A small, two-person (one doctor and one practitioner), London-based cosmetic skin clinic in the competitive non-invasive cosmetic surgery and enhancements niche. 

The clinic was based in the world famous “Harley Street” of London but served nationwide and wanted to increase their organic visibility in order to generate more leads.

In short, below are the results we achieved with a fully-fleshed out case study underneath the stats. We explain, in full, what we did to achieve these results, and how they could have been improved even further!







Yukari Services Used


Client Struggle: 

  • Low rankings due to thin, plagiarised and poor quality content on both their service pages and blogs. 
  • Competing in one of the most famous cosmetic enhancement locations in the world against bigger and older, high authority clinic’s in the industry. 
  • Client’s main marketing channel was PPC ads to generate appointments. This was expensive, and click prices were increasing year on year.

What Yukari did: We improved their existing content on both their service pages and blog posts. On top of that, we created new content for the clinic month on month with our content creation process. 

This was done in a strategic manner to achieve topical authority for the client’s priority services. 

We also ran a high quality backlink campaign alongside this which exploded their rankings in Google. 

Client was on a low budget (just under 4-figures monthly), so we settled on 3 x links monthly (2 x niche edits/link inserts and 1 x guest post)

The Results: 

  • 718% increase in organic visitors vs previous 36 month period, becoming the highest traffic acquisition channel by over 160,000 visitors. 
  • From 8 keywords ranking in the top 10 of Google to 205 keywords (2475%)
  • Over 1,550 organic leads generated over the course of a 36 month campaign (213% increase)
  • Peaking at over 60 monthly leads for a new and competitive service page we created for the clinic which ranked number 1 in Google, with a conversion rate of around 4.9% from organic traffic. 
  • Recovery from a small dip due to the “Medic” Google algorithm update via implementing EAT signals.

Yukari Services Used to Achieve Results: 

  • Content Production (2 x monthly)
  • High Authority Monthly Guest posts (mixture of DA/DR 20, DA/DR 30, DA/DR 40, DA/DR 50+ links)
  • Niche Edits/Link Inserts (monthly)
  • On-Page SEO Audits and Implementation (monthly)
  • Technical SEO Audit & Implementation (service not available at the moment – coming soon)

Skin Clinic SEO Client’s Starting Situation and Problems

Problem 1: Overreliance on PPC Ads

Our client was over reliant on pay per click advertising before they onboarded us for our SEO campaign. 

While their PPC campaigns were doing their job, they were becoming increasingly more expensive in an already expensive space. 

This was not going to be sustainable and meant that if they ever needed to turn off their ads, their traffic and leads would dry up..like turning on and off a tap (except PPC ads in the cosmetic enhancement space are FAR more expensive than water!)

Problem 2: Low Quality Content

The skin clinic didn’t have much of an SEO presence, with thin, uninformative and badly formatted content on their service pages and blogs. A pretty shi**y experience for any potential customer. 

Some content was even plagiarised, for example, copying and pasting a news article they were featured in. 

The website had a low to average domain authority/rating; some publications coined him the “celebrity Skin Doctor” as he’d previously worked with reality TV stars, and this led to a few strong backlinks pointing back to the website. 

Problem 3: Low to Average Domain Authority in a “Your Money, Your Life” Niche

Domain Authority was in the early-20’s when we started, so we had a solid foundation to work from, although many competitors were in the 40’s and 50’s.

The owner of the business was open to many different approaches which was positive and he was receptive to our ideas (mainly, improving the quality of content on his priority service pages initially, and then strengthening those positions by creating a hub of helpful content around those services to build topical authority).

The biggest problems with their website:

Technical issues

The site was relatively small and didn’t need that much work from a technical standpoint. 

If you know me by now or have read my case studies, you know that I like to get the big rocks fixed at the start and move on. 

I find technical SEO to be small ROI work with most small websites (conversely, I believe it can be a high ROI task on larger sites). 

I like to fix the big issues in month 1 and set up monitoring, using tools like Content King, which give you real time alerts when things go wrong or break. 

We fixed these technical issues and set a strong foundation to make our SEO results easier to achieve (more on the exact fixes a bit later).

Thin, plagiarised and poorly optimized content

The biggest SEO issue on the site was a lack of in-depth, helpful content. This affected both the service pages and the blogs. 

