This outline presents a high-level plan for executing a roll-up in the plastic surgery sector. The strategy begins with assembling a top-tier team, followed by targeted acquisitions of plastic surgeon practices, integration of a nationwide telehealth platform, and expansion through complementary businesses.
Strategic Vision
The goal is to achieve a 20x increase in enterprise value from the initial capital investment
By leveraging operational synergies, the team's expertise, and centralized financial/strategic oversight. Assumptions include access to private equity or venture funding, regulatory compliance (e.g., HIPAA for telehealth), and a 3-5 year timeline.
20x
Enterprise Value Growth
3-5
Year Timeline
Key metrics for success: EBITDA growth, patient acquisition cost reduction, and network expansion.
Phase 1
Recruit the Best Team for the Roll-Up
Focus on building a core team with expertise in M&A, healthcare operations, technology integration, and scaling. Aim for key team formation in the first 6-9 months, prioritizing proven track records in roll-ups and running successful plastic surgery practices.
Define Roles and Criteria
CEO/Founder
Experienced in healthcare roll-ups.
CFO
Expert in financial modeling, debt financing, and valuation multiples (target: background in scaling to 20x EV).
COO
Operations specialist in medical practices, with telehealth experience.
CTO
Tech leader skilled in building/scaling telehealth platforms (e.g. Dosevana)
M&A Director
Deal-sourcing pro with networks in plastic surgery
Legal/Compliance Officer
HIPAA and FDA regulatory expert.
Marketing/Growth Lead
Digital marketing specialist for patient acquisition.
Advisory Board
Include world class plastic surgeons, and telehealth pioneers.
Recruitment Strategy
Sourcing & Vetting
Use executive search firms (e.g., Heidrick & Struggles) and networks like LinkedIn, targeting alumni from successful roll-ups (e.g., Aspen Dental or AirSculpt).
Vetting: Background checks, reference interviews, and trial projects (e.g., mock acquisition due diligence).
Compensation & Timeline
Offer competitive packages: Equity stakes (10-20% pool), performance bonuses tied to EV milestones.
Team Leverage
Empower the team to drive decisions while providing oversight to align with overall goals.
Phase 2
Acquire Plastic Surgeon Practices
Target closing on 2-6 practices in the first 2 years, focusing on high-margin, urban/suburban locations with strong patient bases. Use a "hub-and-spoke" model where acquired practices feed into the telehealth platform for hormone optimization and medical weight loss before during and after treatment.
Target Identification
Criteria
Practices with $2-10M annual revenue, 5+ surgeons, low debt, and telehealth potential (e.g., cosmetic consultations).
Geography
Start in high-demand states for nationwide scale; prioritize areas with lax telehealth regs.
Sourcing
Leverage M&A director's network, brokers (e.g., Practice Brokers), and data from sources like IQVIA for market analysis.
Acquisition Process
01
Due Diligence
Financial audits, patient data review, surgeon retention plans (e.g., non-competes).
02
Deal Structure
Mix of cash (60%), earn-outs (30%), and equity (10%) to align incentives. Target 4-6x EBITDA multiples.
03
Integration
Post-acquisition, standardize operations (e.g., unified EMR systems like Epic) and bolt-on telehealth for virtual consults.
Timeline
2-4 acquisitions in Year 1; scale to 6-8+ in Year 2.
Risk Mitigation
Ensure compliance with Stark Law/Anti-Kickback statutes; use team expertise for seamless integrations.
Phase 3
Bolt-On a Nationwide Telehealth Platform
Integrate telehealth to centralize consultations, follow-ups, and marketing, reducing overhead and expanding reach beyond physical locations.
Platform Development/Acquisition
Build vs. Buy
Acquire an existing platform (e.g., partner with or buy a startup like RealSelf) or build in-house using CTO's expertise.
Features
Video consults, AI-driven matching (patient to surgeon), virtual simulations (e.g., for Botox outcomes), and e-prescribing.
Nationwide Rollout
Ensure multi-state licensing for surgeons; comply with varying telehealth laws (e.g., via compact agreements).
Integration with Practices
Training & Incentives
Train acquired surgeons on the platform; incentivize usage with revenue shares.
Marketing
Use digital ads (Google/Facebook) to drive traffic, targeting 1M+ users in Year 1.
Metrics
Aim for 30% of consultations virtual, reducing costs by 20-30%.
Timeline and Budget
Launch in Year 1 Q4; full integration by Year 2. Allocate $20-50M for tech/dev.
Phase 4
Acquire Referring or Complementary Businesses
Expand the ecosystem with 6-8 acquisitions in Years 2-4, focusing on businesses that drive referrals, upsell opportunities, or synergies to amplify value.
Target Categories
Referring Businesses
Dermatology clinics, medspas, or primary care groups that refer cosmetic patients.
Complementary
Wellness centers (e.g., IV therapy), aesthetic product suppliers (e.g., fillers distributors), or digital tools (e.g., AR beauty apps).
High-Potential
E-commerce for post-op care products or insurance-adjacent services for elective procedures.
Similar to Phase 2—due diligence, structured deals, rapid integration into telehealth platform.
Leverage Team
Use M&A and growth leads to identify/negotiate; CTO for tech synergies.
Value Creation
Cross-sell (e.g., telehealth consult leads to in-person surgery + wellness add-ons), creating a "one-stop" ecosystem.
Phase 5
Leverage Team Expertise to 20x Enterprise Value
Scale from initial investment to 20x EV through operational excellence, revenue growth, and exit preparation.
Key Levers
Revenue Growth
Organic (telehealth expansion) + inorganic (acquisitions) to hit $500M+ annual revenue.
Cost Synergies
Centralize admin (billing, HR) to cut 15-20% overhead; use AI for efficiency.
Expertise Utilization
Team drives innovation (e.g., data analytics for personalized treatments) and risk management.
Financing
Raise follow-on rounds or debt; target 15-20% IRR for investors.
Milestones
1
Year 1
$20M EV (post-initial acquisitions).
2
Year 3
$80M EV (telehealth + complements).
3
Year 5
$120M+ EV (via IPO or PE sale), achieving 20x.
Financial and Strategic Oversight
Governance Structure
Board with investor reps; quarterly reviews on KPIs (EV multiples, acquisition pipeline).
Financial Controls
Centralized budgeting, audits; use CFO's models for forecasting 20x growth.
Strategic Guidance
Align all phases with EV goals; pivot based on market (e.g., post-2025 telehealth regs).
Exit Options
Exit by selling the corporation back to ourselves in another corporation. This allows us to take out chips off the table and have the business service the debt over the next 10 -25 years to ensure legacy stays intact, ownership stays in our control and the company continues to grow