San Antonio Cosmetic Surgery Center & Med Spa, Established 2007

$847K

SDE

4.1x

Multiple

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Full Editorial Writeup

This is a San Antonio cosmetic surgery center paired with a med spa, established in 2007. The surgical side offers a wide range of cosmetic and reconstructive procedures with a specialization in breast and body work, while the med spa layers in higher-frequency recurring-adjacent services: injectables, laser and light treatments, skin care, body contouring, wellness, and weight loss. The operation runs out of roughly 2,500 square feet across two suites with all equipment needed to perform procedures in-house, and employs four full-time staff.

The practice is deeply tied to its market. The owner-surgeon is a long-time San Antonio resident, fluent in English and Spanish, which matters in a majority-Hispanic metro where language and cultural trust drive patient referrals. The listing claims competitors exist but none offer the same full breadth of surgical plus med spa services under one roof, a positioning that lets the business capture both one-time high-ticket surgical cases and lower-ticket repeat spa clients.

The headline economics are $847,172 in cash flow (SDE) against a $3.5M asking price, a 4.13x multiple. The real estate is owned but offered separately for $750,000 and is not in the asking price, so the multiple reflects operations only. The key structural issue a buyer must solve is that the cash flow is almost certainly anchored to the selling surgeon, who is retiring, which turns a seemingly clean 4x into a human-capital transition problem.

Why we like it

Cash flow is strong for the size at $847,172 SDE on a four-person shop, implying meaningful per-head economics and real margin in cosmetic surgery and injectables. High-ticket elective procedures and med spa treatments both carry rich gross margins, which is why these businesses throw off cash disproportionate to their headcount.
The med spa layer gives the deal a repeat-revenue engine that pure surgical practices lack. Injectables, skin treatments, and weight loss programs bring clients back on cadence, smoothing the lumpiness of one-time surgical cases and creating a base that a non-physician operator can run even if the surgical side resets.
San Antonio is one of the fastest-growing US metros, and the bilingual, culturally embedded positioning is a genuine local moat. The owner's Spanish fluency and long residency drive trust-based referrals in a majority-Hispanic market, an advantage that is hard for out-of-town competitors to replicate quickly.
The real estate is owned and available separately for $750,000, giving a buyer optionality: lease to preserve capital or buy to control occupancy cost and capture the asset's appreciation. Either path keeps the operating multiple honest at 4.13x rather than burying real estate in the price.

How to improve it

Immediately quantify how much of the $847K SDE is surgical procedures performed by the departing owner versus med spa and non-surgical revenue. If the surgery is 70% owner-dependent, the deal must be repriced or restructured around recruiting a replacement surgeon, and this is the single most important first-90-days action.
Lock in a successor physician before close through an employment or partnership agreement, or negotiate the seller into a multi-year clinical transition with earnout. Cosmetic surgery revenue walks out the door with the surgeon, so continuity of the operator credential is the whole ballgame.
Push aggressively on the recurring med spa economics by launching membership and package programs for injectables and skin treatments. Converting walk-in clients into prepaid memberships raises retention, smooths cash flow, and makes the non-surgical revenue far more transferable and bankable.
Build out a digital acquisition engine with before-and-after content, targeted paid social, and bilingual Spanish-language campaigns. A single-location practice relying on word of mouth is leaving pipeline on the table in a fast-growing metro.
Open a second location as the listing suggests, but only after the first site is de-risked and systematized. San Antonio's growth and the established brand support expansion, yet a second site amplifies the surgeon-dependency problem unless the operating model is already repeatable.
Audit and modernize the equipment and treatment menu to add high-margin, high-demand services like GLP-1 weight loss programs and the latest body contouring devices. These categories are growing fast and attract new clients who then convert into higher-ticket procedures.
Tighten pricing and scheduling to maximize chair and operating-suite utilization across both suites. Small gains in booking density on expensive equipment and surgical time flow almost entirely to the bottom line.

Diligence notes

Demand gross revenue and a full revenue breakdown by service line, since the listing discloses only cash flow and no revenue at all. Without the top line you cannot assess margin, cannot gauge med spa versus surgical mix, and cannot verify the 4.13x is on clean, transferable earnings.
Determine exactly how much of the SDE depends on the retiring owner-surgeon's personal production and referral network. Quantify owner add-backs, personal goodwill, and what revenue realistically survives his exit, because a cosmetic surgery practice without its surgeon is a different and smaller business.
Verify licensing, medical director requirements, and whether a non-physician buyer can legally own this practice in Texas. Corporate practice of medicine rules may force a management-services-organization structure or require retaining a licensed physician owner, which changes the deal mechanics materially.
Review malpractice history, insurance, and any pending claims given the surgical and reconstructive nature of the work. Confirm tail coverage for the departing surgeon and the cost of ongoing coverage, which is a real and recurring expense in this category.
Separate the real estate decision from the operations: get the $750,000 property appraised, confirm the lease terms if you do not buy, and model occupancy cost under both scenarios. Understand how the separate real estate affects total capital required and your return math.
Confirm the condition, age, and ownership of the lasers, body contouring, and surgical equipment, plus any associated service contracts. Replacement of aging medical devices can run into six figures and should be reflected in your capex assumptions.

Source

Originally listed on BizBuySell. View original listing →