Service pages had been thrown up quickly to show visitors which treatments the clinic offered, but they were thin, poorly formatted (bold titles and subheadings instead of H tags, for example) and badly optimised. 

Blog content was minimal and what was there was either copy-pasted from the publications they’d been featured in or just thin on info.

Our main focus for the first year was to work with our client to discover what his priority services and treatments were.

We then cross-referenced these service pages with his Google Search Console data and with tools like SEM Rush to see which services would deliver the easiest wins.

We looked at criteria like: 

  • Lots of impressions in GSC but very few clicks
  • Competition for the treatment(s) on the first page of Google
  • Services that would generate our client the most revenue

Once we prioritised our list of treatments, the plan was to focus on optimizing those service pages with improved on-page SEO and additional helpful content on a monthly basis. 

Average site authority

The clinic had a few powerful backlinks from some UK newspaper outlets, as the skin doctor had worked with some reality TV stars. 

This provided a nice foundation for the site to springboard from, but we needed to create a backlink strategy to intelligently add to their existing authority. 

As well as securing links to their homepage, we planned to align our backlink campaign with the treatments we were optimising monthly.

Example: If we were optimising an anti-wrinkle treatment service page that month, we’d also focus our backlink campaign on that page at the same time.  

This allowed for us to better organise and structure our work, on top of providing a two-pronged attack on each service page to boost results; 

1) on-page SEO/content

2) authority boost 

Tasks We Didn’t Get Buy-in For

Honestly, my client was a joy to work with. 

He was up for everything and placed his trust and faith in us. 

While he was initially cautious as most client’s are, we were able to get a huge win early on (more on this later), at which point he was happy we knew what we were doing. 

We’d check in with him every month when we sent out our reports to ensure he was still happy with our plan of action and he’d either give us the ok, or tell us about a different service he wanted to prioritise.

Once this was done, we mostly had full autonomy. 

The only limiting factor was budget.

But we managed to increase that slightly the following year when he saw the year on year growth and our plans for building topical authority with more content to take the clinic’s SEO results to the next level.

An even higher budget would have increased our rate of content production, as well as the quantity and the power of backlinks we would have been able to acquire. 

The small budget increase allowed for us to create two pieces of blog content and 3 x links built per month Vs optimizing only the service pages and building 2 x links per month.

Basically, a higher budget = a speed boost in results.

Our SEO Process and Solutions 

We went through our usual 3-pillar auditing process to prioritise our work to deliver both quick wins and long-term growth:

  • Technical SEO
  • On-Page SEO
  • Off-Page SEO 

Depending on the size, age and condition of the site we’re working with, some will need more work on  one area than the rest.

Sometimes they’ll need a combination of all three. 

Sometimes the potential client won’t be ready for certain areas of SEO. Here are some examples: 

  • Lots of deep-rooted technical SEO issues, with a custom CMS (content management system), but no internal developer to help fix the issues
  • A tiny amount of domain authority in a competitive niche, but a budget not large enough to bridge the gap
  • A huge content gap between our potential client and their competitors but no internal content team to implement our briefs (or willingness or budget to outsource content production to an agency like ours)

It’s your job (or ours if you work with us) to audit and decide how to prioritize the following three pillars needed for your site to reach maximum potential:

  • Improved site performance: usability/UX, site structure, crawlability, site speed, among other things. (Technical SEO)
  • Better content: this means both the optimization of existing content/pages or creating new content to fill any content gaps in your topical map to make you an authority in Google’s eyes. (on-page optimisation) 
  • More authority and trust: High quality and relevant backlinks (off-page SEO)

How We Fixed the Technical SEO of the Skin Clinic

As mentioned earlier, and if you’ve followed the majority of my case studies, I like to get in, fix the important technical issues and get out. 

I set up real-time technical SEO monitoring and crack on with work that moves the needle.

