How to Start a Plastic Surgery Practice: A Roadmap

Learning how to start a plastic surgery practice is a different exercise from opening most medical offices. A plastic surgeon has to decide where to operate, how to handle cosmetic cash pay alongside any reconstructive insurance work, how to build a brand patients will find online, and how to structure the business to manage higher liability and marketing costs. Each decision affects the others, so the order you make them in matters.

This roadmap walks through the major steps in a practical sequence, from early planning through opening day. It is general information meant to help you prepare better questions for the independent professionals you will work with.

Key takeaways

• Decide your practice model (cosmetic, reconstructive, or blended) first, because it drives location, payer, and OR decisions.

• Choose where you will operate early. Accredited office-based ORs take time to build and certify.

• Have an attorney review your entity, leases, and any restrictive covenants from your current job before you commit to a location.

• Start building your website and search presence months before opening, not after.

Step 1: Define your practice model

Start by answering a few foundational questions:

• Cosmetic, reconstructive, or both? A cosmetic-focused practice relies on self-pay patients and marketing. A reconstructive practice depends on payer contracts, hospital relationships, and referrals. A blended model needs systems for both.

• Solo, group, or shared space? Some surgeons start inside an existing multispecialty building or share an OR with another surgeon to reduce startup costs.

• Non-surgical services? Injectables, lasers, and skin care can smooth cash flow between surgical cases, but they add staffing, supervision, and regulatory considerations.

Step 2: Review your current contract

Before you sign a lease or announce anything, have an attorney review your current employment agreement. Non-compete radius and duration, patient non-solicitation, notice requirements, and tail coverage obligations can all affect where and when you can open. If you need one, we can introduce you to an independent attorney we partner with who reviews physician agreements. Our earlier article on working with a non-compete lawyer covers this in more depth.

Step 3: Form the business entity

Most surgeons operate through a professional entity, but the right structure depends on state law, ownership plans, and other factors your advisors will review.

Questions for your attorney

• What entity types are permitted for physicians in your state?

• If you plan a med spa or management company, how does your state's corporate practice of medicine doctrine affect ownership?

• How should future partners or associates be admitted?

An independent CPA can help with accounting and tax questions related to your new entity. We can introduce you to an independent CPA or attorney we partner with.

Our guide to the best business entity for plastic surgeons goes deeper on entity options.

Step 4: Decide where you will operate

This is one of the most consequential decisions for a new plastic surgery practice.

Hospital or ambulatory surgery center

Operating at a hospital or ASC avoids building your own OR, but you depend on block time and facility fees, which affect cosmetic pricing.

Office-based surgical suite

An in-office OR gives you control over scheduling and pricing, but it requires significant investment and facility accreditation. The American Society of Plastic Surgeons requires member surgeons to operate in facilities that are accredited by a recognized organization, Medicare-certified, or state-licensed when procedures involve more than minor local anesthesia or minimal oral sedation (ASPS). Recognized accrediting bodies include QUAD A (formerly AAAASF), AAAHC, and The Joint Commission. Many states also have their own office-based surgery rules.

Accreditation involves facility standards, policies, staffing, and an on-site survey, so build the timeline into your opening plan.

Hospital privileges

Even if you operate in an office suite, accreditation standards and many state rules expect surgeons to hold hospital privileges for the procedures they perform. Start the credentialing process early because it can take months.

Step 5: Review coverage requirements

Hospitals, surgery centers, accrediting bodies, landlords, and payers often set coverage requirements as a condition of privileges, leases, or contracts. Collect those requirements early, and review your prior employment agreement to see how any tail coverage is handled. An independent insurance professional can review your coverage needs.

Step 6: Credentialing, contracts, and compliance

If you will accept insurance for reconstructive work, payer credentialing takes time, so start it early. Also plan for:

• HIPAA policies, especially for before-and-after photos and social media

• Patient financial policies and cosmetic deposit and refund rules

• Informed consent documents reviewed by counsel

• Vendor contracts for EHR, practice management, and photo software

Step 7: Build the team

Early hires usually include a front desk and patient coordinator, a clinical assistant or nurse, and surgical staff if you operate in-office. In cosmetic practices, the patient coordinator often has a direct impact on consult-to-surgery conversion, so hire and train for that role carefully.

Step 8: Build your marketing before you open

Cosmetic patients research online for weeks or months before booking. A new practice with no web presence on opening day is already behind. This is the one area where we provide services directly: our digital marketing and SEO services for plastic surgeons.

A launch plan typically includes:

• A fast, mobile-friendly website with procedure pages, surgeon credentials, and a clear consultation request path

• A Google Business Profile that is fully completed and verified as soon as you have a physical address

• Before-and-after galleries built only with documented patient authorization

• Local SEO so you appear for procedure searches in your city, and clear, well-structured content that AI search tools can understand and cite

• A review strategy that follows HIPAA and platform rules

For more detail, see our complete guide to plastic surgery SEO and our SEO for plastic surgeons services. Procedure pages are usually the first thing to build, and our guide to plastic surgery SEO in 2026 walks through what each page should cover.

Step 9: Build a realistic opening timeline

New practices often take time to reach steady case volume. Map out the timeline for build-out, accreditation, credentialing, hiring, and marketing so each step is ready when you need it. An independent CPA can help with the numbers side of your plan.

A sample sequence

1. Define the model and review your current contract

2. Form the entity with help from an independent attorney

3. Choose location and OR strategy; start privileges and credentialing

4. Begin build-out and the accreditation process if operating in-office

5. Launch website, Google Business Profile, and pre-opening marketing

6. Hire and train staff

7. Open, then review performance monthly

Frequently asked questions

How long does it take to start a plastic surgery practice?

It varies widely. Credentialing, build-out, and OR accreditation are usually the longest steps, so many surgeons plan a year or more ahead.

Do I need an accredited operating room?

If you plan to perform surgery in your office under more than minor local anesthesia or minimal oral sedation, ASPS standards and many state laws require an accredited, Medicare-certified, or state-licensed facility.

Can I open near my current employer?

That depends on your non-compete and other restrictive covenants and how your state treats them. Have an attorney review your agreement before choosing a location.

When should I start marketing a new plastic surgery practice?

Ideally several months before opening, so your website, Google Business Profile, and search visibility are building before your first patients book.

Do you provide legal or tax services?

No. We provide digital marketing and SEO directly. For legal or accounting questions, we can introduce you to an independent CPA or attorney we partner with.

Request an introduction

Planning a new practice? Call (972) 616-4581 to request an introduction to an independent attorney or CPA we partner with, or to talk about launch marketing. Learn more about business and legal planning and SEO for plastic surgeons, or visit the Knowledge Center.

This article is general information, not tax, legal, or investment advice. Please read our disclaimer.