What we talked about
Dr. Alex Roher, MD is a board certified anesthesiologist who reinvented his career after falling out of love with anesthesia and built SD Botox into a fast growing aesthetics business. He shares how he started in 2012 with only one procedure, renting a room from an esthetician, then learned business by doing it. He explains the turning point when he acquired a struggling practice that became his Pacific Beach location, and how the business expanded through organic growth and smart acquisitions, including rapid growth during the Covid era “Zoom Boom.” Today, SD Botox spans 11 locations across San Diego and Austin, built around four pillars: injectables, laser and energy based treatments, medical grade skincare, and esthetician services.
Show notes
Dr. Alex Roher describes doing a liquid rhinoplasty, using filler to reshape a nose in about ten minutes, and handing the patient a three-way mirror so they can see all their angles at once. There are tears sometimes. He calls it his favorite procedure because the transformation is immediate and undeniable, and it captures something he could never get from anesthesiology: he actually sees what happens to the patient after.
What we covered
- Roher started SD Botox in 2012 knowing only how to do Botox, no filler, no laser, no other procedures. He chose the name because SD is San Diego and Botox was the only thing he knew. The first months were empty. Growth came slowly, then accelerated when he acquired a struggling Pacific Beach practice for very little money and cleaned up its operations. During COVID, he describes swallowing up practices while the rest of the industry panicked, picking up three locations in a single year.
- The “Zoom Boom” was real and specific: people working from home were staring at themselves on video calls, noticing lines they had never focused on before, and booking appointments. The combination of government stimulus money, no travel spending, and remote work created a surge in aesthetic demand that Roher says was unlike anything before or after.
- GLP-1 drugs like Ozempic have meaningfully reshaped parts of his practice. The rapid weight loss they cause has created demand for new treatments, skin laxity procedures, facial re-volumization for what the industry calls “Ozempic face,” and body contouring for areas like the abdomen and postpartum skin. He is actively building this into a growth area.
- His wellness sister brand, Hormones and Wellness by SD Botox, treats perimenopause, testosterone replacement, and peptides, and is becoming a point of entry into preventive care for patients who would otherwise never see a doctor. He describes requiring lab work before prescribing GLP-1 medications and repeatedly discovering undiagnosed thyroid disease, kidney problems, or liver issues, conditions that had gone undetected simply because the patient had not been to a doctor in years.
- The FAA analogy is central to his critique of the current healthcare system: when a plane crashes, the FAA takes the black box and systematically redesigns the process to prevent recurrence. Medicine, he argues, does the opposite, it focuses on prolonging illness rather than preventing it, because the incentive structure rewards ongoing treatment over sustained health.
- Roher went on a surf trip with Laird Hamilton, who told the group he had fallen more times than most people had surfed. That framing, failure as the precondition for mastery, not the opposite of it, is how Roher processes his own mistakes, including a serious vascular occlusion during a nose filler procedure that he navigated while traveling. He came out of it having learned ultrasound guidance and having built a safer practice.
About Dr. Alex
Dr. Alex Roher is a board-certified anesthesiologist and the founder of SD Botox, which now operates 11 locations across San Diego and Austin, and Hormones and Wellness by SD Botox, a sister brand focused on hormone replacement, peptides, and preventive health. He has been practicing aesthetic medicine since 2012.
- LinkedIn: https://www.linkedin.com/in/dr-alex-roher-md-27624413b
- Website: http://www.sdbotox.com
Episode 123 of the PreVetted Podcast.