Surviving the Zero-Click Era: How Aesthetic Practices Win Patients When AI Answers Before the Click

Adeesha: For the last decade, aesthetic marketing was simple. Rank high on Google, get the click, book the patient. But in 2026, AI is answering patient questions directly on the search page. The click is disappearing. So how do you acquire patients when the old playbook is officially dead?

Adeesha: Welcome back to the Business of Aesthetics podcast. I’m your host, Don Adeesha. It’s great to have you here. To help us navigate the most significant digital shift in the history of local businesses, we are joined by our very own co-founder, co-host, Naren Arulrajah. Naren is the CEO of Ekwa Marketing, leading a team of over 250 professionals who manage the digital architecture for hundreds of top-tier healthcare practices. While most agencies are panicking over AI and zero-click search, Naren and his team have been engineering the exact strategies required to protect their clients’ market share and keep patient pipelines full.

Naren: Thank you so much, Don. I really appreciate the opportunity. I think it’s a really important topic, zero-click search and AI search. So I’m really looking forward to having this conversation with you.

Adeesha: Absolutely. So Naren, many practices still rely on an outdated SEO approach. If Google starts answering patient questions before they ever even click, what’s the financial risk that creates for the practice?

Naren: That’s a great, great, great question. And I think before we jump into that, I want to talk about how to think about your marketing, right? And how to think about your options. So what is marketing? Marketing is about helping your ideal patient find you. If they don’t find you, of course, as far as they’re concerned, they can’t even do business with you. So that’s step number one. Second is helping them like you. We don’t do business with people we don’t like. So how do we build that liking? But in the old days, it was happening face to face. Now that liking happens online before they even ever call your office. And then just because they like you, they still don’t want to take a risk because it is important to them. Either they’re spending thousands of dollars on a makeover before a wedding for their daughter or they’re doing something to help them with their job. So this is really important to them. So trust is also important. So the last piece of the funnel is they’re going to Google you around. They’re going to figure out what other people say about you, how many reviews you have. Is it 4.5 stars? Is it 4.2 stars? Of course, the more reviews, the better. I would recommend a minimum 200. So that’s what marketing is.

Naren: Now, you have options. You could become a celebrity using social media, and you could attract people that way. Now, what I mean by that is you post a ton of content, you become a content guru, and you just keep doing it day in and day out, and you put yourself out there, put your life out there. I call them influencers. Now, of all my 500 clients, 1% of you are influencers, meaning you love it, you enjoy it, you put literally one to two pieces of content every day, usually in the form of video. But if you’re not in that one to two percent, really social media, becoming an influencer is not really a good way for you to grow your business because that’s not you. Right. We all need to understand ourselves, self-awareness. So the other options are ads. Right. Google ads typically is five to ten times more expensive than a CEO. Social media ads are even more expensive than Google ads. So you can use ads, but you’re going to look at a five to 10 times the budget. And the reason ads are expensive is twofold. One is these companies have to make more money and the population of the world is not growing. In the Western world, it’s shrinking. As we all know, people are having fewer kids and so forth. So how do they make more money? They charge you more. They charge you more per click every week, every month, every year. Prices keep going up. The second challenge is people know it’s an ad, right? Legally, they have to mark an ad as an ad. They have to call it an ad. And the minute they see it’s an ad, their subconscious mind does something. It’s like, oh, they’re not good. That’s why they’re running ads. So the bar becomes higher. The number of no-shows goes up. So ads are really good if you have, if you’re willing to tolerate a lot of no-shows, if you’re willing to spend five to 10 times as much money.

Naren: So all of that leaves you with what I call organic Google-driven marketing. Just to put things in perspective, outside of NVIDIA, Google is the most valuable company in the world today. It’s worth $4 trillion, and they dominate everything. And they were late to the AI party, but in 2025, they cemented their position as the best. I mean, their models are their best. The usage is like astronomical on the consumer side. Google, you know, is like 17 billion people use Google search and Google Maps every day versus for chat GPT. It’s, you know, 800 million a week. So literally like 17 billion a day versus 800 million a week. So which is bigger, right? Obviously Google is so much bigger, like it’s 90, 95% of the market. So Google is a great option.

