THE Best Practice Guide for Medical Aesthetic Marketing

Cost-per-click (CPC) matters to agencies: we use it to gauge competition, test bidding methods, compare to other accounts for benchmarks, and see how "pricey" a geographic market is. For providers (healthcare practice or med-spa), the critical metric to focus on is Cost-per-lead. If you are receiving leads that are coming it at a reasonable cost, and (importantly) converting into considerable treatment revenue, CPC really doesn't matter in the end.

What factors influence CPC?

1. Knowing your campaign type is important as this will be the biggest factor. Make sure to compare apples to apples. From most expensive to least expensive average CPC: Google Search Ads->Facebook/Instagram Feed Ads->Google Display and Gmail Ads->YouTube Ads
2. Quality Score: Without going into too much detail, having an acceptable quality score will lower your CPC, while having a poor quality score will increase it. Quality score consists of your Ad Quality, Landing Page Experience, and Ad Appeal
3. Competition: More advertisers = higher costs. That said, Google and Facebook even the playing field for everyone -- those even with a small budget can make a huge revenue impact for their practice by being clever and hyper-efficient.

Google Trends has an up-to-date graph of CoolSculpting demand, but this doesn't tell the whole story! By examining years of account data, we're able to see how volume changes by month AND by location. As you'd expect, demand in Florida is more stable than a place like Minnesota, which experiences harsher winters. Being on top of seasonality is critical for expectation setting, and knowing when to staff up.

We split demand roughly into two types:

1. Search Demand: The actual number of Google Searches for CoolSculpting terms that occur in a given month. During slower months, we expect volume to fall. Other factors like Allergan/AbbVie running TV and Radio can impact these figures.
2. Psychological Demand: Warmer weather and bikini season can yield a sense of urgency that you just won't find in the middle of winter. Being able to offer killer promotions during slower times (and predicting when those times will be) is key to a healthy, stable flow of revenue.

Many of our clients have a budget between $3,000 and $8,000/mo., excluding management fees. Assuming $4,000/mo. in spend, I would expect a return of at least $30,000/mo. in CoolSculpting treatment revenue. We routinely have clients spending $6-8k and making a return of $120k+ during busier months. Our larger clients with ad budgets of $20k+ are able to generate a $350k+/mo. return (and more in some cases).

The key to actually driving these figures is to have each pillar of your advertising program up to spec. (that's where we come in):

1. A Solid lead flow to work with
2. Automated SMS and E-mail nurture tailored for a high response rate
3. Importantly, staff who are insanely dedicated to caring for leads and setting appointments. Setting a commission plan for these reps is recommended

Google and Facebook/Instagram may not be friends in real life, but they make a beautiful couple when it comes to ad results. Google is king of higher quality, high intent, high cost clicks. If someone types in "Juvederm near me," it's quite clear what they want. However, we know that even in a best case scenario, 75%+ of Google visits do not result in a conversion. Why should those clicks be thrown away? By having those users captured by Facebook's remarketing pixel that we place on your main website and our landing pages, those high-quality, pricey Google clicks can now be re-marketed to on Facebook and Instagram.

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Even better, it works in reverse: Facebook/Instagram visitors can be shown display (image and video) ads on Google's 3rd party network across tons of websites like NYTimes, Fox News, CNN and more.

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Remarketing clicks are insanely inexpensive and routinely have our lowest cost per lead when compared to raw prospecting campaigns. We run remarketing for our all clients!

The days of the "golden" phone call are gone. I would certainly love to drive my practice more calls, but the reality is that we see 75%+ of our conversions (leads) come in through either form fills that lead to automated SMS funnels, or direct interaction with the SMS contact widget on the website. From this data it's clear that users absolutely prefer initiating a conversation over SMS when compared to picking up the phone to make a call. We make sure to have a robust contact form plus SMS widgets so that visitors can easily reach out to staff members to ask questions and schedule consults. Phone calls can always be initiated from your end later!

Using CoolSculpting® as an example, we have providers that see excellent results with ad media spend as low as $3,000/mo. in smaller markets. Most of our providers average budgets between $4,000 and $7,000/mo. depending on their market and practice size. Our Top-10 providers can routinely spend $15-$25k+ per month across all ad networks.

