Performance Max is Google's everything campaign. One budget, one set of assets, and Google decides where the ads run: Search, YouTube, Gmail, Maps, Discover and websites across its display network. For a med spa that has spent months getting Search right, it looks like the obvious next step.
It is a good next step. It's just a bad place to dump the whole menu. Hand Performance Max every treatment you offer and it will do exactly what it was told, which is book as many appointments as it can. Those are rarely the appointments that pay the rent.
This chapter covers when to launch it, which treatment line to give it first, and the settings that keep it from wandering into your brand searches, your old promo pages and a set of photos Google won't run.
Performance Max Counts a $220 Facial the Same as an $859 Lip Filler
When a campaign bids for the most conversions, every booking counts as one. That's how this guide sets it up at launch: bookings, not booking values, so a new campaign has one simple goal to learn from the tracking Chapter 1 built.
Now look at the menu through that lens. CareCredit's national cost study puts a HydraFacial-type treatment at $220 on average, lip filler at $859 and a single CoolSculpting session at $1,602. To a campaign counting bookings, those are three identical wins. The cheapest one is often the easiest to get: a lower price, a quicker decision, fewer questions before someone books.
So a whole-menu Performance Max campaign drifts toward whatever books most easily. The calendar fills up. The front desk is busy. And the report looks great right up until you compare revenue to spend.
The fix isn't a smarter setting. It's a smaller brief. Give Performance Max one treatment line, with its own budget, its own assets and its own page, and it can only chase bookings you actually want.
Search Books Clients for Months Before Performance Max Gets a Dollar
Performance Max doesn't launch with the account. In our rollout it arrives around months six and seven, after Search has done the hard work.
By that point Isolation, our name for Chapter 6's exact match campaign with bids you set by hand, knows which treatment searches end in a booked appointment. Exploration (our name for the broad match campaign with a target cost per booking) has widened the net and fed Google a steady stream of real conversions. Performance Max learns from that history. On a brand-new account it would be studying an empty notebook.
At launch, set the goal to bookings and leave the target cost per booking off for the first stretch. Let it learn what a booking costs in this new mix of placements. After a few weeks, set a target from its own real cost per booking, just as Exploration's target came from what Isolation's bookings really cost.
Use the same location setting as Search, too. Chapter 9's Presence setting applies here just as much. Performance Max has more ways to find someone three states away than a Search campaign does.
The Right First Line Has Bookings, a Real Page and Photos Google Will Run
Not every treatment line is an equally good first brief. Score each one on four things before you pick.
Bookings in your Search account. This one outranks the others. The line with the most steady bookings from Isolation and Exploration is the line Performance Max can learn from fastest. No outside benchmark can tell you this. Your own conversion report can.
What a client is worth. Chapter 3's math still applies. A line with a strong first ticket or a clear return pattern can support the higher costs of reaching people who aren't searching yet.
How many audience tools Google leaves you. As Chapter 9 explained, ads for injections and prescription drug names fall into Google's sensitive categories, which take away client lists and remarketing. Lip filler and neurotoxins run with fewer tools than a facial does.
Whether Google will run your photos. Performance Max is mostly pictures and video. A line whose best proof is a photo Google restricts starts with one hand tied.
For many med spas the answer is the injectables line that already carries Search, even with the audience limits, because that's where the bookings and the loyal clients are. For others it's laser hair removal packages. The scorecard just keeps you from picking the line that looks best in a brochure.
Body Contouring Before-and-Afters Get Shut Out of YouTube and Display
Body contouring is the line where med spas most want to show results, and it's the line where Google's image rules bite hardest.
Google's nudity policy covers visible buttocks and exposed breasts, including the lower curve, and it counts blurred or censored images the same as uncensored ones. A black bar across a CoolSculpting before-and-after doesn't make it compliant. It just makes it a censored nude.
Content Google treats as sexual can still run on Search. It can't run on the Display network, on YouTube or in image ads, which covers most of the places Performance Max can show an image or a video. A body contouring asset group built on torso and backside photos will quietly lose most of its reach.
