Local Services Ads are the most tempting ad format Google offers a local business. There are no keywords to research, no headlines to write and no clicks to pay for. The practice sets up a profile, Google verifies it, and the practice pays only when a patient calls.
Plastic surgeons can now use them. Google lists "Plastic surgeon" among its US categories for Local Services Ads, which means a surgeon's photo, star rating and a call button can appear in a sponsored card at the top of some searches.
That sounds like the easiest win in this guide. For most plastic surgery practices it isn't, at least not early. This chapter explains what Local Services Ads are, what a practice gives up to use them, and why we treat them as a late, optional addition rather than a starting point.
"Plastic Surgeon" Is on Google's List. "Cosmetic Surgeon" and "Med Spa" Aren't.
Local Services Ads only exist for certain business categories, and only in certain areas. For the US, Google's list includes "Plastic surgeon," along with categories such as dermatologist and weight loss service. It doesn't include "Cosmetic surgeon" or "Medical spa." A practice's category and credentials decide whether it can use the format at all, and a med spa can't list itself as one.
Availability also depends on the market. Google says Local Services Ads are available only for certain categories in certain areas, and offers an eligibility check to confirm. Run that check before planning anything around them.
When the ads do show, they look nothing like the search ads in the rest of this guide. There are no headlines. The patient sees a compact profile: who the practice is, a photo, how many stars and reviews it has, how long it has been open, and a call button. In our check of Dallas searches in September 2026, one such card appeared on "plastic surgeon near me." It belonged to Sono Bello, a national body-contouring chain, showing a 4.7 rating from 656 reviews and "Free consultation." That was a single sighting on one evening, not a count of who uses the format, but it shows the kind of profile that competes for the spot.
You Pay per Lead, and Give Up Nearly Everything Else
The appeal of Local Services Ads is how they charge. A practice pays for leads, not clicks. For health care, that mostly means phone calls: Google doesn't offer booking leads or messaging for health care businesses.
What the practice gives up is control. Compare it with the Isolation campaign from Chapter 6:
- No keywords. Google decides which searches show the card. You choose the services you offer from Google's list for the category and the area you serve, and that is most of the targeting.
- No ad text. The card is built from your profile. There are no headlines to write from patient reviews, the way Chapter 8 described.
- No bid by search. You set a budget and a bidding approach for the whole account, not a price for "tummy tuck dallas" and a different price for "breast augmentation near me."
And because a lead is a phone call, the practice pays for calls it wouldn't choose. The price shopper who wants a number over the phone is a lead. So is the caller asking about Botox, or someone looking for a different practice. Chapter 7 warned about these calls in Search, where the front desk marks them and the bids adjust. Here, each one has already been charged.
The Data Is Thinner Than Anything Else in the Account
This is the part that decides it for us. Everything else in this guide rests on measurement: knowing which searches produce consult requests, and later which consults become surgeries. Local Services Ads give a plastic surgery practice much less to work with.
- Leads live in their own dashboard, separate from the consult tracking set up in Chapter 1.
- No call recordings. Google records Local Services Ads calls for some businesses, but not for health care. The practice can't listen back to hear whether a lead was a real surgical inquiry.
- No automatic credits. Google automatically credits some poor-quality leads for other businesses. That feature isn't available for health care. A practice can report a bad lead through Google's feedback on each lead, but nothing is refunded on its own.
So the only way to know whether Local Services Ads work is to track them by hand. Someone at the practice logs every lead, marks whether it was a real surgical inquiry, notes whether it became a consult, and months later, whether it became a surgery. Without that, the practice is paying for phone calls and hoping.
Google Reviews Decide Who Shows. RealSelf Doesn't Count.
Local Services Ads don't rank by bid alone. Google looks at how the practice treats the people who contact it:
- Star rating and number of reviews. Google's own help pages link better ratings and a larger pile of reviews to more booked work.
- Responsiveness. How quickly the practice answers and responds. Google says missed calls can hurt.
