Selling Your Plastic Surgery Practice Without the $1.5M Tax Check
Plastic surgery PE roll-ups — Atlas Plastic Surgery, Surgery Partners, regional aesthetic platforms — pay 6-10x EBITDA for high-revenue cosmetic practices. A $1.5M EBITDA practice = $10M-$15M sale.
Buyer cash → Assignment Co. → A-rated carrier → You, on schedule
CA owner without §453 structuring loses ~$4M to taxes. With §453, recover $800K-$1M.
The math — $10M plastic surgery practice sale
Assumptions: $10M sale, 70% goodwill, 20% equipment ($2M — surgical suite, lasers), 10% supplies ($1M).
Plastic-surgery tax wrinkles
- Cosmetic surgery revenue is fully retail (no insurance complications). Goodwill character cleaner than insurance-billed specialties.
- Surgical center (ASC) carve-out. If practice owns the ambulatory surgery center, it's separately valued with CON-state implications. ASC has its own §1245 recapture profile.
- Anesthesia contract. CRNA / MD anesthesiologist contracts may be separately valued.
- Implant inventory (silicone, saline). Ordinary income.
- Patient financing receivables (CareCredit, Alphaeon, Cherry). Separately valued AR.
- State medical board ownership. Each state has rules; doesn't affect §453 mechanic.
When this fits
- $3M+ practice value
- Strong cosmetic / non-insurance revenue mix
- PE-backed buyer
When it doesn't
- Mostly reconstructive / insurance-billed
- Solo surgeon, no team
How I work
Hans Goldstein, IRC §453 specialist. A-Rated Carrier, A-Rated Carrier, A-Rated Carrier, A-Rated Carrier — 50 states. Free fit-check.
Frequently asked
Q: I own the ASC. Two §453 structures? A: Often. Practice goodwill in one, ASC sale in another. Each tuned to its own schedule.
Q: My practice is reconstructive with insurance billing. Does that change anything? A: Lower multiple than cosmetic, but §453 mechanic works the same. The goodwill is the deferrable portion regardless.
📘 Get the free Seller's Guide to §453 + a fit-check
A plain-English guide for sellers: how a structured installment sale defers the tax when you sell a business, practice, or property — the math, the alternatives, and how to know if your deal fits.
Drop your info — instant PDF download + within 1 business day Hans will email a preliminary read on which structure fits your deal. No retainer. Carrier compensates the broker — not you.
📞 Hans Goldstein · 615-808-9731 · CA Insurance License #4322192 · Independent §453 specialist · Goldstein & Co. LLC
Educational. Not tax or legal advice.
Run your specific numbers
The calculator runs your sale through real 2026 federal + state tax brackets and shows §453 savings vs lump sum side-by-side.
Run the calculator → 615-808-9731