Performance Max is Google's all-in-one campaign. You give it a budget, a goal, some images, headlines and videos, and it decides where to show your ads across Search, YouTube, Gmail, Maps, Discover and websites that run Google ads. It learns from your conversions and goes looking for more of them.
That last part is the whole story for a dermatology practice. Performance Max does exactly what your conversion data tells it to do. If a new skin check patient and a new Botox patient both count as one conversion, it will go after whichever one is cheaper to find, and it won't know or care that the two are worth very different amounts to you. It can't tell a Mohs patient from a filler patient unless you set it up so it doesn't have to.
This chapter covers when a dermatology account is ready for Performance Max, how to split it so each campaign has a single goal, and what to feed it, given the health rules from Chapter 9.
Six Months of Search Bookings Come Before the First Performance Max Dollar
Performance Max is not a launch campaign. It's the campaign you add once the account has something true to teach it.
In the rollout this guide follows, the Search campaigns from Chapters 5 through 8 run first, building a record of real bookings counted the way Chapter 1 set up. Only after about six months of clean, steady conversions does Performance Max get a budget. Launch it earlier and it has almost nothing true to learn from, but a large budget to explore with, and a dermatology budget spread across video views and banner placements tends to produce motion rather than patients.
There's a second reason to wait. If the conversion tracking has any flaw, such as a portal click still counted as a booking, Performance Max will find that flaw and pour money into it faster than any Search campaign could. Six months of Search is also six months of checking that every conversion is real.
Medical and Cosmetic Each Get Their Own Performance Max
Here is the problem with one Performance Max campaign for a whole dermatology practice. The campaign bids to get as many conversions as it can for the budget. It sees a new eczema patient, a new skin check patient and a new laser hair removal consult as three identical conversions. Whichever type costs least to find is the one it learns to buy more of.
That rarely matches what the practice wants. Cosmetic leads can be cheaper to generate and less likely to turn into a paying patient, or the reverse. Either way, a blended campaign can quietly drift toward one side of the practice while the other side starves, and the reports will still look healthy because the conversion count keeps rising.
The fix is the same one that has run through this guide. Give medical and cosmetic their own Performance Max campaigns, each set to the conversion actions for its own funnel, each with its own budget. Within each campaign, group assets by condition or service so the images and headlines match what's being advertised.
Set each campaign to optimize for conversions rather than conversion value at first, and launch without a target cost per acquisition. Let it learn for several weeks, then add a target based on what it actually achieved, the same approach Chapter 7 used for Exploration.
Search Themes Should Say "Skin Check" and "Eczema," Not "Dermatology"
Performance Max doesn't use keywords, but it does let you suggest the searches you want to appear on. Google calls these search themes, and you can "add up to 50 search themes per asset group."
Use them to point each asset group at specific patient language, the same words Chapters 5 and 8 collected: "skin check near me," "mole removal," "eczema treatment," "psoriasis dermatologist" for the medical groups, and the specific treatments for the cosmetic groups. A single broad theme such as "dermatology" gives the campaign almost no direction.
Watch for one catch. Google sometimes flags health-related themes, particularly ones that combine a condition with "near me." If a theme is flagged, drop it rather than fight it. Your Search campaigns already cover those searches directly, which is where you want them anyway.
Search themes don't override your controls. Google states that "exclusions and negative keywords still apply," so the negative lists from Chapter 5, the product searches, competitor names and far-away towns, keep working inside Performance Max too.
Build Custom Segments From Searches, Not From Your Patients
Performance Max works better with audience signals, hints about the kind of people likely to convert. For most businesses, the strongest signal is the customer list. For a dermatology practice, the health rules from Chapter 9 take that off the table: no remarketing to past visitors, no uploading patient lists, no lookalikes based on them.
What's left is still useful. Build custom segments in the audience manager before you launch, using two kinds of input. The first is search terms: the condition and treatment searches that already book patients in your Search campaigns. The second is competitor websites: the addresses of other practices and chains in your market. Google uses these to describe the kind of person who searches those terms or visits those sites, not to follow the specific people who did. That's profiling, not retargeting.
