Your BODY, His INSTAGRAM
SOCIAL MEDIA GAVE THE REAL DR .6 IX A STAGE ON WHICH TO SHOW OFF HIS SKILLS. BUT WHEN COSMETIC SURGERY BECOME S ENTERTAINMENT, WHO OWNS THE STORY?
ONE AFTERNOON IN DECEMBER 2016,
a woman named Laura walked through the gilded front doors of Toronto’s Fairmont Royal York Hotel toting an overnight bag. A towering neo-gothic landmark, the Royal York is renowned for its luxury and celebrity clientele. Alfred Hitchcock stayed there, and so does the Queen of England when she comes to town. Laura, however, wasn’t a famous visitor. She had come for breast implants.
Laura had wanted bigger breasts for as long as she could remember. As a child she’d gazed up admiringly at the hourglass silhouettes of her mother’s friends. “I remember thinking, I need that body,” she says. In high school, as her friends’ bodies transformed, her own development slowed. “I always felt like less of a woman,” she says. It was a feeling she’d never been able to shake, even after her career as a model took off, even after she met a partner who made her feel sexy and valued. By the time she was 26, she’d saved enough money for surgery. On Instagram, Laura had scrolled by posts extolling the mastery of a plastic surgeon named Martin Jugenburg, whose clinic, the Toronto Cosmetic Surgery Institute, was located on two floors of the Royal York. She checked out the stream of satisfied customers in his online reviews. “I am the happiest I have ever been in my life,” one read. “Dr. Jugenburg is an ARTIST,” said another. She felt empowered just booking an appointment.
Laura knew that Jugenburg had a sizable following on Instagram and Snapchat, where he called himself the Real Dr. 6ix. The 6ix was a cheeky nod to the nickname given to Toronto by its most famous musical export, Drake. The Real referred to the unsparing view of blood and guts inside Jugenburg’s operating room, as well as the limits of what surgery can do. He was a plastic surgeon who would tell it like it is but also keep it light with memes, jokes, and office antics. To build his brand, he’d adapted the wacky style of a celebrity plastic surgeon known on social media as Dr. Miami. Laura had seen the Real Dr. 6ix’s posts. There were selfies from a vacation in the Cayman Islands and a video of a film crew trying to squeeze themselves into the back seat of his Porsche. He dressed himself up in filters and called out celebrities for denying their surgical modifications. She’d seen patients post selfies tagging @realdrsix on their breasts or butt, an artist’s signature for a virtual age.
At Laura’s first consultation, Jugenburg held up different implants, wobbling like water balloons in his hands, for her to try. And he asked if he could stream her surgery on Instagram Live. She remembers the moment the tenor changed, how it felt first like a medical appointment and then like a sales pitch. “Everyone does this,” she recalls him explaining. “Don’t worry about it.” She didn’t want to say yes, but she felt there was no room to say no. Whether it was the nerves of an impending surgery or some desire to please the man who’d be wielding a scalpel on her body, Laura acquiesced.
On that day in December, Laura took the elevator to the clinic on the second floor of the Royal York. Under the warm lights, the reception area glowed: white wood, white armchairs, white floors, and white couches. She felt her chest tighten with anticipation. Laura had seen Dr. 6ix’s Instagram videos of patient procedures, so she could imagine what her own surgery would look like. She expected that, once she was in the operating room, he would take a black Sharpie and mark her body like a map, then slide one saline implant into an incision cut clean below one of her breasts, and then the other. In some of the Instagram videos, patients drifted off under general anesthetic administered by Dr. Sleepy, with Nurse Amazing, one of Dr. 6ix’s operating room nurses, standing beside him. On the other side of the table, scalpel in hand, stood Jugenburg himself, in his “6ix”-emblazoned scrubs.
Jugenburg is a celebrity surgeon, a doctor turned influencer who shares his masterworks with his followers in real time. In his operating room, showmanship
and sutures get equal play. He seems to revel in the way social media gives him a stage on which to perform, to show off his surgical arts—all while providing a kind of public-service education on cosmetic surgery. More surgeries mean more viewers, which mean more followers and more clients. Many of those clients are happy to play a role in his reality show, but others, like Laura, say they’ve felt pressured to participate. And in the years that followed her procedure, Laura wasn’t the only one wondering if the doctor had become more beholden to his fans than to his patients.
