Known on Instagram as Dr. Miami, Salzhauer had amassed 90,000 followers. But in early 2015, Instagram shut down his account for violating its rules against nudity. He was despondent. Salzhauer had grown to love the attention, feeding off of his followers’ energy. He preached a gospel of surgery-enhanced empowerment, calling his clients “beauty warriors.” His oldest child, 15 years old at the time, suggested he try Snapchat. He hired a recent college graduate named Brittany Benson to manage his Snapchat account and film the procedures.Benson’s impact was undeniable: first 100,000 followers, then 500,000, then a million. No filter was too outlandish, no conversation too profane. Rapper 2 Chainz came to the operating room to watch a butt lift, and with gold chains piled over his scrubs and sunglasses hanging low on his nose, he exclaimed, “She gonna wake up with a small waist and a fat ass!” The surgeon was a natural: Handsome and buff, with a dazzling smile, he would break out into choreographed dances in the operating room. (One clip, of Dr. Miami dancing to rapper Plies’ song “Ritz Carlton,” has been watched 4 million times.) The videos also attracted the attention of other doctors, which gave Salzhauer an idea. What if this social media model was something he could sell, not just to patients but to colleagues? He started a consulting business. One of the earliest clients was Martin Jugenburg.The pair met in early 2016, while Jugenburg was in Miami attending a conference. Jugenburg was fascinated by the way Dr. Miami marketed his practice and saw in Instagram and Snapchat a way to communicate visually what he’d been trying to convey on RealSelf.When Jugenburg returned to Miami in May, he was presented with his persona. “It was almost a given,” Benson says. “We had to do something with a 6ix.” They set up his Instagram and Snapchat accounts. He stayed for a week, observing Dr. Miami and receiving branding and social media advice from Benson, including copies of the consent forms signed by Dr. Miami’s willing patients. Benson was struck by how naturally Jugenburg took to the doctor-as-influencer idea. “Some doctors want to be on social media, but you can’t teach them that personality. Dr. 6ix had it,” she says. “He was witty and funny and quirky.”At the end of the week, Jugenburg made his first cameo on Dr. Miami’s feed, in a campy knighting scene. With Benson behind the camera, Jugenburg stood facing his mentor, who wore a red crushed-velvet cape and oversize crown. “Torontoland, you have proven yourself worthy in the operating room,” Dr. Miami pronounced. “Now please kneel.” Wearing a gold-trimmed, black Raptors basketball jersey, Jugenburg pressed his knee to the floor. Dr. Miami brought a clownishly large scepter down onto his left shoulder, then his right. “Arise, Real Dr. 6ix,” he said. “Now, go rescue the princess trapped in this tower.” He handed him a glossy picture of Toronto’s needle-thin CN Tower.Outside of the operating room, Jugenburg’s graying hair hangs floppily over his ears, giving him the air of an affable golden retriever. He speaks with a soft Slovakian lilt, and his eyebrows are slightly upturned, as if posing a perpetual question. On camera, he was the Real Dr. 6ix, a surgeon in sleek black scrubs with a wry smile and a penchant for unfiltered commentary. He hired a social media assistant and emblazoned a Dr. 6ix logo on deep-V T-shirts, surgical scrubs, and baseball caps. If patients asked, they were given a Dr. 6ix T-shirt for free. His fan base couldn’t get enough. When he hit 100,000 followers on Instagram, he celebrated the success with cookies iced with “100K!” and promptly posted them to the feed. “Am I the only one that thinks there’s just something weird about the way she looks?” he asked his followers about Kim Kardashian West. He called the look “diaper butt.” Alongside celebrity callouts were surgery explainers and images of the taut bodies of his own patients. He posted a video of himself headbanging to Sir Mix-a-Lot’s “Baby Got Back” in the operating room. He posted a meme that read, “Med school? Please … I watch Dr. 6ix.” When Instagram occasionally pulled down his posts for violating community guidelines, he blasted the app for being inauthentic and prudish.