On our initial audit, we found and fixed:

  • Fixed the main banner on the homepage which contained headline text built into the image. Added actual H1/H2 text, overlaid on top of (separate from) the banner to be more readable for Google bots.
  • Speed issues
  • Optimised images
  • 50+ Broken links
  • Changed permalink structure of post urls from:
    to simply:
    far better for SEO and cleaner
  • Following on from the above, redirects were created from the old urls to the new ones
  • Fixed internal links pointing to old http versions of pages on the website (pointed to secure https versions.)
  • No-indexed certain pages that were eating up crawl budget like paginated archives and thank-you pages (though, I don’t think this is THAT important for small websites that aren’t so resource hungry for Google bots, but it’s good practice)
  • Duplicate SEO titles/metas
  • 500+ missing alt tags

I had access to our in-house developers to assist with any deeper technical issues discovered which needed their wizardry and magic sauce, but there wasn’t anything too out of whack and it was a fairly small site at the time on a simple CMS (WordPress). 

Done and dusted. 

Skin Clinic Content, On-Page Audits & Optimisation

This was where the magic happened and where the quick, big wins were found. 

Our audits uncovered some gems which allowed us to easily prioritise our work to make maximum impact in the shortest period of time. 

Here’s how our process looked: 

Page Quality Audit and Keyword Mapping

We like to start the on-page process with a page quality audit, which allows us to map target keywords to existing pages. 

We do this using Screaming Frog and integrating this with client Google Analytics and Search Console data (traffic, clicks, impressions etc)

This helps us understand individual page performance and which pages to prioritize first for some easy wins and which pages will be more of a slow-burner. 

The easiest way to start is to look at what Matt Diggity coined the “3 Kings”. These are:

  • URL
  • H1 Title’s (as well as subheadings for secondary, related keywords)
  • SEO Page Title’s

Screaming Frog lets us pull all of this data down into a spreadsheet where we can start to cross-reference the pages that are doing well or poorly vs the pages our client wants to prioritise. 

When going through this process, we’re able to split our tasks effectively and identify some easy wins for maximum results from the campaign.

We found plenty of service pages which were poorly optimized, including: 

  • Thin content
  • Plagiarised content
  • Badly formatted content i.e no subheading tags (bold), big walls of text etc
  • High impressions, but low clicks (which can indicate an easy win; pages around the bottom of page 1 or a result that isn’t getting a very good CTR)
  • Pages that need more link juice (more on this below)

Once the content audit was complete, we sent our plan with the suggestions over to the client for approval. 

As soon as they were approved, we got to work on improving the service pages. 

We optimised as many of the “3 Kings” on as many service pages as possible in the first few months. 

Optimising these can make a big difference in a short period of time and is work that isn’t too time consuming. 

If you’ve done a good job, you’ll see the following improvements fairly quickly: 

  • Target keyword ranking increases 
  • More traffic, if the rank increases improve the keyword to the first page
  • CTR increases from Google (more people clicking on your Google results)

CRO (Conversion Rate Optimisation) 

This is another task that can net you some easy wins in relatively little time for not too much work. 

Is there a way you can optimize conversions from existing traffic? 

In our client’s case, there was. 

The service pages didn’t have a call to action until the very bottom of the content. 

We wanted to capture potential leads at every stage of their journey: 

  • Text CTA’s were added after the first paragraph and in the middle of the content to add to the CTA at the bottom. This was particularly important on the service pages, where visitors landing on these pages were likely to be further along in their decision-making process and don’t want to read a whole bunch of content about the service.
  • A sticky enquiry form was added to the sidebar of every service page and blog for desktop visitors. This works well for most pages, including blogs and service pages. For example, eSparkBiz saw 37% of their users filling their sidebar form. 
  • Clinician profiles were added to the side bar and on to the homepage to build trust (more on this later)

Content Optimisation

As mentioned earlier, the first year of our campaign was mostly spent improving all of the treatment and service pages. 

There was plenty of work to be done here since the content was often thin in a bid for the client to get as many pages up as possible to start running PPC campaigns to them.

This type of content doesn’t fly with Google in the easiest of niches, let alone a medical YMYL niche (Your Money, Your Life).  

With our content plan in hand, we worked down our list of agreed priority pages on a month to month basis. 

We focussed on two treatment pages per month that the client wanted to prioritize and/or the treatments we felt would produce some quick wins based on our GSC and Google first page analysis. 

For each page we used our SEO Content Checklist (which you can get for free) to make upgrades.

Our client also wanted to provide a new service from his clinic and provided us with some content which we also ran through our checklist to optimize. 

This new treatment page we created went straight to number 1 in Google. The result? 

