Every med spa owner eventually sits through the same agency pitch: a portfolio of pretty feeds, a case study with a big percentage, a retainer between $2,000 and $8,000 a month. Some of those agencies are good. The uncomfortable truth is that whether the engagement works is mostly decided by something outside the agency: whether anyone on your side of the table owns the number they are supposed to move.
The question that sorts every agency in one minute
Ask: “What outcome do you own, and what does the report I get monthly look like?” If the answer is reach, impressions, content delivered, or “brand growth,” you are buying activity. If the answer connects their work to booked appointments and cost per new client, and they can show you a real client report in that format, keep talking. Most cannot, not because they are dishonest, but because nobody ever made them report that way. Which brings up the real issue.
The layer above the agency
An agency, even a good one, executes. Someone still has to decide the positioning, set the offer architecture, connect the channels into one system, and hold every vendor to a revenue number. In most med spas that someone is the owner, at 11pm, between everything else. That layer is the difference between marketing that compounds and marketing that churns, and it is exactly the seat a fractional CMO fills: often keeping your existing agency and simply making it accountable. The honest comparison is in what a fractional CMO costs next to what an unaccountable retainer quietly burns.
Red flags, briefly
- Guarantees of rankings, followers or bookings. Nobody honest guarantees outcomes they don’t control end to end.
- Reports you cannot read without a translator. Confusion is a business model.
- The same deck for a med spa in Boca as for a roofer in Ohio.
- No questions about your margins, capacity, retention or team. If they don’t ask, the strategy is a template.
- Twelve-month lock-ins before any result exists.
The order that protects your money
Decide who owns the number first. Then scope the execution to a strategy, whether that execution is an agency, freelancers, or a mix. Run it in that order and even a mid agency performs; run it backwards and even a good one disappoints. If you are choosing between proposals right now and want a senior second opinion before you sign anything, a 15-minute conversation is where it starts. Bring the proposals.