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Ad budgets should be run for 30 days, evaluated, optimized, and run for another 30 days. The most important metric is Cost Per Lead: so long as the lead quality is reasonable, the goal is to keep a satisfactory cost per lead as budget grows. Diminishing returns act differently on Google vs. Facebook. We routinely advise clients on how to best allocate spend to earn the highest lead volume at the lowest cost.

80 to 85% of traffic that we see from paid advertising is from a mobile device. Numbers for organic traffic are very similar. If those numbers don't tell you the situation, I will: every single thing you do that is digital and patient-facing needs to be not just mobile "friendly" but mobile FIRST. We operate on a mobile-first basis for our landing pages, ad copy, content, and overall presentation.

Here is something scary to think about: the quality and content of your landing page is responsible for 50% of the results you'll see on your ad campaign. Furthermore, the quality of your landing page is mostly determined by what is "above the fold" meaning, what is seen on a mobile or desktop PC when the page loads, before you scroll down at all.

Thismeans even if your ad campaign is built absolutely perfectly, a poor landing page will never give it a chance to shine. Sad. The truth is many of our providers websites were not built to be lead generating machines, and using a provider website for a landing page is generally a poor idea. We solve this problem by bringing our own high-performance, conversion-optimized, A/B tested pages and link them to the provider domain (not a third party!) so the user has a seamless experience with your brand.

Promotions are a study in psychology, and Merkava Group is quite fond of the psychological aspect of advertising. Through educated hypotheses and rigorous A/B testing, we've determine the best promotions to run for a wide variety of services (Body Contouring, Injectables, Muscle Toning etc.,). Does BOGO work best? What about a percent or dollar figure off? What discount should i offer on black friday? These are all questions we've answered to supercharge our clients performance.

I cannot stress enough how important automated text messages are for generating consults. Some practices see 85%+ of their consultations being scheduled over text message. I routinely see our clients start absolutely crushing their results once they implement a good SMS platform and sequence for their team to use. The automation sequence handles the thumb-destroying task of following up over days/weeks when the lead doesn't reply, but office staff takes over as soon as users send their first message. The key is knowing what the content of the messages should be. We've tested over 20 message chains to tease out the highest reply rates possible. We offer SMS automation for 45 days FREE as an add-on to our signature marketing plan.

Automated e-mails are a small but important piece of the lead to revenue journey. The first type of automated e-mail is a "chain" that the user will be entered into after they submit a lead form. Ideally this will be accompanies by a simultaneous automated text message and a phone call from the provider. The next type of automated e-mail would be one that is generated within your CMS when a lead is moved to a different stage. For example: an email when the lead moves to "schedule consult" status. Another if they move to "No-show" status. And another if they move to "treated" status. Each email will have appropriate messaging to match the status they are in, thus reducing staff follow-up time and boosting efficiency throughout each step of the sales funnel

Absolutely. Although we see the greatest number of bookings though text messages, it's clear that a subset of patients prefer to have a phone call in addition to, or instead of a text message. We recommend that providers call leads within 20 minutes of being generated, within business hours. Leads generated after business hours should be called first thing the next day.

If you aren't tracking every possible user action, you are wasting money on clicks. When using automated bidding algorithms, they only perform as well as the data they're fed! We track: Form submissions, phone calls, live chat starts, online bookings, visits to critical pages (patient portal, qualify for financing) and much more. All of this is routed into Google/Facebook algorithms to create a feedback loop that drives more of the users that perform the actions you desire.

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For net-new leads coming from paid search ads that schedule an appointment, we see an average no-show rate of about 35% across all clients! We routinely see clients able to keep no-show rates to 20% or less by following recommended best practice: text, e-mail, and phone call confirmations pre-consult and pre-treatment. By reaching out across e-mail, SMS, and in person on the phone, the no show rate can be drastically reduced. Take it a step further by properly phrasing your request when booking: "If you need to cancel, will you please let us know?" Getting a verbal (or SMS) "yes" to that question can reduce no-show rates by up to 80%!

"Who is this? I don't remember filling out a form for this procedure/treatment" Facebook can be notorious for generating low quality leads when targeting is poor. Facebook "lead ad" campaigns (where a user completes the form without leaving Facebook) may seem like a bargain, but they have consistently shown to yield some of the worst results we've seen, and we do not recommend running Facebook Lead Ads.

