Guide to Selling a Plastic Surgery Practice in Indiana

The market for plastic surgery is expanding, with a 19% increase in procedures since 2019. For practice owners in Indiana, this translates to strong demand and significant opportunity. However, turning high demand into maximum value for your practice requires strategic preparation. This guide provides a clear overview of the key factors you need to consider when navigating the sale of your Indiana plastic surgery practice, from understanding the market to planning your life after the transaction.

Market Overview

The timing for considering a sale is strong. Nationally, the demand for cosmetic procedures is robust, driven by a key demographic of patients aged 40-54 with high disposable income. While specific Indiana volume data is limited, we see a highly competitive and active market, particularly in hubs like Indianapolis. For owners, this presents both an opportunity and a challenge. To stand out, you need to understand the landscape.

Three key factors define the current market:
1. High-Value Demographics: The primary patient base consists of individuals with an annual household income of $100,000 or more, making this a lucrative, cash-pay-friendly specialty.
2. Reputation is Currency: In Indiana’s competitive environment, a strong online presence and a high volume of positive reviews are not just marketing tools. They are tangible assets that directly impact practice value.
3. National Trends, Local Impact: Procedures like breast augmentation and liposuction remain popular everywhere, including Indiana. Practices with a strong focus on these core services are well-positioned.

Key Considerations

Beyond market dynamics, selling your practice involves navigating specific operational and regulatory hurdles. Buyers look for well-run businesses, so addressing internal challenges before a sale is critical. This includes managing rising overhead, ensuring adequate staffing, and streamlining your administrative processes. A practice that runs efficiently is a practice that commands a higher value.

Furthermore, Indiana has introduced new layers of oversight. As of July 1, 2024, Senate Bill 9 requires that certain healthcare transactions, particularly for entities with over $10 million in assets, provide a 90-day advance notice to the Attorney General. Navigating these state-specific regulations requires careful planning and precise execution to avoid costly delays. Preparing your practice for this level of scrutiny is not something you should do alone. It is a detailed process.

Market Activity

While you will not see many plastic surgery practices listed for sale publicly, the market is very active. The primary driver of this activity is private equity (PE) and other large strategic buyers looking to partner with successful practices. These groups are seeking to build regional and national platforms. They bring capital and business expertise, but their goals and methods differ significantly from a traditional sale to another physician.

Understanding the motivations of each potential buyer is key to finding the right fit for your personal and financial goals.

Comparing Potential Buyer Types
| Buyer Type | Primary Goal | What This Means for You |
| :— | :— | :— |
| Private Equity Firm | Build a larger platform for a future sale (typically in 5-7 years). | Often involves retaining a stake in the larger company (rollover equity) and a potential second payday. More focus on financial metrics. |
| Hospital or Health System | Expand their service lines and capture a new referral base. | Sale may be simpler but could lead to less clinical autonomy and integration into a large corporate structure. |
| Another Physician/Group| Grow their local footprint and patient volume. | This can be a more personal transaction, but the buyer may have limited access to capital, impacting the final valuation. |

Sale Process

Selling your practice is not a single event. It is a structured process that unfolds over several months. It begins long before you ever speak to a buyer, with deep preparation of your financial, operational, and legal documents. The next step is confidentially marketing your practice to a curated list of qualified buyers to create a competitive environment. Once offers are received and negotiated, the most intensive phase begins: due diligence. This is where the buyer verifies every aspect of your practice. Many deals fail at this stage due to poor preparation. A successful process ends with the negotiation of a final purchase agreement and a smooth closing. Each step has potential pitfalls, but with proper guidance, they are all manageable.

Valuation

One of the first questions any owner asks is, “What is my practice worth?” The answer is more complex than a simple multiple of your revenue. Sophisticated buyers value your practice based on its Adjusted EBITDA (Earnings Before Interest, Taxes, Depreciation, and Amortization). This figure represents your true profitability after “normalizing” for owner-specific expenses like a high personal salary or a leased vehicle run through the business. From there, a valuation multiple is applied.

Your final multiple is not fixed. It is influenced by several key factors.
1. Scale and Profitability: Practices with over $1 million in Adjusted EBITDA consistently command higher multiples (e.g., 5.5x to 7.5x or more) because they are seen as less risky.
2. Provider Reliance: A practice that can operate successfully without the owner-physician being present every day is far more valuable than one dependent on a single person.
3. Growth Story: Can you show a clear path to future growth? Buyers pay a premium for a compelling and believable growth narrative, not just past performance.

Post-Sale Considerations

The final sale price is not the only measure of a successful transaction. It is equally important to consider what your life and career will look like after the deal closes. Many owners choose to continue working for a period, and a key point of negotiation is defining your future role, compensation, and level of clinical autonomy. The right deal structure protects not only your financial interests but also your professional satisfaction and the legacy you have built. Planning for this transition protects you and your staff. Finally, the structure of your sale has major implications for your after-tax proceeds. The difference between a tax-efficient structure and a standard one can be substantial, making expert financial and legal guidance a critical part of the process.