See for yourself in the image below – almost 1500 organic visitors per month, generating over 65 organic leads at a 4.67%-4.9% form conversion rate for a treatment with an average value of £1600! Massive win. 

It was doing so well that it caught the attention of an unhappy competitor.. (more on this in the “challenges” section of this case study)

Informational Content Hubs to Build Topical Authority (Blogs)

We needed to build some topical authority to the Skin Clinic. 

In plain English, we needed to prove to Google that our website didn’t just have one treatment page about “botox”, for example, but that we were THE authority on the topic. 

How do you do this? And what’s the benefit?

You cover every conceivable piece of information and answer as many questions as you can around the main topic. 

  • “Is botox worth it?”
  • “How much does botox cost?”
  • “Does botox hurt?”

You get the picture. We needed content, and lots of it. 

The benefit is that eventually you’ll have enough content around your main topic or keyword (and in our client’s case, treatments) for Google to trust your site as an authority on the topic (hence, topical authority). 

What you should see when this happens is an exponential rise in ALL keywords around that topic, including the main service page aka your money page.

Especially if you have been strategically internally linking these content pages together and interlinking them to the main treatment page too.

Consider it pouring lots of small drops into a bathtub full of rubber ducks. 

You know that saying; a rising tide lifts all..rubber ducks? Or something like that. 

The rubber ducks are your keywords. 

Unfortunately, the original client budget didn’t cover for additional content but he saw the benefits of achieving topical authority when we laid out our plans after the first year, so we got the ok for a small budget increase to include 2 x pieces of content per month. 

It wasn’t going to help us achieve critical mass quickly, but it was a start. 

With this budget, we could target treatment pages that were doing fairly well, but needed a little push. 

  • Maybe they were at the bottom of page 1 or the top of page 2 in Google
  • Maybe they were receiving tons of impressions in Search Console but generating relatively few clicks

We targeted these informational topics first for our blog content and since our budget wasn’t huge, we needed to be even more surgical (no-pun intended..this client only performed non-surgical treatments ;)) with our topic selection to get the most bang for the client’s buck.

Enter, BOFU keywords. 

What is BOFU Content and What Are the Benefits?

BOFU stands for “bottom of the funnel” content i.e. people who are close to a buying decision and aren’t just asking investigative questions without any current buying intent.

Examples of BOFU keywords: 

  • How Much Does Botox Cost? (if they are considering costs, they’re almost ready to buy)
  • Best Type of Botox (again, they’ve shown interest, they just want to nail down the best type)
  • Best Place to Get Botox (they’re ready; they just want to know where to get it)

Many of these keywords won’t have much search volume and some might not even show up in your traditional keyword tools. 

Some tools will show them as having “zero” search volume, which leads many to dismiss them; a huge mistake.

Take a look at some of the estimated keyword search volumes for some BOFU keywords we built content for, and now look at the real amount of monthly traffic the content we built generated.

Estimated Traffic
Actual Traffic

The estimates were well off, with almost all of them underestimating the actual search volume by a significant amount. Ironically, the only one that was overestimated was the keyword with the most search volume. 

Why is this? 

Firstly, almost all keyword research tools are inaccurate and shouldn’t be used as the end all, be all, when considering which content to produce. 

Secondly, not every single person will be using that exact keyword phrase to find your page or ask a question. One person may ask: 

  • “How much does botox cost?”

The other may ask:

  • “What is the cost of botox?”

So, the actual search volume of these long-tail keyword variations are far greater together than just a single phrase in isolation. 

The best part? Long tail keywords are usually far more specific which is good news for you because: 

  • 70% of all searches made on Google are long-tail keywords
  • Searches made up of 3-5+ words get between 50-65% click through rate in the number 1 positions from Google (That’s a huge increase on the average 39.8% CTR)
  • Conversion rates for long-tail keywords are 2.5x higher!

That last stat is worth paying attention to; 2.5 x more people will wanna buy what you’re selling if they arrived on your site via long-tail keywords.

(Source: HitTail )

We focussed on these long-tail, BOFU types of content to ensure we were maximizing the small budget we were given.

We wanted to generate leads AND build topical authority at the same time.

Backlink Audits & Campaign

Backlinks and building authority were especially important for the skin clinic, since they were in a niche that can affect people’s money or their life (health); this is what Google refers to as “YMYL”.

