosmetic procedure
Once she is in her suit, the entire team flip Henny over onto a specially shaped bed which will hold her shape
The end result: Dr Schulman’s blue record sheet gives an insight into the staggering number of fat injections that goes into creating a BBL
WHY A BRAZILIAN BUTT LIFT IS THE ‘SNAPCHAT ERA’ PROCEDURE: SURGEONS ARE SEEING A SPIKE IN YOUNG PEOPLE WANTING BIG BUTTS LIKE SELFIE QUEEN KYLIE JENNER
Nip n’ tuck-spiration: Most of Dr Schulman’s patients bring in wish pics of Instagram stars with bodies like Kylie Jenner (pictured), the 20-year-old curvaceous Kardashian sister, who has transformed from a skinny thin-lipped tween to a big-breasted, full-lipped woman with a derriere four times the size of her waist
Snapchat fame aside, Dr Schulman has spent years cultivating a name for himself in the BBL community.
Today, in ‘the age of the butt’, a clinic would be remiss not to include the procedure on its menu.
But Dr Schulman is one of just three doctors in the US that has substantial experience.
He started offering it eight years ago, in the days of J-Lo and early Kim Kardashian. With more than 5,000 under his belt, his name is bandied around forums and blogs for women on the hunt for a BBL-sculptor.
‘I kind of caught the wave when it was starting. In the beginning there was only a handful of people doing it.
‘Now everyone’s trying to do it but you know the good thing for me is I have eight years’ experience. I have 5,000 cases already done before everyone is just starting. There’s really only two or three of us in the country routinely performing it.
‘For the most part, the BBL community kind of recognizes that. I get a lot of patients from all over the world, because they’re willing to travel for it.’
Over the years his client base has changed – particularly since courting social media savvy Millennials.
Most of his patients’ wish pics tend not to be celebrities – they are just perfect-bodied Instagram stars. However, he points to 20-year-old Kylie Jenner, the curvaceous young Kardashian sister, as today’s biggest inspiration for plastic surgery patients.
He’s hardly the first to say it.
Earlier this year, a report from the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) name-dropped celebrities like Kylie as a driving force behind the current boom in demand for plastic surgery.
Rates are rocketing, mainly driven by unprecedented rates of young girls and men seeking tweaks to their appearance.
Americans spent a record-breaking $16 billion on plastic surgery and minimally-invasive procedures in 2016 – up from $13.5 billion in 2015.
One of the biggest factors driving the increase has been minimally-invasive procedures, such as Botox muscle relaxers. But breast augmentations are still the third-most popular ‘job’, with more than 1.5 million done in the US last year.
And now, surgeons say the biggest trend is all below the waist: bigger butts and ‘designer vaginas’ – particularly among Millennials, aged 23 to 30.
Americans spent a record-breaking $16bn on plastic surgery and minimally-invasive procedures in 2016 – up from $13.5bn in 2015
Experts credit the impossibly taut and voluptuous Kardashians – in particular, Kylie, who has transformed from a skinny thin-lipped tween to a big-breasted, full-lipped woman with a butt four times the size of her waist.
Dr Schulman agrees, and says one of the biggest components of his job involves managing patients’ expectations.
‘Now it seems like everybody on Instagram is showing off a big round butt,’ Dr Schulman laughs. ‘And that’s what my patients want, all bringing in the same wish pics.
‘Yes that’s why they call it a “wish pic”. But that’s not realistic and I tell them that from the start.
‘We have some women come in that say “I want a big butt because my butt’s always been flat”, and I look at them and say ‘yeah your butt’s flat because you’re 130 pounds’. You can’t have a big butt if you don’t have enough fat on you. So there are people that I turn away because they’re too skinny.
‘Conversely there are some people that I turn away because they’re too overweight. I can’t take someone that’s obese and give them an 18-inch waist and a big round butt. It doesn’t work.
‘So the real challenge with this procedure is people have to be realistic. It is not as simple as molding clay. If it was, everybody would do it. But it’s not, I have to work with your body, I have to work with where your fat is, I have to work with what your bone structure is.’