Guide to Selling a Plastic Surgery Practice in Cleveland, OH

Selling your Cleveland plastic surgery practice is one of the most significant financial decisions you will ever make. The market is active, with interest from hospitals, other practices, and increasingly, private equity firms. A successful sale requires more than just finding a buyer. It demands careful preparation, strategic timing, and a deep understanding of your practice’s true value. This guide provides the insights you need to navigate the process confidently.

Market Overview

The market for plastic surgery practices in Cleveland is influenced by powerful national trends. We are seeing a significant influx of capital from private equity (PE) firms targeting aesthetic medicine. These well-funded groups are actively seeking to partner with or acquire established practices to build regional and national platforms. This trend adds a new layer to the traditional buyer landscape, which historically included hospitals looking to expand their service lines or local physician groups aiming to grow their footprint.

Each of these potential buyers comes to the table with a different playbook. A hospital may prioritize community integration and referral networks, while a PE group will focus intensely on financial metrics like EBITDA and scalable growth potential. Understanding the motivations of each buyer type is the first step in positioning your practice to attract the best possible partner for your specific goals. It is a competitive environment, which can be a great thing for a prepared seller.

Key Considerations for the Seller

Before you dive into financials and valuations, it is important to reflect on the personal side of selling. A successful transition depends as much on your own readiness as it does on the market. Here are three critical areas to consider:

1. Your Personal and Professional Goals. The first question is not “What is my practice worth?” but “What do I want next?” Are you prepared to transition from an owner to an employee, even for a short period? Answering this honestly is the foundation of a good exit plan. Many buyers will require you to stay on for a period, so understanding your comfort level with giving up some autonomy is key.

2. The Health of Your Operations. Buyers, especially sophisticated ones like PE groups, are not just buying your revenue. They are buying your systems. A practice with clean financial records, efficient operations, a strong patient base, and a stable, well-documented team is far more attractive. It demonstrates a professionally run business, not just a job for the owner.

3. Assembling Your Advisory Team. Selling a medical practice is a team sport. You would not perform surgery without a skilled team, and you should not enter a sale without one. This includes legal counsel specializing in healthcare transactions, a knowledgeable accountant, and an M&A advisor who understands the nuances of the plastic surgery market. Trying to manage this complex process alone often leaves value on the table.

Market Activity

The driving force behind much of today’s market activity is consolidation. Private equity groups are deploying capital to build larger platforms that benefit from economies of scale, greater negotiating power with payors and suppliers, and professionalized management. This activity has created a seller’s market for high-quality, profitable plastic surgery practices.

For practice owners, this represents a unique window of opportunity. Many physicians we speak with say they might want to sell in two or three years. That is the perfect time to start preparing. Buyers pay a premium for proven, predictable performance, not for potential. The work you do in the years leading up to a sale to clean up financials, optimize operations, and document growth is what transforms an average valuation into a premium one. Timing the market is important, but preparing for the market is what gives you control.

The Sale Process

The journey from deciding to sell to closing the deal typically takes 6-12 months or more. While every transaction is unique, the process generally follows three main phases.

Phase 1: Preparation and Valuation

This is where the most important work happens. It involves gathering all your corporate, financial, and operational documents and getting a clear-eyed, professional valuation of your practice. This is also when you normalize your financials to calculate your true Adjusted EBITDA, the metric that sophisticated buyers care about most.

Phase 2: Confidential Marketing and Negotiation

With a solid valuation and a compelling narrative, your advisor can confidentially approach a curated list of qualified buyers. The goal is to create a competitive environment to generate strong offers. Once offers are received, you move into negotiating the key terms of the deal, including price, structure (cash vs. equity), and your role post-sale.

Phase 3: Due Diligence and Closing

Once a Letter of Intent is signed, the buyer begins an exhaustive review of your practice. This is the due diligence phase. They will scrutinize your financials, compliance, contracts, and more. Being prepared for this is critical. A smooth due diligence process leads to the final legal agreements and, ultimately, the closing of the sale. Many deals encounter unexpected issues here, but proper preparation can prevent most of them.

How Your Practice is Valued

A common mistake owners make is thinking their practice’s value is based on a simple percentage of revenue. Sophisticated buyers use a more precise method: Adjusted EBITDA x a Market Multiple. First, we calculate your Adjusted EBITDA by taking your net income and adding back interest, taxes, depreciation, amortization, and any non-business or one-time expenses. This reveals the true cash flow of the business.

That EBITDA figure is then multiplied by a “multiple.” This multiple is not a fixed number. It changes based on risk and growth potential. A practice that is less risky and has more potential for growth will receive a higher multiple. Here are a few factors that influence your valuation multiple:

Getting this right is the foundation of a successful sale. A professional valuation tells you what your practice is worth and provides a roadmap for how to increase its value before a sale.

3 Things to Plan For After The Sale

The work is not over once the sale documents are signed. The structure of your deal will have long-lasting implications for your finances and your professional life. A well-planned transition protects your legacy and sets you up for success in your next chapter. Here are three things to plan for.

1. Your New Role. In most sales to a larger group or PE firm, you will be expected to stay on as an employed physician for at least two to three years. Your employment agreement is a critical part of the negotiation. It will define your compensation, responsibilities, and schedule. It is vital to ensure these terms align with your personal goals.

2. Handling Financial Loose Ends. The sale agreement needs to clearly state what happens to the practice’s financial assets and liabilities. Who is responsible for collecting the accounts receivable that existed before the sale? Who pays for the tail medical malpractice insurance policy? These items can represent significant sums of money and should be negotiated carefully.

3. Ensuring a Smooth Transition. Your staff and patients are the heart of your practice. A successful transition plan involves clear communication with your team about the change in ownership. It also includes a plan for notifying patients and other stakeholders to ensure continuity of care. Protecting your team and your reputation in the community is the final step in securing your legacy.