We’ve audited a lot of Google Ads accounts for orthodontists and plastic surgeons over the past 15-20 years.

On paper, these reports often look great: high click‑through rates, “strong” conversion numbers, and reassuring cost‑per‑lead graphs. But when we ask a simple question:“Does your schedule feel busier with the right kinds of patients?” the answer is often “no.” 

Otherwise, why would they be reaching out to us?!

In this article, I’ll walk you through how Google Ads reports can be misleading and how to analyze results (or grill your agency) so you know what’s really working.

We’ll focus on orthodontic and plastic surgery practices, but the principles apply to any elective medical practice.

1. The Core Problem: Pretty Reports, Flat Schedules

Google Ads wants to show you big numbers: impressions, clicks, “conversions.” Agencies often want to show you the same.

The problem is that none of those tell you whether you’re getting more starts or surgeries. For high‑value, consult‑driven services like braces, aligners, breast augmentation, or rhinoplasty, “activity” is cheap. Real growth is not.

When we come in, we usually find at least one of these:

• Branded and non‑branded keywords mixed together, inflating overall results
• “Leads” defined so loosely that almost anything counts
• No way to tie ad‑sourced leads to actual consults and bookings
• Heavy reliance on Google’s defaults and automation with almost no guardrails

Your job is not to become a Google Ads expert. Your job is to know which questions to ask so you can see past the pretty charts.

2. Branded vs Non‑Branded: The #1 Way Results Get Skewed

If your practice name is in the keyword, that’s branded traffic. For example:

• Orthodontist: “Smith Orthodontics,” “Smith Ortho reviews,” “[Your Practice Name] braces”
• Plastic surgeon: “[Your Name] plastic surgery,” “[Your Practice Name] breast augmentation”

If the keyword does not include your brand, that’s non‑branded traffic:

• “Invisalign near me,” “orthodontist [city],” “braces for teens”
• “breast augmentation [city],” “tummy tuck near me,” “rhinoplasty cost [city]”

Branded leads usually:

• Click more, convert more, and cost less
• Come from people who already know who you are or have been referred

Non‑branded leads are:

• More expensive, but
• Far more important for growth, because they’re people who didn’t already have you in mind

If your agency mixes branded and non‑branded keywords in the same campaigns and the same reporting, your cost‑per‑lead can look fantastic while your real new‑patient growth is weak.

Our rule:

• Branded campaigns should be separate – their own campaigns, their own budgets, and their own section in the report.
• You should be able to see CPL and lead volume from non‑branded search alone, not blended with brand.

Questions to ask your agency:

• “Can you show me separate reports for branded vs non‑branded keywords?”
• “What is our cost per lead on non‑branded search only?”
• “How much of our spend last month was on branded keywords vs non‑branded?”

3. What Counts As A “Lead”? (And Why Your CRM Disagrees)

The word “lead” gets abused.

In many Google Ads accounts, a “lead” might be:

• Any click on a phone number
• Any call longer than X seconds
• Any form submission
• A chat started
• Sometimes even a pageview on a certain URL

For a serious orthodontic or plastic surgery practice, a real lead is something you can tie to a name and follow through the funnel. For example:

• A completed form with contact details
• A call where the caller’s name and purpose are captured
• An online booking or consult request that lands in your practice management or CRM

This is why we lean so heavily on ADvance Leads as the “source of truth.” When calls, forms, and bookings flow into one system with names, sources, and statuses, you can finally see:

• How many leads actually exist
• Which ones came from non‑branded Google Ads
• What happened to them after the initial contact

Questions to ask your agency:

• “How are you defining a ‘lead’ in our Google Ads reporting?”
• “Can you show me, by name, at least a sample of those leads from last month?”
• “How do your lead numbers compare to what we see in our CRM or ADvance Leads?”

If you can’t tie leads to names, you can’t tie ad spend to revenue.

4. How Are Those Leads Converting? (Clicks → Consults → Starts)

Let’s assume you are getting legitimate non‑branded leads you can tie to real people.

The next question is: “Do they actually turn into consults and bookings?”

For orthodontics:

• How many Google Ads leads became consults?
• How many consults became starts for braces or aligners?
• What is your cost per start from non‑branded search?

For plastic surgery:

• How many Google Ads leads showed up for a consultation?
• How many consults became booked surgeries?
• What is your cost per surgery from non‑branded search?

With ADvance Leads (or any serious CRM), you should be able to see:

• Lead source: Google Ads – Search – Non‑branded
• Status: New lead → Consult scheduled → No‑show / Completed → Booked / Not booked

If your agency is only talking about “conversions” and “cost per lead,” but can’t speak to booked consults and starts/surgeries, you’re missing the metric that matters most.

