Most practice owners flinch the first time they see what a plastic surgery click costs. In Dallas-Fort Worth, Keyword Planner showed top-of-page bids for "tummy tuck near me" reaching about $21. Twenty dollars for one person to visit one page feels like a lot.
Now set it next to the surgery. RealSelf's patient-reported average for a tummy tuck in Dallas-Fort Worth is $12,626. If one click in a few hundred becomes a tummy tuck patient, that $20 click is one of the cheapest things the practice will buy all year. If none do, it is one of the most expensive.
Bidding is how you tell the difference, and how you pay enough to win the searches that book without paying for the ones that don't. This chapter covers how we bid a plastic surgery account, from the first week of the Isolation campaign to the day Exploration takes over.
Price the Click Procedure by Procedure
Chapter 3 worked out how much a click is worth, from what the practice can afford to spend to win a patient, through the share of clicks that request a consult, the share that show up and the share that book surgery. Bidding starts by putting that number next to what the market is charging, and doing it for each procedure separately.
Using the same example rates as Chapter 3 (1 in 20 clicks requesting a consult, 7 in 10 showing up, 1 in 4 booking surgery), here is how three Dallas searches compare. The amounts each practice can afford per patient are illustrations; use your own:
- Tummy tuck. A practice that can afford $2,500 to win a tummy tuck patient can pay up to about $22 a click. Keyword Planner put a top-of-page spot on "tummy tuck near me" at roughly $5 to $21. The whole range fits under that ceiling. The same click at a practice that can only afford $1,500 per patient is worth about $13, and the top of that range loses money.
- Breast augmentation. At $1,200 per patient, the most a click is worth is about $10.50. "Breast augmentation dallas" ran from about $3 to $12. The top of the market is just past the ceiling.
- Mommy makeover. At $3,500 per patient, a click can be worth about $31. "Mommy makeover dallas" ran from about $4 to $19. There is room to bid for the top spot and still make money.
That is the whole case for bidding by procedure family. One account, the same week, and one procedure can afford to win every auction while another needs to bid carefully.
Let a Small Budget Show You the Real Prices First
Keyword Planner's ranges are a starting point. The real prices show up once the ads are live, so we launch the Isolation campaign on a modest budget for the first several days and let the market tell us what it charges.
Inside the account, the keywords view has a column called "Est. top of page bid": Google's estimate of what it takes to appear above the organic results for that keyword. Google is careful about what it is: an estimate built for exact-match searches, not a price guarantee. Read it for each ad group's main keywords and compare it with your ceiling from the section above.
Where the estimate sits comfortably under the ceiling, bid to win. Where it sits above, you have a decision to make: improve the ad and page so the price comes down (Chapter 4), accept a lower position, or leave that search for later.
Bid for the Top on the Searches That Book
In the Isolation campaign, bids are manual and set at the ad group level, so each procedure gets its own price. The goal on the searches that matter most is to show near the top of the page most of the time.
Four columns in the account tell you whether that is happening:
- Search top impression share: how often your ad appeared above the organic results, out of the times it could have. On your most important searches, aim for roughly 75% to 90%.
- Search absolute top impression share: how often your ad was the very first one on the page.
- Search lost top impression share (rank): the share of top-of-page chances you gave up because Ad Rank fell short, whether from the bid, the ad and page, or both.
- Search lost top impression share (budget): the share you gave up because the day's budget was already spent.
The two "lost" columns point to different fixes, and mixing them up wastes money. Losing to rank is a bid or quality problem: raising the budget won't help. Losing to budget is a money problem: raising the bid will only spend the budget faster.
Launch Bids Run High. Quality Brings Them Down.
A new account starts with no history. Google has no track record for your ads or pages, so early on it usually takes a higher bid to earn the positions you want. That is normal, and it is worth paying during the first weeks, because those weeks are when the account learns which searches produce consult requests.
As the ads and procedure pages earn better ratings, the price of holding a position tends to fall. Google's own guidance is that ads of higher quality often end up costing less per click. So as the account matures, ease the bids down while keeping an eye on top impression share. If share holds, the lower bid is the new price. Expect this to take one to three months for a new plastic surgery account.
The Chains Will Show Up in Your Auctions
In most local markets, an independent plastic surgery practice is not only bidding against other local surgeons. In our September 2026 check of Dallas searches, the ads we saw included:
- Mia Aesthetics: "Tummy Tuck Starting At $3,800" and "Breast Aug Starting At $2,300."
- AirSculpt: "A Less-Invasive Tummy Tuck," with "No drains, awake procedure."
- An independent surgeon in the Dallas-Fort Worth area: leading with board certification and a consult offer.
Chains like these have budgets built for many markets at once, and they compete on price certainty. Google's Auction insights report shows you who you are actually meeting for your keywords, and how the auction is going: how often their ads appear alongside yours (overlap rate), how often theirs shows above yours (position above rate) and how often you outrank them (outranking share).
Use it to make a decision, not to start a bidding war. If a chain moves into one of your searches and the price climbs past your ceiling, the profitable move may be to step back from that search and put the budget where you still win at a price that works. Chapter 8 covers the other response: ads that compete on what a chain can't offer.
Judge Bids by Consults and Surgeries, Not Clicks
A cheap click is not a good click if it brings the wrong person. In plastic surgery, some of the calls and form fills an ad produces are not surgical consult requests at all: price shoppers who want a number over the phone, Botox questions, current patients calling about a follow-up.
That is why the conversion data needs a human check. Ask the front desk to mark each call and form from the ads as a real surgical consult request or not, and review the results weekly by ad group. When one procedure's ad group produces plenty of conversions but few real consults, its bid is too high for what it is bringing in. When another produces fewer, better consults, it may deserve more.
The last check comes later, because surgeries come later. Every month or two, compare the consults from each ad group with the surgeries that followed. That is the number Chapter 3 said decides what a click is worth, and it is the number your bids should follow in the end.
Exploration Takes the Bidding Over
When the Exploration campaign launches (Chapter 6), bidding changes hands. Exploration uses Maximize Conversions with a target cost per conversion, and Google sets each bid automatically to hit that target.
The target should come from Isolation's real results, not a guess: what Isolation has actually been paying for a consult request, adjusted for the quality you saw in the weekly review. Set it too low and the campaign won't spend; set it too high and it will spend freely on consults you can't afford.
Expect a learning period. Learning, in Google's description, lasts up to roughly 50 conversion events, or three conversion cycles. For a plastic surgery practice, that can mean weeks. Changing the target later does not restart learning, but give each change a cycle or two before judging it.
Plastic surgery adds one more wrinkle. The campaign is optimizing toward consult requests, but the surgeries that pay for them arrive months later. Judge Exploration on its cost per consult week to week, and check it against surgeries every few months, the same way you do with Isolation.
Next: Write Ads Patients Would Write
A good bid wins the position. What the ad says decides whether anyone clicks, and whether the right people do. Chapter 8 covers writing plastic surgery ads, starting with the words patients already use about their surgeons.
Every chapter is on the Google Ads for Plastic Surgeons home page.
Bidding procedure by procedure, and checking every bid against consults and surgeries, is how our Google Ads management runs plastic surgery accounts. If you are running your own, start by writing down your ceiling for your two most important procedures before you touch a single bid.