Be realistic about how far these signals go in healthcare. Google's own policy says custom segments built around sensitive health topics can only be used in limited ways, mainly on the Display network to non-sensitive audiences or through the content of the page. Treat audience signals as a nudge in Performance Max, not a steering wheel. The real steering comes from your conversion data and your search themes.
Show the Office and the Team, Not Close-Ups of Skin
Much of Performance Max runs on images and video, and dermatology imagery is where practices run into Google's policies fastest.
Google's rules on clickbait don't allow ads that use "clearly altered zoomed in body parts," and they specifically name "before and after" images used "to promote significant alterations to the human body." Google's sexual content policy separately restricts nudity, even when it's blurred, which matters for anything showing a full-body skin exam. Where exactly a close-up of acne, a rash or a mole falls under these rules isn't spelled out, and that uncertainty is the point: skin close-ups and treatment before-and-afters risk a rejected asset or a restricted ad, and they buy you nothing a photo of your team can't.
So build the asset groups from what's safe and more persuasive anyway: real photos of the practice, the waiting room, the front desk and the dermatologists, and short videos of a provider explaining a visit. Leave out stock photos of flawless models, which look like every med spa ad on the internet.
Two more choices matter. Turn down Google's offer to write text and create images for you with AI; in a medical practice, every claim and every face should be real. And supply your own video. If you don't, Google may build one from your images, and those rarely look like a practice anyone would trust with their skin.
For headlines and descriptions, bring the winners from your Search campaigns. They've already proved which patient words get clicks and bookings.
Exclude Your Own Practice's Name So It Can't Claim Your Brand Searches
Left alone, Performance Max will happily show ads on searches for your own practice's name. Those are the cheapest, easiest conversions in the account, people who were already looking for you. The campaign's numbers look wonderful, and almost none of it is new business.
Add a brand exclusion for your practice's name and each dermatologist's name, so brand searches stay with the brand campaign from Chapter 6, where they cost little and are counted honestly. Confirm the location is set to Presence, as Chapter 9 explained, since Performance Max has the same default.
If Performance Max Is Already Running, Check What It's Counting First
Many practices come to this chapter with a Performance Max campaign already live, often set up by a previous agency or by Google's own setup assistant. Before changing anything else, open the conversion actions it's optimizing toward.
The usual problems are the ones Chapter 1 described: page views counted as conversions, clicks to the patient portal counted as leads, or every contact form lumped together regardless of whether it came from a new patient. Performance Max amplifies whatever it's given, so a campaign built on those signals can report dozens of conversions a week while the schedule stays flat.
Fix the conversions first, even if the numbers drop. Then decide whether the campaign's history is worth keeping or whether it's cleaner to pause it, let Search rebuild a true record of bookings, and relaunch Performance Max split by funnel. A smaller, honest conversion count is worth more than a big one that teaches Google the wrong patient.
Check Which Searches and Placements It Bought Every Month
Performance Max used to be hard to see inside. It's much less so now. Each month, open its search terms report and its placement and channel reports, and look for three things: searches that belong on the negative list, placements that bring clicks but no bookings, and a drift toward one type of service you didn't intend.
Judge it by bookings the front desk can confirm, as with every campaign in this guide. A monthly half hour with those reports is usually enough, as long as someone actually does it. If Performance Max is booking real new patients at a cost that fits the ceilings from Chapter 3, give it more room. If it's mainly producing cheap conversions that never become patients, tighten its goals, fix the tracking, or pause it and put the budget back into Search.
Next: Demand Gen for People Who Haven't Searched Yet
Performance Max works on people who are, in some sense, already looking. Chapter 11 turns to the ones who aren't: Demand Gen campaigns on YouTube, Gmail and Discover, and how a dermatology practice can use them to put the idea of a yearly skin check in front of people who never searched for one.
The Google Ads for Dermatologists guide home lists every chapter. Performance Max is added to an account under our Google Ads management only once Search has proved what a real booking looks like.
