Strong reviews did not put these MedSpas in the top three.
We examined a deliberately selected gap cohort of 24 established MedSpas across 12 US metros. Every clinic had strong public review signals. Every clinic appeared between positions 5 and 10 for the local treatment query captured in its dated snapshot.
This is not a prevalence estimate and it is not a random industry sample. We intentionally selected visible gaps to study what a prospective patient sees.
How the cohort was built.
Twelve named US metros
Atlanta, Austin, Charlotte, Dallas, Denver, Houston, Las Vegas, Miami, Nashville, Orlando, Scottsdale, and Tampa. The final cohort contains two clinics per metro.
Established local practices
Each selected listing pointed to an owned clinic website, had a public phone number, held at least a 4.0 rating with at least 10 reviews, and matched a medical aesthetics query. Large national chains were excluded.
Not a random sample
We selected clinics outside the top three because the research question was specific: can an established, highly rated MedSpa still be easy to miss in a local result set? This design cannot estimate how common that gap is.
Dated public snapshots
Position, rating, review count, address, phone, and listing identifiers were captured from the observed Google Places result. Public clinic pages were checked separately. Internal evidence records retain the observation time and source hash.
Observed ranges in the selected cohort.
Position is the clinic's place in the captured local result list for its query. Ratings and review counts are the public values visible in the same dated snapshot.
| Metro | Positions | Rating range | Review range |
|---|---|---|---|
| Atlanta, GA | 9-10 | 4.9-5.0 | 170-183 |
| Austin, TX | 7-10 | 4.8-5.0 | 146-163 |
| Charlotte, NC | 6-8 | 4.9-5.0 | 168-330 |
| Dallas, TX | 8-10 | 4.8-4.9 | 109-509 |
| Denver, CO | 5-8 | 4.9-5.0 | 164-276 |
| Houston, TX | 8-9 | 4.9-4.9 | 122-178 |
| Las Vegas, NV | 9-9 | 4.9-5.0 | 45-197 |
| Miami, FL | 9-10 | 5.0-5.0 | 63-90 |
| Nashville, TN | 5-8 | 5.0-5.0 | 71-73 |
| Orlando, FL | 8-10 | 4.9-5.0 | 65-199 |
| Scottsdale, AZ | 7-9 | 5.0-5.0 | 574-576 |
| Tampa, FL | 7-9 | 5.0-5.0 | 358-440 |
Clinic identities are withheld because this is a research and audit cohort, not a public scorecard. Position can change by location, query wording, device, personalization, and time.
Ratings are not the whole visibility system.
Within this selected cohort, a high rating and a substantial review count coexisted with positions outside the top three. A useful audit should therefore inspect discovery, page clarity, and inquiry handling separately.
No causal or industry-wide claim.
The cohort cannot tell us how many US MedSpas miss the map pack, why a particular clinic held its observed position, or what a ranking change would do to revenue. Those require a different study design and longitudinal data.
This field study is listed separately from paid-client results in the VitalSignal evidence ledger.
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