Questions to ask your agency:

• “Of the leads you reported last quarter, how many became actual consults?”
• “How many of those consults came from non‑branded search?”
• “Can we review cost per booked consult and cost per start/surgery, not just cost per lead?”

5. Campaign Setup: Smart Campaigns, Performance Max, And “Let Google Handle It”

Google loves automation. So do most non‑specialist agencies.

The problem is that default automation often trades control for convenience in ways that hurt practices like yours.

Common issues:

• Smart Campaigns and heavily automated setups lump search, display, and maps together, making it hard to see what’s actually working.
• Performance Max can drive a lot of “conversions,” but they may be low‑quality actions you wouldn’t call real leads. You don’t know unless you can track the ROI. In many cases we’ve seen Performance Max campaigns both drive low-quality leads and generate huge ROI.
• Auto‑applied recommendations can quietly turn on broad match keywords or placements you would never choose on purpose.

We’re not anti‑automation. We’re pro-control!

Our approach is usually:

• Use automation where it helps (bidding strategies, some targeting) to leverage the algorithm, but
• Maintain manual control over the things that matter:
  • Keyword strategy, especially…
  • Negative keywords
  • Budgets by campaign
  • What counts as a conversion
  • Where your ads are allowed to show

Questions to ask your agency:

• “Are we using Smart Campaigns or Performance Max? If so, why?”
• “How are we controlling where our ads show and what counts as a conversion?”
• “What auto‑applied recommendations from Google have you accepted or rejected lately, and why?”

If they can’t answer that clearly, too much control has been handed over.

6. Negative Keywords: What You Should Never Pay For

Negative keywords tell Google “do not show my ad when people include these words.”

Without a solid negative keyword strategy, orthodontists end up paying for:

• “free braces,” “Medicaid braces,” “DIY braces,” “how to take braces off at home”
• Jobs, careers, and competitor names you don’t want

Plastic surgeons end up paying for:

• “cheap tummy tuck,” “DIY nose job,” “plastic surgery gone wrong,” or “[insert famous celebrity] boob job” to name a few.
• General research terms with no local intent

We often see:

• No negative keyword list at all, or
• A tiny starter list that’s never updated as you gather search term data

Questions to ask your agency:

• “Can you show me our current negative keyword lists?”
• “How often are you reviewing search terms and adding new negatives?”
• “Can you show me a few recent examples of bad searches we’ve successfully excluded?”

A few dozen good negatives can save thousands of dollars over the course of a year.

7. Separate Campaigns And Budgets For Different Placements

Google can show your ads in multiple places:

• Search (the core of what most practices care about)
• Display (banner ads across the web)
• YouTube
• Local Services / Maps surfaces

If you lump these together, you:

• Can’t tell which channel is actually working
• Let cheaper, lower‑intent impressions steal budget from high‑intent search

For orthodontists and plastic surgeons, we almost always recommend:

• Separate campaigns for:
  • Search (branded vs non‑branded)
  • Display/remarketing
  • YouTube (if used)
• Separate budgets and separate reporting, so you can see cost and leads by placement

Questions to ask your agency:

• “Are search, display, and YouTube in separate campaigns with separate budgets?”
• “How much of our spend last month went to non‑branded search vs everything else?”
• “What is our cost per lead from search only?”

8. Landing Pages vs Website Pages

Where you send people matters as much as the ad.

Common problems we see:

• Ads for “Invisalign” or “breast augmentation” send people to a generic page with no call-to-action.
• Crucial information (who you help, what you’re known for, why trust you, what happens next) as well as social proof (before & afters, testimonial videos, reviews) are buried below the fold.
• The page loads slowly or looks terrible on mobile. 

In general:

• For high‑intent, non‑branded search, we want dedicated landing pages or very focused service pages:
  • Braces, Invisalign, clear aligners for ortho
  • Breast augmentation, mommy makeover, tummy tuck, rhinoplasty for plastic surgery
• Those pages should have:
  • Clear headlines that match the ad
  • Proof (reviews, before/after)
  • Simple, obvious next steps (consult, call, schedule)
  • Fast mobile performance

Questions to ask your agency:

• “For each of our main campaigns, can you show me the landing pages we’re using?”
• “How fast do those pages load on mobile?”

9. Call‑To‑Actions, Offers, And Message Match

Even great traffic underperforms if:

• The ad says one thing, but the landing page says another
• There is no clear offer or next step
• The next step isn’t obvious or feels high‑friction

For orthodontics:

• Ad: “Free orthodontic consultation for kids, teens, and adults.”
• Page: should clearly repeat that offer, show who you help, and make it easy to request that consult.

For plastic surgery:

• Ad: “Private breast augmentation consultation in [City].”
• Page: should talk about breast augmentation, not just generic “cosmetic surgery,” and make it clear what happens in that consult and the area(s) you serve.