I have been running Google Ads campaigns for 17 years, and I've been auditing accounts for the past 10 years. When I take over a Google Ads account I am routinely shocked at the terrible quality of campaigns and settings I find. I hope to set the record straight about what every Google Ads campaign needs. This isn't specific to Medical Aesthetic, it can be applied to almost every lead-gen focused business in existence.

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1. Geographic Targeting: Target an appropriate radius, EXCLUDE nearby areas you wish to avoid, EXCLUDE every other U.S. state
2. Keyword Selection: Find keywords that work. Google's keywords recommendations are misleading and will waste money.
3. Negative Keywords: We have lists of negatives for every service. You should be going through twice-monthly to add negatives to avoid garbage traffic
4. Ad Extensions: Sitelinks, Callout Extensions, Call Extensions, Promo Extensions and Structured Snippets should all be "maxed out" in terms of how many are created. That's 5 sitelinks, 12+ callouts, 1 call extension, 1 promo extension, a structured snippet with 5+ items.
5. Ad Copy: At least 3 "old-school" ETA's (expanded text ads) and at least 1 RSA (responsive search ad). Ad copy should be interesting, unique, competitive, and enhance the brand behind it.
6. Conversion tracking: Form submissions, phone calls, live chat starts, and text message starts should all be tracked! Which brings us to the next topic:
7. Bidding: Automated bidding is only useful if you are feeding good conversion data to the campaign. If you have 50+ conversions per month, you should test automated bidding. If you have less than 50 conversions per month, you do not have enough data for automated bidding to be effective in many cases!
8. Integration: Integrating with Google Analytics plus 3rd party tracking platforms like CallRail will give you even more data and insight to help optimize campaigns (pages per visit, time on site, pages viewed, first time caller or not, and call duration)

Facebook/Instagram and Google are very different beasts. Whereas Google search ad volume is limited by the number of people actually searching for a target term (e.g., "CoolSculpting"), Facebook/Instagram lets you target any user on their platform - a MUCH larger audience. It is absolutely critical that you nail down what group of users your ad is shown to. If the audience is off, you risk running into two issues.

Common Facebook Lead Issues and How to Fix:

1. Users aren't receptive to your ads, so your cost per lead is too high to get a reasonable return.
2. Users ARE receptive to your ads, but they aren't the right demographic and are unresponsive to follow-up

So what are the proper audiences to target? It varies by type of cosmetic procedure. The audience for CoolSculpting is different from that of BOTOX, and even BOTOX audience has a distinct profile when compared to JUVEDERM.

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How to Solve the Audience Problem

1. Lookalike Audiences: Facebook has a fantastic feature that allows you to upload an anonymized list of high value existing patients from your practice. Larger practices can leverage this patient list to have Facebook find similar (lookalike) audience members. This shortcut takes guesswork out of figuring out who your best audience is, and saves a ton of time and money testing, but it's still limited in scope. It needs to be combined with...
2. Interest targeting: This is where our secret sauce comes in. We've spent millions of dollars testing thousands of demographic combinations to come up with the ideal audiences types for a wide variety of cosmetic services. There are certainly some basics that ring true: those who visit gyms and value personal appearance are good indicators, but you'd be surprised about what combinations yield the best results.
3. Remarketing: When a visitor comes to your site for the first time, there is best-case 25% chance they actually contact or call you. Whether that click was paid for (let's say from Google Ads), or they visited directly from a referral, most clicks just simply don't convert on the first visit. Remarketing solves this problem by showing Instagram/Facebook ads to any user, regardless of source, who has visited your website in the past. This type of campaign tends to be the most cost effective (lowest cost per lead) out of any, and is boosted by practices who have a large patient base or get a lot of organic traffic.

Common Facebook Creative Issues and How to Fix:

1. Audiences matter, but creative is especially important. After testing hundreds of stock photos and provider content (images, videos, timelapses, boomerangs) we've determined the best mix of creative for success. All of our providers are given access to a "creative recommendation guide" that shows them how to use their cell phones to record high performance creative in a matter of minutes. We time creative to avoid ad fatigue and make sure visitors aren't just lured in for leads, but are actually entertained and provided value as well.

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Obviously, cost per lead varies by market, but there are some benchmarks you can use to determine if your cost per lead is within reasonable bounds.

