This chapter translates the economics of oral and maxillofacial surgery into actionable management. It defines the surgeon as a clinician-entrepreneur and delineates revenue formation, cost measurement via time-driven activity-based costing, and cash discipline. It links CPT/RBRVS reimbursement to service-line strategy and site-of-service choices across office, ASC, and hospital settings. It specifies dashboards that couple access, quality, and financial metrics; outlines budgeting, rolling forecasts, and capital appraisal using NPV/IRR; and frames staffing, scheduling, and Lean/Six Sigma as levers for throughput and safety. Evidence on office-based anesthesia, outpatient orthognathic pathways, and virtual surgical planning is integrated with risk, compliance, and medicolegal considerations. Growth options—ancillary imaging, education, research, intellectual property, and partnerships—and risk management for shocks are formalized through scenario planning and liquidity buffers. The chapter provides templates, ratios, and decision rules that align clinical excellence with sustainable margins.