Laura says her surgery was streamed on Instagram Live that December day. Then, a few months later, as her body began to feel like her own again, she noticed a picture on Dr. 6ix’s Instagram. She recognized her long fingernails, her tattoo, the slight etch of her abs and her bare breast. This was not a photo from the operating room. Jugenburg had pulled it from her personal feed and reposted it to his. It felt like a step too far. When she asked him to take it down, she says he refused. (Jugenburg did not respond to a request for comment about Laura’s account.) Three years later, it’s still up. The tattoo along her ribcage just below her breast reads, “My body. My rules.”
Martin Jugenburg was born in 1975 in what was then Sovietdominated Czechoslovakia. His childhood seems plucked from a Milan Kundera novel. One night, his parents packed what they could into a few suitcases, tucked the adolescent Martin in the back seat of a car, and passed through the Iron Curtain. His father, Ivan, told the guards at the Yugoslavian border that they were taking a summer holiday. The family became refugees, living for a year in Vienna as they waited for Canadian visas. In 1989 they settled in Canada, and Ivan eventually took a job as a pathology assistant at a Toronto hospital. He had been trained as a plastic surgeon and used his skills to help restore the skin of burn victims and trauma patients. But he couldn’t practice medicine in his new home.
Martin grew up hearing his father’s stories of being a surgeon and felt pulled toward the same calling. In high school, Ivan got him a summer job in the pathology department where he worked. After graduating from high school, Martin was accepted to the University of Toronto. He studied biology, specializing in molecular genetics, and took home scholarships and awards from the intensely competitive school. Along with two doctors, he and his father coauthored a paper that was later published in a medical journal. (Jugenburg declined to be interviewed for this story but did respond to some fact-checking questions.)
In 1997, Martin was admitted to the University of Toronto’s medical school, where he took on a dizzying load of extracurricular activities. He edited the web page of the school’s medical journal, mentored high school students, designed the faculty yearbook, and taught judo. He met the woman who would eventually become his wife. Even back then, he extolled technology as the future of medicine. He envisioned a world in which doctors and patients would use the increasingly popular email to communicate with one another. He pored over the latest medical inventions, imagining a future where a surgeon could command three robotic arms at a time in an operating room.
As a boy, Jugenburg met a man whose injured hand had been reconstructed by his father. The hand inspired him, and after medical school Jugenburg was accepted into a plastic surgery residency program in Winnipeg, Manitoba. During his residency, Martin trained his focus on breast reconstruction surgery—years before, his mother had been diagnosed with breast cancer, and he saw firsthand the impact that surgery could have on someone’s life. He then spent a year training as a plastic and reconstructive surgery fellow at Memorial Sloan Kettering Cancer Center in New York. He coauthored papers on radiotherapy’s impact on breast reconstruction, neck reconstruction, and foot defects. The next year he returned to Toronto.
Jugenburg began to work as a plastic surgeon at the city’s downtown hospitals, performing reconstructions on cancer patients and attending to fire victims and workplace accidents in the ER. He was helping people, just as his father had, but he was also the new guy in the OR, assigned just three and a half hours of surgery a week. Jugenburg grew frustrated with how little time he got to spend actually operating. He frequently posted on a blog, Askasurgeon.com, where he was determined to share information with the public. He authored posts like “Tanning beds will kill you” and “Unreliable certification … Who is a real plastic surgeon?” As the years went on, his view of hospitals—and the Canadian health care system—grew more grim. “The entire system is underfunded, squeezed, and abused,” he wrote. “After years and years of cutbacks, restructings [ sic] and improvements, how much more juice can be squeezed out of this old dried up lemon?” Jugenburg joined a private practice, and in 2010 he started his own.
Jugenburg threw himself into building his business, which he eventually named the Toronto Cosmetic Surgery Institute. He stopped publishing papers and presenting at professional conferences. When a mentor suggested he coauthor a paper on a new surgical technique, Jugenburg demurred. He turned his attention to answering thousands of patient questions on Realself, a cross between Yelp and Wikipedia for plastic surgery.
When a prominent doctor who worked in the posh Fairmont Royal York Hotel retired, Jugenburg seized the opportunity. It’s not unusual for plastic surgery clinics to partner with hotels to offer their patients a discreet and discounted place to recover, and in late 2012 he moved his practice to the hotel. His focus changed too. Where once he spoke on national television about the psychological benefits of breast reconstruction for cancer patients, he now performed breast augmentations and liposuction. He registered the domain brazilianbuttlifttoronto.com and advertised himself as an internationally renowned Brazilian-butt-lift expert. He opened a clinic within the facility for injectables like Botox and fillers, which his wife ran. He appeared on an entertainment news show talking up Brazilian butt lifts, inviting film crews into his operating room to watch.