- Business hours, which Google uses to judge responsiveness.
- The profile, including photos and completed verification.
- The searcher's location and what they searched.
The reviews on the card come from the practice's Google Business Profile. That matters in plastic surgery more than most fields. Chapter 8 showed how much of a surgeon's reputation lives on RealSelf, where patients review a specific procedure in detail. None of that feeds Local Services Ads. A surgeon with hundreds of glowing RealSelf reviews and a thin Google profile starts behind a chain with hundreds of Google reviews.
The phone matters just as much. A practice that lets calls roll to voicemail over lunch isn't just missing those patients. It is telling Google to show someone else.
Why It Comes Late, If at All
Put together, Local Services Ads trade control and measurement for simplicity. That trade makes sense for some businesses. For a plastic surgery practice building an account the way this guide describes, it belongs near the end, and only if a few conditions are already true.
- Search is already profitable. The Isolation and Exploration campaigns are producing consult requests at a cost the practice can afford, and there is budget left over.
- The Google reviews are strong. Not just the RealSelf reviews.
- Someone answers the phone. Every call during business hours, including lunch.
- The practice can track leads by hand. Lead, consult and surgery, for every call.
If all four are true, run a small test with a fixed budget and a fixed end date, long enough to see a few months of consults. Judge it on consults and surgeries, the same way Chapters 3 and 7 judge everything else. A low cost per lead means nothing if the leads are price checks.
If any of the four isn't true yet, the money does more in Search.
If You Try It, Set It Up for Surgery
A Local Services Ads profile is short, so every setting carries weight.
- Services. Choose only the services you want calls about. If injectables run through a separate med spa, leave them out here, so the calls you pay for are about surgery.
- Hours. Set the hours someone actually answers the phone, not the hours the building is open. Google measures responsiveness against them.
- Photos. The surgeon, the team and the practice, the same real images Chapter 10 recommended for Performance Max.
- Service area. The same places the Search campaigns target, including the towns traveling patients come from (Chapter 9).
Then the price. There are three bidding choices. Google can bid for as many leads as the budget buys, which is its suggestion for newcomers; it can aim at a cost per lead you name; or you can cap what you will pay for any one lead. Google's guidance is to budget for ten or more leads a week and to allow about two weeks of data before reading the results.
For a plastic surgery test, we prefer the manual maximum, set from the same math as Chapter 3. Take a practice that can afford $2,500 to win a tummy tuck patient, where 7 in 10 consult requests show up and 1 in 4 of those book surgery. That practice can afford about $440 for a real consult request. A Local Services Ads lead isn't always a real consult request, because some calls are price checks, Botox questions or wrong numbers, so the maximum per lead has to sit well below that. The front desk's lead log tells you how far below within a few weeks.
Review the leads every week. Mark each one, report the ones that weren't real inquiries through Google's feedback, and watch for patterns. If the same wrong kind of call keeps coming in, the services or hours in the profile probably need changing.
In 2027 It Moves Into Performance Max
Local Services Ads are being folded into the main Google Ads platform. They will run as Performance Max campaigns that still charge per lead rather than per click. The move is happening in phases, and health care businesses are scheduled for the final phase in 2027.
For a plastic surgery practice, that change could help. Leads that sit in the same account as the Search campaigns may be easier to measure alongside everything else. It won't change what decides who shows: reviews, responsiveness and a complete profile. Building those now pays off either way, because they are also what patients look at on the map and in search results.
Next: AI Max
One piece of Google's automation remains, and it is the one Chapter 9 switched off in the Isolation campaign. Chapter 13 covers AI Max: what it changes about how ads match searches, and when a plastic surgery account is ready to try it.
Every chapter is on the Google Ads for Plastic Surgeons home page.
Deciding whether Local Services Ads have earned a place, and measuring them by hand if they do, is part of how our Google Ads management works with plastic surgery practices. If you are considering them for your own, start by counting your Google reviews, not your RealSelf ones.
