Cosmetic Surgery SEO Case Study

Medic updates in Google have made it a turbulent year for cosmetic surgery websites, their traffic and rankings. However, we still achieved great results.


  • 89% organic traffic increase
  • 28% total traffic increase
  • 40% increase in enquires

(These are all year on year stats).

We started working with the company in May 2018.  During the first few months, we had started outreach and fixing some of the glaring issues on the website.

Organic traffic had started to climb around 20% year on year by the end of July.  Then at the start of August, the traffic drifted down slightly, and we breathed a sigh of relief that we made it through the update.

At the end of September that all changed, and we were in emergency mode to find fixes.

Thankfully, we recovered in the March update.  The following is my reasoning for the recovery.

In this SEO case study, I am not sharing who this client is publicly as the risks are too high.  We managed to recover due in part to gaining a few high authority links.  It is far too easy for competitors to find those if we shared the client’s name.

Campaign Goals

The 12 month goal for this SEO project was to reduce or have the option to reduce the several thousand spent on Google Ads each month.

The traffic split was 65% Ads and 30% organic (5% from other sources).

Today, the traffic split is almost 50/50 with an overall year on year increase of 28%.

But the organic increase year on year is 89%.

Initial SEO Work

An initial SEO review of the website discovered that it was over optimised.  Keywords were stuffed in places where they had no right to exist, for example, images.

Title tags and meta descriptions were rewritten to be more visually appealing in search results, while still targeting the main terms on each page.

Lowering the on page keyword density and adding in LSI keywords helped the pages rank for a larger breadth of keywords (it is worth noting that head keywords usually only send about 20% of the traffic to a well optimised page).

We no-indexed pages that were not useful to be included in Google’s index.

At the start of the project, we wanted to take the text out of tabs and display it all on the page – that was refused.  We also suggested some rewrites that did not proceed.

Monthly SEO

Link building.  Anyone reading this from the Cosmetic Surgery industry will already know how competitive this market is.  Because of that, link building is one of the main ongoing monthly tasks.

We built links each month from guest posts, linking to all areas within the website.  We also managed to pick up other types of links.

Each month, we compared the keywords in Google Search Console with each page to look for improvements.  We used TF-IDF data comparing not just locally, but with other locations to look for keyword breadth improvements, and have since moved on to optimise content using Clearscope (conversion data from Ads had been used from the start to inform the main keywords to target).

Local SEO / Google Maps Listings

Only one of the three locations were listed in Google My Business, and it did not rank in the map pack.

Two other pages were then optimised for other locations in Ireland and they were added to GMB.

Citation directory and some local links were built to each of the three pages.

Each now ranks in the local map results, jumping between spots 1 and 3, depending on search location using the same city modifier keyword.

It would have been great to stop at this point and see some great increases over the year.  But we had hardly started and along came Medic.

Google’s Medic Update

I have been running my own websites and optimising client websites since 2006.  I have learned not to panic when an algorithm update hits – having a day at the beach is less harmful than panic about websites.

The first update in August reversed some of the growth for this client, though we were still up.  I spent August examining websites that had not been affected and reading the many opinions being blogged.

We were hit at the end of September 2018 with a loss of 40% organic traffic – overnight.

I ran a website back in 2011 and woke on February 23rd to see half of the traffic disappear overnight (I check traffic and rankings with my breakfast…). This update had all the same hallmarks.

EAT – Expertise, Authority & Trust

Since mid August, I had been reading blogs promoting the idea that EAT was the solution to this update.  Sometimes an explanation resonates and makes complete sense, and this one jarred.

If EAT was the answer, why had Menshealth, Forbes, and IGN lost 30% of their traffic?  Are these sites not authoritative?

During October, we came up with the following plan:

  1. Agree with EAT and add doctors & surgeons to each page
  2. Remove the text from the tab
  3. Deal with some duplicate content that was in the tabs
  4. Find some very high quality links
  5. Focus on keyword intent

We added the surgeons’ and doctors’ names at the end of all the pages.  I was at a loss to believe that Google would trust third-party data – they haven’t done this to date.  The idea that a link from the doctor’s bio to LinkedIn or governing bodies is a ranking factor does not make sense.

We removed all text from the tabs and could see that some of the text was duplicated.  Some, not all, of that has been rewritten.

From my investigation of sites not affected by the update, I had become convinced that links spread to internal pages and high-quality, relevant links were the main issue (I understand that Google likes to combine issues in updates).

We managed to gain some niche-relevant links that could not be replicated easily.  All the onsite work was completed quickly.  It had no effect.  The links took until early December.

There are some relevant keywords that a service page is not going to rank for.  Continually pushing buying pages to rank for informational queries will lead to disappointment and poor performance. Separating the intent of keywords is necessary, as Google is much better at understanding the intent of a user’s query.

By the start of January, we were starting to see a very slight improvement in Google Search Console Impressions – traffic was still awful.  By the end of the month, we saw an increase in traffic, and the slow increase continued until March when the last update hit.  You can see that jump in the image above.

It is worth noting that we took the details of the doctors and surgeons off the bottom of the pages.  It became too difficult to have each of them review and put their name to any changes we made to the text.


Many people are making a lot of money by pushing the EAT myth.

You will suffer from an algorithm update if you run a website long enough.

During the 5 months of lower traffic, we spent more on Google Ads and discovered a lot more business to be gained by expanding the keyword list.

We failed to reach the goal of spending less on ads.  The client discovered that their capacity for growth was higher than first thought.

I hope this Cosmetic Surgery SEO case study has helped you. You may also want to take a look at our SEO case study for a WooCommerce website. If you would like us to work for you, let’s have a chat.

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