Cosmetic surgeons have always occupied a hazy area, bound by the ethics of their profession but dependent on advertising. The aesthetic nature of the industry makes visual social media platforms like Instagram and Snapchat natural showcases. At first, surgeons posted beforeand- after galleries of patients. But by 2014, one Florida plastic surgeon named Michael Salzhauer had taken things quite a bit further, posting not just the pleasing outcomes but the gory procedures themselves, in real time.
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 into choreographed dances in the operating room. (A clip of Dr. Miami dancing to rapper Plies’ song “Ritz Carlton” has been watched 4 million times.) The videos also caught 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-asinfluencer 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 goldtrimmed black Raptors basketball jersey,
LAURA REMEMBERS THE MOMENT THE TENOR CHANGED, HOW IT FELT FIRST LIKE A MEDICAL APPOINTMENT AND THEN LIKE A SALES PITCH .
I WAS TOTALLY EMBARRASSED ,” SARA SAYS .“HE HAD ME SLICED OPEN AND WAS STICKING AC ANNUL A IN MY BODY. THAT WASN’ T ENOUGH? WHY WAS HE SHAMING ME IN FRONT OF EVERYBODY ?”
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.
Jugenburg developed his Dr. 6ix persona with the same determination he displayed in medical school. He operated on a Playboy Playmate. He worked as an official ringside surgeon for Toronto’s UFC fights. He became one of a group of 15 surgeons called the Dr. Miami Squad. There’s Dr. Bfixin (Long Island, 215,000 followers), the Real Dr. Feelgood ( Fall River, Massachusetts, 521,000 followers), the Real Dr. Bmore (Baltimore, 36,500 followers). The doctors pay for the affiliation: $15,000 for the initial branding and social media training session in Miami, then $2,500 a month for social media promotion on the Dr. Miami platforms.
In private practice, Jugenburg could set his own hours. He operated from sunup to sundown three days a week, posting surgeries on Snapchat and Instagram. He was tracking a societal shift, one in which many of the millions who underwent cosmetic procedures talked openly about them as expressions of agency. Chrissy Teigen has said liposuction made her feel more confident. The rapper Iggy Azalea rhapsodized about her breast implants. “I love them so much I had to talk about them,” she told an E! News reporter as she walked the red carpet at an awards show. Jugenburg’s patients talked about them too. Five days after Latoya Forever, a Youtube vlogger with 1.45 million subscribers, got breast implants from Dr. 6ix, she posted a comedic confessional video about how excited she was to no longer be on the “itty-bitty-titty committee.”
Jugenburg worked to perfect his social media routine, which included asking patients like Laura for their permission to film and post their surgeries. One woman named Sara, who came to Jugenburg for liposuction in 2018, says she initially refused to give permission. In the pre-op room, she says, she was asked to reconsider and reluctantly agreed to be filmed during surgery as long as her face was covered. But when she watched Dr. 6ix’s Instagram Stories after her surgery, she was horrified. Her doctor bantered with his social media assistant over her body. “She’s in her forties and, as you can see, she’s well tanned,” he told the camera. “Tanning and smoking are the two worst things that you can do for aging your skin.”
The video replayed over and over in her mind. Her doctor’s real talk stung. “Look at all this loose skin she’s left with,” her doctor told the camera. “This is not going
to bounce back on its own. It just doesn’t have the elasticity, unfortunately.” Her face was covered in the video, just as she’d been promised, but it almost didn’t matter. She felt like a piece of meat. “I was totally embarrassed. He had me sliced open and was sticking a cannula in my body. That wasn’t enough? Why was he shaming me in front of everybody?” she says. “I didn’t want this in the first place.”
Amonth after Sara had her procedure, another patient, Ana, walked through the Royal York’s doors for a follow- up appointment after liposuction. She was in searing pain. “Liposuction feels like your skin is being peeled off of your muscles, because it is,” says Ana (who asked not to use her real name). Her torso was so sensitive that the slight shake of riding in a car made her want to cry. So did the feeling of her girlfriend’s fingertips on her skin. She worked in fashion, as a designer for brands like Escada and Adidas, and for years had avoided crop tops because she felt self-conscious about the flesh around her waist.