Questions to ask your agency:

• “Can you walk me through one of our main ads and the page it goes to?”
• “Is the headline on the page clearly connected to the ad promise?”
• “What is the main call‑to‑action above the fold, and would a new patient understand it in three seconds?”

If you feel confused, your patients definitely will.

10. Online Scheduling vs Forms vs “Call Us” – And What To Test

Orthodontic and plastic surgery patients are busy and often anxious. The easier you make the next step, the better.

Options usually include:

• Online scheduling into specific consult slots
• Simple “request a consultation” forms
• “Call now” buttons and call tracking

We like to test combinations:

• For some markets, online scheduling wins because people want to lock in a time instantly.
• In others, short forms work better because people have questions and aren’t ready to commit to a date.
• Phone calls can be powerful, but only if your team consistently answers, captures details, and logs them.

ADvance Leads is built to handle all three paths in one place and track what actually leads to booked consults and completed starts/surgeries.

Questions to ask your agency:

• “What is the primary action we’re asking people to take from our ads?”
• “Have we tested online scheduling vs forms vs calls?”
• “Which path leads to the most completed consults, not just ‘conversions’?”

11. Mobile‑First Landing Pages And Conversions

Most of your ad traffic is on mobile.

Yet we still see:

• Pages designed for desktop that are painful on a phone
• Tiny buttons, long forms, and text walls
• Pop‑ups that cover the screen or are hard to close

Mobile‑first means:

• The page loads quickly on a phone connection
• Key messages and CTAs are visible without scrolling
• Forms are short, and buttons are thumb‑friendly
• Phone numbers are click‑to‑call and clearly labeled

Questions to ask your agency:

• “Can we look at our landing pages on a phone together?”
• “How quickly do they load on a typical connection?”
• “Is it obvious what to do next on a small screen?”

If the answer is “not really,” your conversion rate is suffering.

12. Leakage And Waste: Where Your Money Disappears

When we run Growth Architecture Audits, we often find the same leak points:

• Spend going to branded keywords that mostly capture people who would have found you anyway
• “Leads” that are really low‑quality actions, not real prospects
• Calls that go unanswered or untracked
• Campaigns targeting too broad a geography
• Ads running at times when no one can answer the phone
• Weak or missing negative keywords

Each leak might seem small. Together, they can easily eat 30–50% of your ad budget.

With ADvance Leads and a clean Google Ads setup, you can:

• See exactly which keywords, campaigns, and times of day produce real consults and starts/surgeries
• Cut budgets from what isn’t working and reallocate to what is
• Build a tighter, more efficient funnel instead of just “spending more”

Questions to ask your agency:

• “Where do you see the biggest waste or leakage in our account?”
• “What changes are you making to reduce that waste this month?”
• “Can you show me an example of something we stopped doing because it wasn’t producing real bookings?”

13. Leverage The Algorithm – But Don’t Hand It The Keys

Google’s algorithm can:

• Help you bid smarter
• Find patterns in search behavior
• Optimize toward defined conversions

It cannot:

• Decide what a high‑value patient looks like in your practice (unless you feed in actual sales data)
• Know the difference between a spammy click and a real prospective patient
• Set your strategy for which procedures you want to grow and when

Our philosophy:

• Use automation for what it’s good at (bidding, some targeting, dynamic ad testing).
• Keep human control over what matters most (keywords, negatives, budgets, placements, conversion definitions, and messaging).

That balance lets you enjoy the benefits of the algorithm without waking up one day to realize it has been “optimizing” toward the wrong goals.

Questions to ask your agency:

• “Where are we relying on Google’s automation, and why?”
• “What are we manually controlling to protect our budget and lead quality?”
• “If Google made a change tomorrow, how quickly would we catch it and adjust?”

14. When To Ask For A Growth Architecture Audit

If you’ve read this far and you’re thinking:

• “Our reports look good, but I don’t trust that we’re getting the right patients,” or
• “I’m not sure our agency could answer half of these questions clearly,”

you’re exactly the kind of practice we built the Growth Architecture Audit for.

In a Growth Architecture Audit, we:

• Separate branded vs non‑branded performance and show you the true cost per lead and cost per booked consult
• Define what a real lead is for your practice and connect ads → leads → consults → starts/surgeries using ADvance Leads
• Review your campaign structure, automation, negatives, placements, and landing pages with a fresh set of eyes
• Map out where your money is being well‑spent, where it’s being wasted, and what changes will make the biggest difference fastest

You don’t have to fire your current agency to get this kind of clarity. You just need a second opinion from a team that lives in orthodontic and plastic surgery advertising every day.

Before you sign your next contract or increase your budget, make sure you know what your Google Ads reports are really saying…and what they’re hiding.