A cosmetic-only dermatology practice does not bill insurance. Every dollar that comes in is patient-pay: card, cash, financing platform, or membership plan. Operationally, that is closer to retail than to medicine. The banking that fits a cosmetic-only practice is also closer to retail than the banking most dermatology practices use (opens in a new tab). Most practices still bank like a medical clinic, and pay for the mismatch.
Cosmetic-only cash looks like retail
A typical cosmetic-only derm practice processes:
- Daily card deposits from in-office procedures (Botox, fillers, lasers, microneedling).
- Patient deposits for upcoming bigger procedures (refundable or non-refundable, depending on policy).
- Membership plan subscriptions (monthly or annual auto-renew).
- Financing platform settlements (Cherry, CareCredit, or similar).
- Retail product sales (skincare lines).
Five revenue streams, all cash-pay, all on different deposit cadences. In one operating account, it is a soup. In a structured set of virtual accounts, it is a clean P&L.
The right structure for a cosmetic-only PC
The pattern that works:
- Root operating account.
- Virtual account: in-office procedure revenue.
- Virtual account: patient deposits for future procedures.
- Virtual account: membership subscriptions.
- Virtual account: financing platform settlements.
- Virtual account: retail product revenue.
- Virtual account: payroll reserve.
Each stream lands in its own bucket. Margin per category is visible. The financing platform settlements stop being a mystery. Membership churn shows up as a number, not a guess.
When this pays off
Solo cosmetic practice doing $1M a year? Worth setting up. A multi-injector practice, where each injector's revenue needs its own ledger (opens in a new tab), a med spa, or any cosmetic-only group with retail and membership? The math closes itself in the first quarter. Practices that still see medical volume alongside cosmetic work face a different version of this problem, one covered in why aesthetic and medical revenue need separate accounts (opens in a new tab). ACH between virtual accounts is $0. Wires are a flat $15. Operating cash earns up to 1.75% APY across the structure, with FDIC coverage up to $10M per entity through the IntraFi sweep network. Account opening is 5 minutes.