“In the early 2000s, the look was skinny, skinny, skinny,” Ana told me. “Now it’s shifted and it’s curves, big breasts, a tiny waist, a big butt. The curves are so disproportionate. Back then, you could only achieve that skinny look by being bulimic or anorexic. Now you can only achieve it through surgery.” She sighed. “It never stops.” At 25, she’d started to get injections in her lips and Botox in her face. But she’d always wanted liposuction on her torso, and now, in her thirties, she felt ready.
She had met Jugenburg just minutes before her surgery. Doesn’t he want to see what my body looks like in person before surgery? she thought. But she loved the new curve of her waistline, and that, she told herself, was more important than bedside manner. At her follow-up appointment, as she stood in an examination room while a nurse pulled out one stitch, and then another, Jugenburg sauntered in. “Have you been massaging?” she says he asked her. She shook her head no—it had been too painful. “Now you will see me rant,” he told her, pulling out his phone. (Jugenburg denies that he ranted at anyone.) In Ana’s recollection, he began to lecture the camera about the importance of deep-tissue massage after surgery, the implication being that Ana hadn’t done her homework. He turned to the nurse, reminding her to remove the stitches from Ana’s chin, where she’d also had some fat removed, and then walked away. She was stunned.
It seemed to Ana that he’d spoken to his followers on Snapchat longer than he’d spoken to her, and she’d spent $11,995, a price she felt merited his focus and attention. She thought back to a nurse who lifted her gently and changed her sheets after another surgery years before. That’s what care felt like, not this. In the examination room, her hand ran over a ridge of skin above her belly button, a ripple she knew Dr. 6ix would fix for free. She left, too intimidated to say anything about how ashamed he’d made her feel.
That same year, in 2018, a journalist for the Canadian Broadcasting Corporation who was working on a story about breast implant marketing visited Jugenburg’s clinic. She was posing as a patient and carried a hidden camera. She noticed security cameras in the clinic’s ceilings, in both the waiting room and in the examination room where she was told to undress. After the story aired that December, Jugenburg acknowledged that there were cameras in all areas of the clinic, including examination rooms. Footage was captured on 24 cameras and could be accessed through an app on his phone. He said he did this for his own protection to guard against breakins and so that he would have a record if a patient complained. A sign at the clinic entrance and another in the OR mentioned the surveillance, but they were small and didn’t say where or why the footage was captured. The College of Physicians and Surgeons of Ontario, the province’s regulatory body, disabled the cameras while they investigated, and the following February the board directed Jugenburg to permanently turn off the cameras in rooms where his patients undressed.
The regulator also investigated an allegation that Jugenburg had allowed a film crew to shoot a patient’s procedure without her informed consent, and the footage of her body aired on TV. Nine months after the surgery, Jugenburg added a line to her chart saying she had consented. At a disciplinary hearing, Jugenburg said that he’d erred by not making a record of the conversation right away. In June a panel of CPSO representatives heard that complaint, along with allegations related to the surveillance cameras, and a third accusation that Jugenburg had posted a patient’s image on social media without her consent. It found that Jugenburg engaged in professional misconduct. The panel was scheduled to hold a penalty hearing in February.
After the CBC story aired, Ana canceled the appointment she’d made for Jugenburg to fix the crease above her belly button. The more she reflected on the totality of her experience—the pressure she’d felt to agree to appear on social media, the two hospital visits she made after a nurse left stitches in her bikini line and back—the more she dreaded returning to the clinic. When she learned about the surveillance cameras, she began to look for a lawyer.
Laura saw the report too, and she took to social media. She’d recommended her doctor to friends, and she felt she had a responsibility to share the news. The same day, Jugenburg appeared in her DMS. “Laura, our security cameras were
not activated when you were here. You were not ‘violated,’” he wrote. “Have a wonderful day.” Laura stared at her phone in shock. “I thought, You’re a doctor. You just did a surgery, and now you’re in my DMS arguing. I couldn’t believe it.” By then, she was starting to worry that the implants were making her sick. She made an appointment to have them removed. The shame of the experience was like a stain she couldn’t scrub away. “It was just so much invasion of me,” she says.
