Medical and MedSpa
Bookkeeping

Plastic surgery practices work with a financial flow that is very different from other medical specialties. Large deposits, full prepayments, high-ticket procedures, product sales, and refund risks all create a bookkeeping environment where accuracy matters more than ever. Clean books help a surgeon see real profitability, understand cash flow, and run the practice with confidence instead of relying on estimates or assumptions. When the financials are structured properly, the business side becomes predictable and easy to manage.

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Tracking Deposits and Prepayments Correctly

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Most plastic surgery patients pay deposits or even the full amount for a procedure well before the surgery date. If these payments are automatically recorded as revenue, the financial statements become distorted and unreliable. Clean bookkeeping keeps deposits and prepayments separate from revenue until you choose how they should be treated. Treating prepayments as liabilities is the most conservative and clearest method because it prevents overstated income and keeps monthly numbers accurate. When the procedure date arrives or the funds are recognized, the financials will show that revenue clearly and honestly.

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Revenue Timing on Cash-Basis Books

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Nearly all plastic surgery practices operate on a cash-basis accounting system. Revenue is recorded when the money hits the bank, not when the procedure is performed. This is simple and appropriate for the industry, but it can still become inaccurate if deposits, prepayments, refunds, and adjustments are not categorized correctly. Clean cash-basis bookkeeping ensures deposits are tracked separately, patient payments are recorded in the correct period, and the financial statements match real cash activity. When this structure is followed, monthly reporting becomes reliable and easy to interpret.

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Handling Refunds, Chargebacks, and Cancellations

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Plastic surgery carries a higher likelihood of refunds or chargebacks, especially when patients prepay. These adjustments must be cleanly documented and tied back to the original payment. Without a clear workflow, refunds accidentally inflate expenses or reduce revenue in the wrong period. Clean bookkeeping records refunds against the original liability or payment method and keeps the general ledger transparent. This protects the practice from distorted revenue trends and ensures the financials stay consistent.

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Inventory Tracking for Injectables and Products

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Plastic surgery practices often sell injectables, skincare products, and post-care supplies. These items need consistent tracking so the practice understands margins and usage. Poor inventory bookkeeping leads to inaccurate cost of goods sold and makes it difficult to identify which products are profitable. Clean bookkeeping separates inventory purchases from general supplies and keeps usage, sales, and remaining stock aligned. This gives the surgeon clarity on product performance and prevents waste or shrinkage from going unnoticed.

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Payroll and Staff Compensation

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Payroll is a major component of overhead in a plastic surgery practice. Nurses, surgical techs, patient coordinators, and front office staff all contribute to the cost structure. Accurate payroll bookkeeping ensures wages, taxes, overtime, and benefits reflect the correct period and provides visibility into staff costs relative to surgical volume. This is essential for evaluating staffing levels, planning future hiring, and understanding how labor affects profitability.

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Month-End Reconciliation and Financial Accuracy

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Plastic surgery practices experience major cash flow swings, so month-end reconciliation is essential. Clean month-end bookkeeping ties deposits, refunds, card payments, payroll, inventory, and liabilities together into one consistent financial picture. When every account reconciles and revenue is tied to real cash activity, the surgeon gains a reliable view of the business. With accurate month-end reporting, the practice can plan investments, marketing, staffing, and expansion with confidence.

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Clean plastic surgery bookkeeping requires:

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• Accurate tracking of deposits and prepayments

• Proper revenue timing on cash-basis books

• Clear documentation of refunds and chargebacks

• Consistent tracking of injectables and product inventory

• Reliable payroll management and month-end reconciliation

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What Clean Financials Look Like in a Plastic Surgery Practice

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When the bookkeeping is done correctly, the surgeon sees the real financial health of the practice. Deposits and liabilities are tracked cleanly, revenue reflects actual cash received, inventory costs make sense, and payroll aligns with the operational demands of the office. Case profitability becomes clear, cash flow becomes predictable, and the practice gains the stability needed to grow without turbulence. Clean books give plastic surgeons confidence and control over the business side of their work.