So a body contouring line needs different proof: clothed results (a dress that fits differently, a profile in a fitted top), the device itself, the treatment room and the person running it. If your landing page is a wall of uncensored before-and-afters, that can restrict the ads pointing to it as well.
Your Exact Match Searches Stay With Isolation. Everything Else Is Up for Grabs.
Owners worry, reasonably, that Performance Max will swallow the Search campaigns they spent months building. Google's own rule is more specific than that.
Google's rule: when a search is identical to an exact match keyword in one of your Search campaigns, that Search campaign serves, not Performance Max. So the "lip filler near me" searches Isolation owns stay with Isolation. Search themes, the search hints you give Performance Max, get the same priority as phrase and broad match keywords, which means they compete on equal footing with Exploration.
Two things follow. Keep Isolation funded, because a Search campaign that runs out of budget can't serve, and the searches it can't take go to whoever can. And watch Exploration's numbers after launch. If they dip as Performance Max climbs, some of those searches changed hands rather than growing.
Injectables Campaigns Can't Use Your Client List. Search Themes Do the Steering.
Performance Max takes audience signals: suggestions about who to look for first. Most advertisers start with their customer list. For an injectables or weight loss line, that isn't available. Customer Match and remarketing are both off the table in Google's sensitive categories.
Custom segments, built from searches or websites, are the usual next move. They come with a catch here. Google's policy page says custom segments tied to sensitive ads or landing pages won't serve outside Display, so an injectables campaign shouldn't lean on them.
And any signal is only a hint. Google says Performance Max may show ads to people outside your signals when it thinks they're likely to convert. The signal is a head start, not a fence.
The better steering tool for these lines is search themes. Take the searches that already book in Isolation, the treatment-plus-place searches and specific ones like "lip flip," and add them as themes in the lip filler asset group. If Google flags a health-related theme, drop it rather than rewording it to sneak it through.
Performance Max Will Happily Bid on Your Own Name. Brand Exclusions Stop It.
Left alone, Performance Max will show ads on searches for your own spa. Those people already know you. They'd have found you through the brand campaign from Chapter 2 at a fraction of the cost, and Performance Max would take the credit for finding them.
Brand exclusions fix that. Add your spa's name to a brand list and exclude it from the campaign. Small businesses often aren't in Google's brand library yet, and Google lets you request to add yours. If clients search for your injectors by name, check whether those names can go on the list too.
While you're in the settings, look at final URL expansion. With it on, Google may swap the landing page you chose for another page on your site that it thinks matches the search, and write a headline to fit. For a med spa with years of old specials pages, that's a risk. Turn it off for the first campaign, or exclude the promo pages. Chapter 13 goes further into keeping Google's automation away from old prices.
A Real Injector on Video Beats Whatever Google Stitches Together
Performance Max needs headlines, descriptions, images, logos and video for each asset group. Leave the video slot empty and Google can fill it with one it generates from your other assets. It will be exactly as interesting as that sounds.
A phone and one afternoon beat it. Film the injector explaining a lip filler consult, the room, the mirror moment when a client sees the result. Clients in the example market's reviews praised being told what was happening and the injector they trusted. Video can show both.
For the text, don't start from scratch. Chapter 8's best-performing headlines have already been tested against real searchers. Move the winners into the asset group, and skip the option to let Google write new ones.
For images, use your own: the actual room, the actual team, results that pass the image rules above. Stock photos of a model with perfect skin look like every other med spa ad, and clients can tell.
Next: Start Demand Gen Before Laser Season
With Performance Max working one treatment line, the account has covered people who are searching and people Google can find across its network. The next step is reaching people before they start looking, timed to when demand for each treatment actually rises. Chapter 11 covers Demand Gen and why laser hair removal ads should start months before summer.
Lost track of where Performance Max sits in the order? The Google Ads for Med Spas guide home lays out all fifteen steps. Chapter 9 has the sensitive-category limits this chapter builds on.
In the med spa accounts we run under our Google Ads management, Performance Max gets one treatment line at a time, and only after Search has shown which line has earned it.
