How a Triangle Med Spa Went From 1.8× to 4.8× ROAS in Five Months

Business

Medical spa, two locations

Market

Raleigh, Cary & Durham, NC

Services Used

Google Ads, Meta Ads, Conversion Tracking, Landing Pages

Engagement

5 months • $12,400/mo blended ad spend

This med spa was running $9,800 a month across Google and Meta and getting about $17,600 back — a 1.8× return that barely covered the cost of delivering the treatments. Their assumption was that they needed cheaper leads. They didn't. Their cost per booked consult was already reasonable. The problem was that every lead was being treated as equal when a $180 facial inquiry and a $4,800 body contouring inquiry are not remotely the same thing.

The short version
• Cost per booked consult barely moved — $65 to $62. The ROAS gain came almost entirely from lead quality and show rate, not lead price.
• Fourteen active Meta disapprovals for before-and-after imagery had the ad account close to being shut down. Compliant creative fixed it and performed better anyway.
• Assigning a dollar value to each conversion type changed what the algorithm went looking for. That single change is most of the story.

The Problem

Aesthetics is an expensive category to advertise in. Clicks on head terms run into double digits, the competitive set includes national chains with real budgets, and the platforms treat the category as sensitive — which means creative that works in other verticals gets disapproved here.

Under all of that sat a measurement problem. The account counted every form fill and every phone call as one conversion, worth the same. So Google's bidding, doing exactly what it was told, went and found the cheapest possible conversions: price-shoppers on entry-level services who were never going to book anything else. The account looked efficient on the platform dashboard and unprofitable on the P&L.

What the Audit Found

• All conversions valued identically. A hydrafacial inquiry and a body contouring package inquiry reported the same value to Google. Bidding optimized toward the cheap one.
• 82% of spend on three broad-match head terms. The search terms report showed 61% of clicks coming from queries that were informational, out-of-area, or for services the spa doesn't offer.
• Fourteen active Meta disapprovals. Before-and-after skin imagery and body-focused copy repeatedly tripped Meta's personal attributes and health policies. Repeated violations put the whole ad account at risk, and the team had been re-submitting the same rejected creative for months.
• One landing page for eleven services. Someone searching "coolsculpting cary" landed on a general homepage and had to go find it themselves.
• No lifetime value in the math. Targets were set on first-visit revenue only, which made a perfectly profitable acquisition cost look unaffordable.

What We Actually Did

Month 1 — Value-Based Conversion Tracking

We rebuilt tracking so each conversion carried a real dollar value by service line, added enhanced conversions, and imported booking-system outcomes so the account learned the difference between a consult that was booked and a consult that actually showed and spent. Then we moved bidding to Target ROAS. This was the foundational change — everything after it worked because of it.

Month 1 — Get Compliant and Stay Compliant

We rebuilt the Meta creative library around what the policy actually permits: outcome and experience language rather than before-and-after body imagery, no implied personal attributes, no direct "you" statements about someone's appearance. Disapprovals went to zero and stayed there. The compliant creative also outperformed the old set, which surprised the client and did not surprise us — aspirational imagery converts better than clinical comparison shots for this audience anyway.

Months 1–2 — Restructure the Search Account

One campaign per service line. Exact and phrase match on the terms that matter, a 340-term negative keyword list built from the historical search terms report, and geo-targeting tightened to a realistic drive radius around each location. Broad match came back later, deliberately, once the value signal was strong enough to steer it.

Months 2–3 — Service-Specific Landing Pages

Five dedicated pages for the highest-value service lines, each with transparent starting prices, provider credentials, real clinic photography, and an embedded booking widget. Price transparency is contested in this category — the objection is that it scares people off. What it actually does is filter out the shoppers before they consume a consult slot, which is exactly what you want when consult capacity is the bottleneck.

Months 2–5 — Offer and Retention Architecture

A first-visit consult offer that leads into a membership, and LTV-based targets instead of first-visit-only math. Once a retained member is worth roughly $2,900 over eighteen months, an acceptable acquisition cost moves from about $60 to about $145 — which unlocks inventory the old targets made unbuyable.

The Results

Month five: 200 booked consults, 114 converting to treatment, at an average first-visit ticket of $522 — $59,500 in attributed revenue on $12,400 in spend. Baseline was 150 consults, 57 treatments, $310 average ticket, $17,600 on $9,800.

What Actually Moved the Needle

Telling the algorithm what a customer is worth. Look at the table again: cost per booked consult moved 5%. Everything else moved enormously. The account did not get cheaper, it got pointed at different people. Value-based bidding is the difference between buying leads and buying revenue.

Treating ad policy as a strategy problem. Sitting on fourteen disapprovals is not a nuisance, it is an account-suspension risk and a permanent drag on delivery. In regulated and sensitive categories, compliance is part of the media plan, not a legal afterthought.

Pricing on the landing page. Counterintuitive, consistently effective. Fewer consults booked per hundred clicks, far more of them showing up and buying. When your constraint is provider hours rather than lead volume, qualification beats quantity every time.

Who This Applies To

Any business with a wide range of transaction values and limited service capacity — aesthetics, dental, cosmetic surgery, veterinary, high-end salons, elective healthcare, home services with both small repairs and large replacements. If your ad account treats a $200 job and a $5,000 job as the same conversion, this is your situation.

Related reading: why your Google Ads aren't converting and how to choose a bidding strategy. Or see our PPC services.