How should a plastic surgeon measure return on ad spend?

What is return on ad spend?

Return on ad spend compares what advertising produced with what it cost:

• ROAS = revenue attributed to the ads ÷ ad spend

A ROAS of 10× means every dollar spent on ads produced ten dollars of revenue. The formula is simple. The judgment is in deciding what counts as revenue.

What should count as revenue?

For a surgical practice, the honest answer is booked surgeon's fees from patients who came through the ads. For a facelift, booked surgeon's fees are the total price the patient pays, minus the anesthesia cost and minus the facility cost. Leads, clicks, followers and impressions are not revenue. They are vanity metrics if they are treated as results.

“There's only one thing that counts — the patient that physically walks into my door, sits down, and signs up.”

How does the calculation work for a real practice?

Dr. Malcolm Lesavoy is a board-certified plastic surgeon in Beverly Hills and a former Chief of Plastic Surgery at UCLA. These are his published figures with Pagerising:

The calculation:

• ROAS: $447,906 ÷ $18,185 = 24.63×
• Net of ad spend: $447,906 − $18,185 = $429,721

Every consultation in the case was prepaid, so each patient the surgeon met had already been qualified by phone and had paid to attend. The full figures are in the case study.

What does ROAS leave out?

ROAS measures ads against the revenue they produced. It is not profit. Before judging a campaign, a surgeon should also account for:

• Other marketing costs, such as the fee for the service that runs the ads and handles the patients.
• The surgeon's own costs. Booked surgeon's fees already leave out anesthesia and facility costs, but not the practice's own costs, such as staff and time.
• Booked versus collected revenue. Booked surgeon's fees count surgeries that are scheduled. A patient can still change their mind, which is why a deposit matters.

"Net of ad spend" subtracts only the ad spend. It is a useful figure, but it is not the practice's margin.

How should ad spend be counted?

Count all of it, over the same period as the revenue. That includes spend on ads that produced no bookings: they are part of the cost of finding the patients who did book. Leaving them out makes any campaign look better than it was.

Keep the attribution honest in the other direction too. Revenue should come from patients who actually came through the ads, not from patients who would have arrived through referrals anyway. A prepaid consultation booked by a coordinator from an ad lead has a clear source, which makes the calculation easier to trust.

Which numbers lead up to ROAS?

ROAS is the end of a chain, and each link can be measured:

1. Leads collected
2. Prepaid consultations scheduled
3. Consultations attended
4. Surgeries booked
5. Booked surgeon's fees

If ROAS is low, the chain shows where. Many leads but few prepaid consultations points to qualification. Many consultations but few surgeries points to fit or pricing. Lead generation vs patient acquisition explains why measurement should not stop at the first link.

When should you measure it?

Surgery bookings follow consultations, and consultations follow ads, so ROAS taken too early understates the result. The first 30 days give a clear indication of performance. Pagerising agreements start with a three-month term so the campaigns have enough time to generate meaningful data. How long ads take to produce consultations covers the timeline.