The client had an average starting domain authority of around 25. Not terrible, but also a fair bit below some competitors who were in the 40-60 ranges. 

Backlinks formed a small portion of the work we did to move the needle, mainly due to budget constraints.

Here’s what we did:

Backlink Audit

To start with, we needed a plan of action instead of building links randomly. 

We added a column to the on-page audit spreadsheet we mentioned in the previous section to show how many backlinks each url had on the site. 

From there we could do two things: 

  • See how many links our individual pages had vs the top 10 results in Google (and build links accordingly)
  • Prioritize which keywords or services were drawing in the most impressions for the clinic, while not ranking in the top 3 positions. 
  • Perform an anchor text audit for each page to create a strategy that made sure we were building links with enough anchor text diversity (spamming the same anchor text for every link you build, will get you slapped by Google..Unless you’re watching this from the year 2011. Psst, a big-ass penguin is about to steamroll your site)

penguin algorithm update 2012

Something we noticed straight off the bat was that the majority of the links were pointing to the homepage of the site.

This is to be expected, generally, but more so when a PR campaign has been run previously. 

The homepage had some powerful publications pointing to the homepage, which provided us with a great foundation of authority.

This is cool and that link juice can filter nicely through the entire site if it has been structured in an easy-to-navigate way – where most important pages are a maximum of 3-4 clicks away from the homepage – but securing links to individual pages can juice them up even further and bring higher rankings. 

We used SEM Rush to perform this task, but you can use whatever tool you want, whether that’s Ahrefs, Majestic or another tool that tracks links (none of them will give you a full database of links pointing to your site, but they’ll give you a good idea.)

From there, we had a clear backlinking strategy and we could get to work on building up the site’s authority to close the gap on our competitors on the first page of Google.

Here’s what we did: 

  • Made a list of niche-relevant sites (beauty/cosmetic enhancements/health) and general-themed high authority sites (“news”, for example)
  • Outreach campaign to contact site owners to see if they allowed guest posts or link insertions into their existing content
  • If there was a cost (and there almost always is; see image below), we started negotiation or offered a value swap (content/infographics/keyword research/something they needed)
  • We added niche-edits into the mix (these links are great for clients on a budget who want more links, but have their pros and cons

This process worked very well and pushed many keywords that were ranking toward the bottom of page 1 or page 2 in Google, on to the first page and even the top 3 positions.

How many links did we land and what type for this SEO campaign?

We landed 71 links in a little over 36 months of working with this client. 

The links were a mixture of: 

  • Guest posts 
  • Link inserts
  • Niche edits

Their authority ranges were between DR/DA 20-70+ with varying levels of traffic but we always try to land links on domains with a minimum of 500 organic visitors (according to SEMRUSH/Ahrefs). 

The biggest thing holding back the number of links we were able to secure in this campaign was the client budget, which was less than 4-figures a month; sorry future clients, you missed the boat to hire me at that rate!

But, overall. We still landed over 70, decent links for the money that were niche-relevant and/or powerful general niche sites.

The site went from a DA of the early 20’s into the early 30’s, but more importantly, contributed to moving the needle for the ranking increases, traffic and leads we were able to generate.


Top 10 Keyword Ranking Progress

The skin clinic started with just 8 keywords in the top 10 of Google in April 2018 when we started on this campaign. 

We ended the campaign around the end of April 2022 with 206 keywords in the Top 10. 

51 of those keywords were in the Top 3. 

That may not seem like much over 4 years, but from start to finish, that’s a 2475% increase on top 10 keywords from where we started in a competitive YMYL niche, with a 3-figure monthly budget!

KEYWORDSBEFORE – March 2020AFTER – July 2021
TOP 4-106155
TOP 3251
TOTAL8206 (+2475%)

Dream Keyword Ranked Top 10 

We even managed to take their dream keyword “Skin Clinic”, which had a search volume of 12,000 monthly and wasn’t ranking in the top 100 when we started, and managed to rank it top 6, nationally, with our small budget which was a huge win.

Organic Traffic and Leads

We ended the campaign with a 718% increase in organic traffic vs the previous period. It became the number one traffic source

Unfortunately, I’m missing around 10 months of data (explained later) which actually works against me as the first year was where we created the new service page that shot into the #1 spot, so the traffic and leads figures would have been far greater than they show here.