1. Google: your cost per lead for CoolSculpting should be under $80 unless you are spending in excess of $5,000 per month. For injectables, your cost per lead should be under $60. Injectable performance on Google is HIGHLY influenced by whether or not BOTOX ad keywords are approved and requires coordination with Allergan/AbbVie. EMSCULPT has an average cost per lead closer to $35.
2. Facebook: Cost per lead on Facebook is often dramatically lower than Google. For CoolSculpting and most other services, cost per lead should be $15-$50 depending on budget

Of course, cost per lead doesn't matter much if your lead quality is consistently poor. See our answers about lead quality to learn more there.

Again, having audited hundreds of accounts, I'm astounded to see the reports that clients are provided. We firmly believe that clients should have full visibility into their performance, be able to break down that performance by campaign, and be able to see all key metrics updated on a daily basis. (We update our reports twice-daily).

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Here are the key components of any good digital ad campaign explained. Before you read on remember this: Data only makes sense in aggregate. If you look at things on a daily (or weekly) basis, your brain will start to find patterns that don't exist. Start to look at patterns that emerge from 100+ clicks per campaign-- for smaller budgets this may be on a monthly basis, while for larger budgets it can be every few days.

1. Spend: How much you spent in the given time period set on the report
2. Clicks: Clicks and interactions on your paid search, paid social, or display ad. For most ads this is a click, but will also include actions like tap to call on mobile or scroll-ups on Snapchat, for example.
3. Average CPC (cost per click): Spend divided by clicks. A measure how much a click costs. This is impacted heavily by factors like how fully built out your campaign is, how compelling your creative is, how good your keyword selection is, and how much competition exists in your market. Google search ads tend to have the highest cost per click, while Facebook/Instagram Ads and Google Display ads have the lowest.
4. Impressions: How many times your ad was shown. For Google search, impressions are triggered when your keywords match a user's search. For Facebook/Instagram, impressions are when a user sees your ad on their feed or similar placement.
5. CTR (Click Through Rate): Clicks divided by impressions. CTR is ameasure of how appealing your ad is, but NOT a good indicator of performance. CTR varies greatly by campaign type and should be viewed on an individual campaign basis. A Google search campaign (CoolSculpting, for example) will have a CTR of 3% to 10% depending on how attractive the ad copy and promotion are (along with other factors).
6. Conversions (leads): The big daddy of metrics. Conversions are user actions that are being tracked by your agency. These are usually obvious things like form fills and first-time phone calls, but should also include detailed things like live chat starts, appointment bookings, and clicks to any e-mail links on your website. Knowing what your conversions are made up of is critical to understanding performance. Having more items tracked means more information to feed Google's algorithms, and better results overall.
7. Cost per Conversion (cost per lead): Spend divided by conversions. This critical metric lets you calculate ROI by factoring in lead to consult rate, consult to treatment rate, and revenue (or LTV) of that patient. So what is a "good" cost per lead? Again it depends on the network and treatment. We find Injectables (BOTOX/JUVEDERM) have some of the lowest cost per leads across the board, about $12-$30 on Facebook and $20-$50 on Google. CoolSculpting can range from about $10-$50 on Facebook and $30-$85 on Google. Remarketing ads consistently drive the lowest cost per lead, so if you aren't leveraging your existing patient lists plus website traffic, you are doing yourself a disservice.
8. Conversion rate: Conversions divided by clicks. A seemingly important metric, but cost per lead gives a way better idea of what performance is like. Conversion rate varies wildly by campaign type, so trying to define what's "good" ranges from <1% for Google display ads, up to 30%+ for Google brand ad campaigns. In general for Google search campaigns like CoolSculpting, Ultherapy, EMSCULPT etc., a conversion rate of 10% is good, 15% is great, and 20%+ is awesome. Since conversion rate depends on conversions, it's important to know what you're tracking.
9. Search Impression Share (Google Only): This is KEY metric that measures what percent of the time your ad showed for a search in your geographic targeting area, with a keyword that you targeted. Example: My keyword is "CoolSculpting" and my market is a county in New York. If 1000 people search in a month, and my ad shows up for 900 of those people, I have a 90% impression share. For most of our clients, we have an impression share of 85%+ and are the biggest advertiser in our area.