The CBC report also circulated through Toronto’s litigation community. Three lawyers, Kate Mazzucco, Valérie Lord, and Tina Yang, worked at different firms but were united in their view that what the doctor was doing on social media exploited women’s bodies to build his brand and make money. “Plastic surgery is a choice that’s extremely private. For many of these women, they realized that their privacy was invaded,” Mazzucco says. “They felt extremely violated.” In February 2020 they filed a proposed class-action suit against Jugenburg that called for $75 million in damages. Ana is one of three proposed representative plaintiffs. More than 200 other women, including Laura and Sara, have reached out with their own stories, saying they want to join the suit if it moves forward.
The lawyers claimed that Jugenburg recorded his patients in various states of undress without their knowledge and also published—and profited from—intimate photos of his patients’ bodies on his social media platforms without their informed consent. In April a judge will decide whether there’s enough evidence for the case to proceed. In his defense, filed in court, Jugenburg said his social media presence is designed to “increase transparency, education, and awareness, as well as decrease public misinformation” and the stigma of cosmetic surgery. His clinic obtains informed and written social media consent from each willing patient, according to the court filing. (Jugenburg’s lawyer declined to comment for this article.) Ana acknowledged that she’d signed a consent form, but for her and Mazzucco, her lawyer, the question is whether informed consent can truly be granted before surgery by a patient concerned that her refusal could affect her care.
Like cosmetic surgery, social media can also be an expression of agency. When a doctor takes control of patients’ stories, it can feel like a violation of something deeper than privacy. “It changes how you see yourself,” says Alka Menon, an assistant professor of sociology at Yale. She researches the role of the plastic surgeon as cultural gatekeeper. The surgeons Menon has interviewed talk about themselves as artists, as scientists, as psychiatrists with a scalpel. “What drew many of them into this kind of work is the idea of what’s possible. The idea of sculpting someone’s body,” she says. On social media, patients become muses. “Doctors want to showcase their artistry, showcase a brand and a lifestyle to appeal to a wider range of patients,” she says. But the patients have a different point of view. For them, “it’s a journey of self-discovery.”
I wanted to ask Jugenburg about this. When I called him one afternoon in June, he answered with a soft hello. I introduced myself and said I wanted to ask him some questions about his life, to get to know the man behind the brand. He said that there are things he wants to say, but he didn’t think his lawyer would like it if he did. “These allegations,” he said, “they’re just not true. I’d have to be a psychopath. I’d be locked up in prison.” His was a story he’d wait to tell, he said, until the time was right.
When the coronavirus pandemic hit in March and elective surgeries were shut down, Dr. 6ix’s clinic closed temporarily. At first, Jugenburg spent his days in the leafy backyard of his sprawling white mansion or playing with his two young daughters. He posted memes about growing increasingly restless in quarantine. He went into his clinic and, phone held high, walked its empty halls. He filmed a video about how desperate he was to perform surgery again. To keep his audience amused, he took a pair of lemons into his OR, sliced them open, and stuffed them with silicone implants. When the video panned back to the operating table, he’d replaced them with melons, the Eurythmics’ “Sweet Dreams (Are Made of This)” playing in the background.
In the months to come, Jugenburg faces a penalty hearing from the College of Physicians and Surgeons of Ontario as well as a court hearing on the proposed class action. But that morning in May, he looked around his empty clinic, thinking about a video he’d seen online. In it, Cardi B walks toward the camera showing off the sleekest stomach money can buy. But then she turns to the side, tosses a defiant look over her shoulder, and exhales: Her stomach balloons over her bikini bottoms. Jugenburg held his phone up to his face and hit Record. “Despite Cardi B being a worldwide celebrity and having more money than she can know what to do with, and having access to the best plastic surgeons in the world, she still has a bulging tummy after liposuction.” People come to his office with particular wishes, pictures of celebrities who embody their hoped-for future selves. When they don’t get the results they’re hoping for, they get upset. They blame it on the surgeon or say it was a botched job. But those beautiful women with flat stomachs on Instagram are sucking in their abdominal muscles. “They all suck it in,” he said.
He continued: “There are some things surgery just cannot do,” he said. “Thank you, Cardi B, for showing us and demonstrating what this is all about, for keeping it real. And all the people out there, I hope this visual demonstration was able to explain to you that not everything you see online is real.” He paused. “Hopefully I was able to explain why the real world is a little different than what you see on social media.” He took one final beat and cracked a slight, self-satisfied smile. “Thanks for watching,” he said, and the screen went dark.