We generated 1,558 leads through organic traffic in the data period I have access to, (just over 36 months) and this translated to a 213% increase. 

This will have been much higher if I had access to the first 10 months of data but either way, they are great figures for a one-Doctor clinic (with a couple of employees) and his calendar was always full.

Why the SEO Campaign Ended

The SEO campaign for the client simply ended because I left the agency I was working for to start my own. 

The client was happy with progress and results which shows in the fact that they stuck with our campaign for 4 years! 

It’s something I’m particularly proud of since 65% of companies switch SEO service providers at least once in 12 months. (source) 

But as ever, with all of my case studies, as proud as I am of the results, SEO campaigns can always be improved, however great the results were.

Here’s how this one could have been improved…


Challenge 1 – Plagiarism

Remember, when I mentioned earlier about that angry competitor because we’d hit the number 1 spot in Google for a treatment page we optimized?

Turns out there was a good reason for the competitor’s wrath. Unknown to us, my client had lifted most of the copy for this new treatment page from this competitor’s website and sent it over to us to upload. 

We had made the tweaks and optimizations to the content we needed to and uploaded it. Our work had the piece of content shoot straight into the number 1 position. 

And the competitor was threatening legal action…


My client asked us to totally rewrite the content (he wasn’t mad at us, so I’m pretty sure he understood what he’d done).

In a way, we got lucky here. Plagiarism is not ok and this taught us the valuable lesson to run every piece of content received from our clients through a plagiarism checker. We already check for this when receiving content from our writers.

Another solution is to simply ask where they got the content from. Many old-school business owners don’t understand the implications and think that information is usable online. Spoiler alert; it’s not cool.

Despite our rewrite, we didn’t lose our number 1 spot, and this was likely because the page was still satisfying user behavior for Google’s visitors. The page was clearly effective since so many visitors were converting into leads. Win.

We turned a potential disaster into a flood of monthly organic leads for our client with an average treatment value of £1600. A massive win early on in the campaign. 

Challenge 2 – Low Budget and No Resources For Blog Content

The client, already on a low budget, couldn’t stretch it to include a blog content execution plan like we suggested in the first year. There were also no internal resources, like writers, to help produce more content.

As mentioned earlier, in the second year, the client did agree to a small increase which helped us to produce two pieces of blog content per month. 

This wasn’t ideal, but we still produced some pretty steady increases as you saw earlier. 

Results could have been anywhere from 3-10x’d with a higher budget. 


While we were able to increase budget slightly the following year, the client was a legacy client who was signed up just before I arrived at the agency. 

There wasn’t really a fix beyond this, and sometimes there just isn’t a valid solution to a problem. 

Sometimes, you need to make a difficult decision. If a client isn’t understanding towards rising costs and their fee is less than the work and time you’re putting in, and most importantly, the results you’re producing, it may be worth referring them to another service provider who you trust. 

Our client was a joy to work with and we had a fantastic working relationship. He cooperated with us quickly for anything we needed, and we then had trust and autonomy to work because we produced results, so we didn’t take this route. 

The best solution is to figure out your costs ahead of time to avoid this from becoming an issue. Be honest with yourself and your client – don’t underprice your services because that’s not sustainable.

A compromise we sometimes reach if a client has the internal staff resources, but not the extra budget is  that we would set up content briefs in Surfer SEO for them based on the keyword research we did, and our content calendar.

Then their in-house team can create the blogs based on our content briefs. 

This is actually the preferred route to take if your client is in a particularly technical niche.

Challenge 3 – Agency Deleting 6 Months of My Work During a Web Redesign


Web developers, clients and agencies in general; don’t make any changes to a website without consulting your SEO. 

Don’t make any changes to a website without consulting your SEO. 


If you want to make an enemy out of your SEO, then the easiest way is to affect the hard work they’ve been putting in for months or years, without telling them. 

Even worse when it’s the agency you work for who should know better. The betrayal…

This happened to me around 6 months into the campaign, when the agency I worked at decided to do a website redesign without telling me. 

Somehow, they deleted everything I’d done from the start of the SEO campaign and the only backup they had were some SQL files which took me over a week to restore because they were simply in plain text. 


