The Framework Plastic Surgeons Use to Hire an SEO Agency They Won't Regret

Most SEO agencies are competent at what they do — for e-commerce stores, SaaS products, and local service businesses. Plastic surgery is a different category entirely, and the gap shows up fast.

The regulatory environment alone changes the engagement. HIPAA, the FTC Endorsement Guides (16 CFR Part 255), FTC Health Products Compliance Guidance, and state medical board advertising rules all constrain what you can publish, how you can present patient results, and what claims your content can make. An agency unfamiliar with these rules will produce content that looks fine until your compliance officer, a patient, or a regulator reviews it.

Beyond compliance, the keyword landscape for plastic surgery requires clinical literacy. Terms like rhinoplasty, blepharoplasty, and abdominoplasty have specific search intent profiles that a generalist copywriter will misread. Patients at different stages — awareness, consideration, and pre-consultation — use different language, and matching content to intent requires understanding what those patients are actually looking for.

Local SEO for plastic surgeons is also more competitive than most industries. Map Pack positions in major metros are contested by well-funded practices with years of review velocity and citation authority. An agency that has never competed for healthcare local rankings will underestimate the timeline and overestimate quick wins.

This is educational content, not legal or compliance advice. Consult your healthcare attorney and state medical board for guidance specific to your jurisdiction.

Before any SEO agency accesses your website backend, analytics platforms, call tracking data, or CRM integrations, they become a potential point of exposure for protected health information (PHI). Under the HIPAA Privacy Rule (45 CFR § 164.502), vendors who handle PHI on behalf of a covered entity are classified as Business Associates and are legally required to operate under a signed Business Associate Agreement (BAA).

This is not a bureaucratic formality. It is a foundational requirement that defines liability, breach notification obligations, and data handling standards for your vendor relationship.

What to do before signing any SEO contract:

• Ask directly: "Will you sign a HIPAA BAA with our practice?"
• If the agency hesitates, asks what a BAA is, or says it is not necessary, stop the conversation
• Confirm which tools they will use — Google Analytics 4, call tracking platforms, heatmap software — and verify each has a BAA path available
• Have your healthcare attorney review the BAA before execution

Agencies with genuine healthcare experience will have a BAA template ready and will not treat the request as unusual. Agencies without that experience will often push back, minimize the requirement, or offer vague assurances that they "handle data securely." Secure handling and HIPAA compliance are not the same thing.

This section is educational. PHI handling obligations vary by practice type and data architecture. Consult your healthcare compliance counsel for individualized guidance.

Not every red flag is obvious in a sales call. Some of the most problematic agency behaviors only surface after you have signed a 12-month contract. The list below covers the signals worth identifying before you commit.

Ranking Guarantees

No agency controls Google's algorithm. Any guarantee of a specific ranking position — "we'll get you to page one in 60 days" — is either a misrepresentation or a signal that they plan to use tactics that create short-term movement and long-term risk. Legitimate SEO involves probabilistic timelines, not guarantees.

Vague Deliverable Descriptions

If a proposal describes services as "SEO optimization," "content strategy," and "link building" without specifying what those terms mean in measurable outputs per month, you have no basis for evaluating performance or holding the agency accountable.

Ownership Ambiguity

Ask explicitly: who owns the website, the content published on it, and the backlinks built during the engagement? Some agencies build practices on platforms they own, meaning you lose your digital infrastructure if you leave. Your contract should state clearly that all assets transfer to you at termination.

No Healthcare Portfolio

Requesting case studies from medical or aesthetic practices is reasonable. An agency unable to produce any — even anonymized — examples from healthcare or high-consideration service industries has not operated in this environment before.

Single Point of Contact Who Does Everything

SEO for a plastic surgery practice requires technical expertise, content development, local SEO management, and analytics. One generalist handling all of it is a capacity problem that will show in output quality within the first 90 days.

Use these questions across your agency evaluation process. Strong answers are specific and verifiable. Weak answers are vague, deferential, or pivot to sales language.

