The Plastic Surgeon’s Guide to Picking an MSO That Will Deliver on Growth
This second payout happens when the private equity-backed MSO you’ve partnered with grows the group of practices they’ve purchased and recapitalizes (essentially refinances their debt with a larger PE group) down the road. The right buyer can make this an incredibly lucrative opportunity. But not all buyers are created equal, and partnering with the wrong one can mean missed opportunities, broken promises, and a future that’s out of your control.
The “Second Bite of the Apple”—Why It Matters
Imagine selling a majority stake in your practice today, taking chips off the table, and securing financial stability while still retaining a meaningful ownership interest. A few years later, your practice—now part of a larger, well-run organization—has grown significantly, and when your MSO sells or recapitalizes, you cash in again. In many cases, this “second bite” is worth far more than your initial cash out and can drive the final average multiple of your transaction into double digits. That’s the ideal scenario.
But it doesn’t happen automatically. The second bite of the apple depends on finding a buyer who has the financial strength, operational expertise, and long-term vision to actually create that value. A buyer who makes big promises but lacks the ability to execute can leave you in a stagnant organization, watching from the sidelines as your equity fails to appreciate—or worse, loses value. Making the wrong decision in a partner can significantly impact the overall value of your transaction and your quality of life through the course of your employment agreement, both to the negative.
The Right Buyer Makes All the Difference
Some MSOs and private equity firms have a clear track record of success, a strategy for growth, and access to capital that fuels expansion. Others, however, may be operating on shaky financial ground, over-leveraged, or relying on overly aggressive projections to justify their offers. And as a seller, it can be difficult to tell the difference without deep industry knowledge and access to historical deal data.
This is why due diligence is critical. A buyer might say all the right things—talk about their industry experience, their commitment to your brand, their plans for future growth—but unless you know how to verify those claims, you could be walking into a deal that doesn’t deliver. The good news is that many PE firms in the plastic surgery space have operated with great success in other healthcare verticals. The key is to ensure you’re getting in front of the right groups, at the right time, with the right investment thesis to support the goals of the group and your business. Properly vetting all options and narrowing down to a few that are a good “fit” is a critical component of short-term happiness and long-term value.
The Advantage of Exploring the Full Plastic Surgery Market
The best way to maximize your chances of finding the right buyer for your plastic surgery practice is by running a competitive, marketed sales process. If you only speak to one or two MSOs, you’re operating with blinders on, and you’ll never know what you left on the table. But when your practice is introduced to the full market, multiple buyers compete for your business, giving you leverage to secure the best deal possible—not just in terms of upfront value but in structuring your future upside as well.
A well-run process also helps uncover critical information about potential buyers. Have they successfully recapitalized before? What’s their growth strategy, and do they have the resources to execute it? The right advisor doesn’t just connect you with buyers—they help you assess them, ensuring you’re aligning with a partner who can actually deliver on their promises.
Don’t Just Sell—Strategize
When you decide to sell your plastic surgery practice, you’re not just transacting—you’re making a strategic decision about your future. The difference between a great deal and a bad one often comes down to how much information you have, how well you understand the buyer landscape, and whether you have the right people in your corner helping you navigate the process.
By taking the time to evaluate all your options, understanding the true financial health of potential buyers, and ensuring you’re working with a group that has a proven ability to scale and recapitalize, you put yourself in the best position to benefit not just today but years down the line.
If you’re considering selling your plastic surgery practice, don’t leave the outcome to chance. Make sure you see the full market, do the right due diligence, and position yourself for a second bite of the apple that’s worth taking.