We take 99% of the work off your plate by making sure your ads are compliant with co-op and MAP policy while still being compelling and click-worthy. At the end of each quarter, we provide every screenshot and file you need to submit to AbbVie/Allergan/Merz etc., to make sure you get reimbursed. Following policy means making sure to stay afoot of the ever-changing guidelines that corporate provides, something we're happy to do for our clients.

Facebook lead ads sound very attractive: you can capture a user's contact information without them even leaving Facebook! Even better, their information is pre-filled, meaning they make one click to submit. Great, right? Nope. Our comprehensive testing has shown that while Facebook lead ads can yield a remarkably low cost per conversion (cost per lead), the lead quality is abysmal. For 95% of cases, we run "standard" Facebook and Instagram ads that require more work: a compelling message that leads to a click, and a strong landing page that leads to a conversion. By striking the proper balance of user interaction/intent and ease of conversion, lead quality will be acceptable, your office managers will be happy, and your lead to consultation rate will increase greatly.

I've had the luxury of working at 3 amazing, prominent digital agencies throughout my career, and the Merkava team members are all ex-agency as well. I cut my teeth serving Mom and Pop HVAC companies, moved on to Franchised SMBs, then Enterprise and international clients. Throughout it all I've been carefully observing what works well, what could use improvement, and how it can be improved (and scaled). Here are the hallmarks of a good digital agency (spoiler: there's lots of overlap with our golden rules).

1. Results-focused. Anyone can talk for hours about ideas, branding, click funnels, being a "guru," or theory of advertising. Getting actual results in the form of leads that turn into revenue needs to be the prime focus of the agency.
2. Transparent: The agency should be direct and honest with their client. Sometimes that means gently shooting down an idea that won't work well, or being honest about a campaign that spent $500 and only returned one lead. See our related question on "what metrics should my agency be reporting to me?"
3. Proactive: The agency should actively be guiding the client, ideally based on data from past similar clients or campaigns. Actively exchanging ideas is great, but it's on the agency to be making suggestions around things like ad copy refreshes, changing up targeting, checking in, and so forth.
4. Tenacious: Sometimes an idea doesn't work, or a campaign performs poorly. A good agency will call out the poor performance, examine the data, and come up with a new strategy to try again (or suggest to shift budget elsewhere).
5. Responsive: Waiting 2+ days for a response to an e-mail is not OK. At a minimum, a good agency will respond to a customer inquiry within the same business day noting when they expect the task to be complete.
6. Curious: Always Be A/B Testing. Landing pages, ad copy, promotions, and image/video creative should all be continually tested to boost conversion rate and lower cost per lead. Good, and even great, should never be enough. You can always get your conversion rate a little higher.

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In 90% of cases, no you should not be advertising with Yelp. When compared to spending your ad budget on networks like Facebook or Google, Yelp has shown a significantly higher cost per lead. For our larger clients who are already close to "maxed out" on other major networks, AND who already have a good presence on yelp (100+ reviews), yelp then becomes a viable option as a cherry on top, not as the foundation of the cake.

Google Ad reps will call, e-mail, and generally harass you any way possible into turning on automated bidding. Automated bidding comes in a variety of forms that are a bit too technical for this answer, but suffice to say that they all use account data to find you the best possible cost per conversion. It sounds great on paper, but letting Google take full control over bidding can be disastrous if things aren't set up properly. There are a few critical elements that come into play when deciding if automated bidding is the right choice for your particular campaign:

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1. Start with manual bidding first, then TEST automated strategies. In 70% of cases, we are able to outperform automated bidding on Google Search campaigns. Testing involves running a strict A/B experiment where manual bidding and automated bidding run in tandem until significant results arise.
2. AI and Machine Learning (automated bidding) is only as "smart" as the data it receives. If you don't have AT LEAST 50 conversions on a monthly basis, consider adding more conversion events to help let the AI know what type of visitor it should be finding.
3. Display, Gmail, and YouTube campaigns often do best with automated bidding. For those campaigns only, we do recommend starting with automated bidding for best results.

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What type of automated bidding do I use? Below is an extremely short guide.

1. Maximize Conversions: Use when limited by budget
2. Target CPA: Use when not limited by budget
3. Maximize Clicks: Use in the rare event no conversion data exists
4. Maximize Conversion Value: Use when each of your conversions has a different dollar value
5. Target Impression Share: Best for branding campaigns when your only goal is exposure, not conversions.
6. Enhanced CPC: Use sparingly to enhance manual bids