MEDICAL SPAS · AESTHETICS · PLASTIC SURGERY
Med spas, aesthetic clinics, and plastic surgery centers run somewhere between a medical practice and a luxury retail business. The accounting has to handle both — and the regulatory structure that holds them together.
WHAT MED SPAS LIVE WITH
Aesthetics and plastic surgery sit at the intersection of medical practice, retail, and luxury services. Six places that hybrid breaks generic accounting.
Botox, Dysport, fillers, and biologics aren't just supplies — they're inventoried medical products with batch tracking, expiration shrinkage, and per-unit COGS that affects every treatment's margin.
IPL, CO2 fractional, RF microneedling, body contouring — single devices range $80K-$300K+. §179 and bonus depreciation timing on these has six-figure tax implications.
California Corporate Practice of Medicine doctrine requires medical procedures be owned by a licensed MD's PC. Non-MD owners typically operate through a Management Services Organization. Getting the structure wrong creates corporate-practice exposure.
Aesthetic services run on prepaid packages, monthly memberships, and tip-heavy cash flow. Each model has its own revenue recognition treatment under GAAP — and tax treatment that follows.
Skincare retail and at-home device sales create sales-tax obligations that don't apply to medical services. The split has to live on the books or you'll hear from CDTFA.
Accredited surgical facilities (AAAASF, JCAHO) carry their own depreciation, supply, and staffing structure. Facility-fee revenue is its own line, and surgical case-cost accounting drives pricing decisions.
WHAT WE DO
Accounting, tax, and advisory — integrated for med spa and plastic surgery owners.
Monthly close that handles inventory, deferred revenue, sales tax, and per-treatment margin reporting.
Federal + CA returns with entity structure, depreciation strategy, and MSO/PC structuring built in.
Owner-level guidance for growth, capital decisions, and the transitions aesthetic owners face.
What you can expect
You work with a CPA, not an associate.
Scoped upfront and committed in writing.
Response within one business day.
Quarterly planning — not just at deadlines.
What we do
We work with California med spas, plastic surgery practices, and aesthetic clinics on the financial side of an MSO/PC operation — entity structure, injectables inventory, and equipment tax.
California Corporate Practice of Medicine compliance — MSO/PC structuring, fees, and operations.
Toxin and filler cost tracking, lot management, expiration, and shrinkage controls.
Tax planning for $50K–$300K+ laser, RF, and aesthetic devices — Section 179 and bonus depreciation.
Deferred revenue accounting for memberships, packages, and pre-paid treatment plans.
Nexus analysis, state licensing, and entity structure for opening additional locations.
Provider productivity, treatment margin, monthly P&L, and year-end tax coordination.
Related services
Adjacent clinical practices using similar MSO/PC structure considerations.
Explore →How we work with California healthcare practitioners across specialties.
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Common Questions
Not directly under the corporate practice doctrine. The standard structure is a Management Services Organization (MSO) that owns the brand, leases the equipment, employs non-clinical staff, and contracts with a separate Medical Corporation owned by a licensed MD or DO. We help structure both entities and the management services agreement between them.
Each vial is tracked as inventory with batch and expiration. COGS is recognized at the unit/syringe level when the treatment is performed. This gives you true per-treatment margin and prevents the bad surprise of "we did $X in injectables, where did the money go?"
§179 expensing and bonus depreciation both apply to qualifying devices. The question isn't can you, it's should you — we model the elections against your taxable income, multi-year projections, and any equipment financing terms to find the right answer.
Yes for retail sales of products that customers take home. Medical services are not subject to sales tax in California, but retail product sales are. We set up the chart of accounts, the POS mapping, and the CDTFA registration so this stays clean.
Deferred revenue. The cash goes on the balance sheet when received and is recognized as revenue as treatments are delivered. This prevents overstating income in package-sale months and creates an accurate picture of practice economics.
Significantly. Accredited surgical facility build-outs carry their own depreciation strategy, leasehold improvement accounting, and capital structure decisions. We model the project, structure the financing, and integrate the facility-fee revenue stream into the existing books.
An Invitation
A complimentary 30-minute review. We look at your practice specifically — structure, services, locations, devices — and tell you honestly what we'd do.
Call directly: 925-320-0309 · ronak@milestonecpas.com