If you are making any changes to your website, even if you think it won’t affect SEO, give them a quick message to double check. 

It benefits everyone to make sure anybody working to grow a website is kept in the loop. 

I had already set up a process in the agency to ensure this didn’t happen, but it wasn’t followed.

I rewrote the process and sent a “friendly” email to remind everyone of the implications this can have.

Challenge 4 – The Medic Update Hit Our Site

At around the one year mark, Google did what Google does best. Changed the game. 

You may have heard of the “Medic” update.

If you haven’t, it was a core algorithm update in late 2018 that affected the medical niche and other YMYL sites.

Now, we actually cruised through this first update but Google revisited the update in March 2019 (though it wasn’t officially a “medic” update, it clearly affected health sites) and this time, we weren’t so lucky.

medic update health sites

Our client’s site went from 68 keywords in the top 10, down to 18. That’s over an 80% loss in visibility and back to where we started the SEO campaign.


Of course, that’s highly embarrassing for us and made for a difficult conversation with the client. 

We outlined our plans to reverse this trend, based on the data we’d seen so far about the algorithm update. Our client liked our plan and gave us the go ahead. 

Luckily, our client saw what we’d achieved up to that point, so we had trust and credit in the bank to put it right. 

Here’s what we did: 

  • Made their website much more trustworthy. We built surgeon/practitioner profiles, bios and linked out to their qualifications, governing body websites and accreditations. We put our client, the skin Doctor, at the front and center of the homepage. 
  • Continued building high authority links and guest posts to strengthen the site authority

Within around 6-12 months, we got a boost back to where we were and progressed rapidly from there.

The lesson to learn here is to do all of these things BEFORE you’re affected by an update. 


We could have done more for local SEO. After all, the clinic was a physical location in London and local SEO tends to be easier than national. 

We went after national SEO terms because the clinic had the ability to perform consultations from a few sites across the U.K. before sending the client down to London for treatment if they wanted to proceed. 

In this particular case, local SEO was more difficult than most niches, since the location is one of the most popular in the world for this particular niche. 

We were also getting fantastic traction with national SEO and generating valid leads, so doubled-down on this to great effect. 

The Fix

With a budget increase, we could have allocated more resource to local SEO, but for other, less competitive niches who only serve particular areas, local SEO could be your best bet. 

I’ll write another post going into local SEO in more detail. 

Caveats and Missing Data

As always, I like to be honest and want to present some caveats and make you aware of some missing data sets in this case study. 

This campaign actually started in around April of 2018, but since I don’t work at the agency anymore, I only have the data that’s available on my home computer which is a little over 36 months and starts from 2019 (and I don’t fancy breaking into my old agency’s office!) 

This actually worked against me in this case study, since we had some major traction in the first year with that new service page I created for the client which shot to number 1.

My traffic and lead numbers would have looked far better if I had this data, but I only wanted to report on data I had.

How is the website doing now?

Obviously, I couldn’t tell you the exact traffic or lead numbers today, but the site seems to be chugging along nicely if we look at some third party graphs.

It continued to do well months after I left, but has now experienced a slight dip.

My theory is that it has been halted by an iteration of the “helpful content” update or simply isn’t ranking further because content quality has clearly dipped since I left.


top traffic generating pages today
My content still brings in the most traffic to the site today

All of the top performing pages in the image above are still ones I created between 2020 and early 2022, and when I look at the new content on the website, it’s easy to see why..

  • No internal links to other relevant blogs or service pages
  • No external links to scientific studies or authority sites to back up points made
  • No call to action on pages
  • No custom images, just a generic stock image
  • Blogs seem thin in comparison
  • New design that isn’t very readable (line breaks really close together, walls of text)

Content seems to have just been copy and pasted to the website with little care.

You can see my BOFU content is still doing very well and every green arrow points to a piece of content or service page I created or optimised.

Summary & Your SEO Plan

So, that’s how we took a client in a difficult and competitive niche and put their skin clinic on the map with an SEO campaign with a low budget.

I’ve outlined the steps which you can replicate or, if it seems like too much work and too expensive to do in-house, jump on a call and let’s see if we can grow your website for you (if we’re a good fit).


Similar Posts

Leave a Reply

Your email address will not be published.