1. "Will you sign a HIPAA Business Associate Agreement before work begins?" — The only acceptable answer is yes, without hesitation.
2. "Which members of your team will work on our account, and what are their specific roles?" — You want named individuals, not "our team."
3. "How do you handle before-and-after photo compliance with FTC Endorsement Guide requirements?" — Look for familiarity with disclosure requirements and atypical results language.
4. "What does your technical audit cover, and what deliverable will we receive?" — Should include site speed, crawlability, schema markup, mobile performance, and Core Web Vitals.
5. "How do you approach Google Business Profile optimization for plastic surgeons?" — Should reference service categories, photo compliance, Q&A management, and review response strategy.
6. "What is your link acquisition approach, and can you show us examples of placements from healthcare or adjacent industries?" — Watch for evasiveness or overreliance on low-quality directory links.
7. "How often do we receive reporting, what metrics are included, and who interprets the data for us?" — Monthly reporting minimum; the agency should contextualize numbers, not just deliver dashboards.
8. "What happens to our website, content, and backlinks if we terminate the engagement?" — Asset ownership should be unambiguous.
9. "What does the first 90 days look like in specific deliverables?" — See the next section for what a credible answer includes.
10. "Do you have experience with multi-location practices or are you set up primarily for single-location clients?" — Relevant if you operate more than one office.
11. "How do you stay current on Google algorithm changes that affect healthcare content?" — Should reference E-E-A-T, helpful content, and medical content quality signals.
12. "Can you provide a reference from a current or former medical or aesthetic practice client?" — Willingness to provide references signals confidence in their work.

The first 90 days of an SEO engagement are diagnostic and foundational. Practices should be skeptical of any agency that promises ranking movement in this window — meaningful organic results in a competitive market typically take four to six months to materialize, and that timeline varies based on your starting domain authority, local competition, and the volume of issues uncovered in the audit.

What a well-run agency should deliver in the first 90 days:

Days 1–30: Discovery and Audit

• Signed BAA and platform access granted
• Full technical SEO audit with prioritized issue list
• Competitive landscape analysis across target keywords and local map pack
• Google Business Profile audit and baseline documentation
• Content gap analysis identifying highest-priority pages to build or improve

Days 31–60: Foundation Work

• Technical fixes implemented in priority order
• On-page optimization of existing high-value pages (procedure pages, location pages)
• GBP optimization: categories, services, photos, Q&A
• Schema markup deployment (LocalBusiness, MedicalBusiness, Physician)
• Internal linking audit and corrections

Days 61–90: Content and Reporting Baseline

• First content assets published (procedure guides, FAQ pages, or location pages depending on strategy)
• Citation audit and NAP consistency corrections underway
• First monthly performance report with baseline metrics established
• 90-day review call to align on priorities for months four through six

If an agency cannot produce a deliverable-specific roadmap at this level of detail before you sign, that is a meaningful signal about how they operate under contract.

Practice owners at the evaluation stage often raise the same concerns. These are worth addressing directly.

"We already tried SEO and it didn't work."

In our experience, this usually means one of three things: the previous agency lacked healthcare-specific knowledge, the engagement was too short to see results in a competitive market, or there was a mismatch between what was promised and what was actually delivered. Before ruling out SEO, it is worth doing a brief audit to understand what was built previously and whether it created any lasting foundation.

"We get most of our patients from referrals — do we really need this?"

Referral networks are valuable and worth protecting. But in our experience working with aesthetic practices, a significant share of referred patients still search the practice name or surgeon before booking. What they find — reviews, website quality, content depth — influences whether the referral converts. SEO strengthens the conversion layer that referrals depend on.

"We don't have time to manage an agency relationship."

A well-structured engagement requires roughly one to two hours of your time per month — primarily for a reporting call and content approvals. The agency should be doing the heavy lifting. If an agency requires significantly more of your time to function, that is a workflow problem on their side, not a normal expectation.

"How do we know results are from SEO and not other marketing?"

Good agencies establish attribution baselines at the start of the engagement: organic traffic segmented from paid, direct, and referral channels; call tracking by source; and form submission tracking by landing page. This does not eliminate attribution complexity, but it creates enough signal to evaluate organic performance independently.