Naren: And you asked me a question about zero-click search. What is it? So let me start by defining what is zero-click search. Zero-click search is where people don’t have to go leave Google to get the answer they want. They can get the answers right off of Google. So for example, I type in your practice name, Google shows your location, right? Google shows your phone number. I don’t need to go to your website to get your phone number. I don’t need to go to your website to get your location. Google shows me your reviews. You have 4.7 stars, 472 reviews. So I don’t need to go anywhere else. I can write there itself, see what I’m looking for. So Google tries to understand what you want and then gives you the answer directly. If it thinks you’re trying to find the location, it’ll show you the address. If it thinks you’re trying to find out how good the practice is, it’ll show you how many reviews you have. So that’s the idea of zero click search.

Naren: Now, the good news about Google and which is, I think, one of the reasons Google has become so powerful over the last 25 years is they’re very consistent. They don’t just cause problems for the sake of causing problems. Straightforward people, they tell you what they’re going to do when they do it. As long as you follow what they’re telling you, you are okay. But following what they’re telling you takes hard work, takes consistency, takes dedication, takes experts. So where a lot of companies go wrong is they don’t have that machine built in like we have 250 people and we are able to like dedicate nine teams just working on all the pieces of Google so that way everything Google cares about we just take care of it. So if you do what Google is telling you, Google is your best friend literally. Remember, nobody goes to Google to see the ads, right? They go to Google to see what the organic result is. So, if you can become one of the 3%, 5% of the businesses in your area that dominates that. Remember, Google also needs to make a lot of money from ads. So, they don’t give free traffic to anyone other than the top 2% to 3%. So, if you’re in that top 2% to 3%, you have an unfair advantage. Your cost of acquiring your new customer is pennies versus dollars for your competition who’s relying on ads. So it’s a significantly huge advantage, but it’s really, really hard.

Naren: So zero click search is about how do you show up again and again in anything and everything to do with your type of services, your business, etc. So there is you who’s in the top 3%, who’s like winning everything versus everybody else who shows up once but never show up again. Think about zero click search. I gave you an example of Google Maps, right? Where if Google thinks you’re looking for directions, they’ll give you the address and help you with driving directions and so forth. Same way Google has realized a lot of people want Google to do the work for them. That’s where AI comes in. So for example, if I type in the cost of Botox, or cost of XYZ in a particular city name, what Google is realizing is people want Google to go and do the research and give them like a paragraph answer versus giving them five links to click on and for them to figure it out. So Google will go through those five links, the top links, and then they will summarize it. Okay, in your area, here are the different types of things people are using Botox for and here is the cost structure and number of treatments and so forth. So it’ll give you like a very thoughtful essay kind of an answer. That’s what’s called AI overview in the Google world. Right. So Google really tries to understand the user’s needs and give a very thoughtful answer right on screen.

Adeesha: Right. Now, Naren, you work with hundreds on hundreds of practices, so you can see what is working right now. What shift are you making to help your clients keep attracting those high value patients as search keeps on changing?

Naren: Yeah, so I think our entire business, which is now started in 2017, so 19 years old, we still have our very first client we signed up, you know, in 2017 Dr. Mary Lupo with us as our client even today. What we have noticed is the idea of Google helping people make decisions hasn’t gone away. Just Google has gotten so much better today than 19 years ago in helping people make decisions, whether it’s finding a restaurant, whether it’s helping their child with homework, or whether it’s, you know, finding a dermatologist or a med spa, you know, for whatever they’re looking for. So that hasn’t changed. Just that Google has become so much more powerful today, was 19 years ago. So it’s embedded in everything, Google Maps, mobile devices, Chrome UX, iPhones, Android, like everywhere you go, Google just dominates. They could dominate 90% of the market. So back then, we said, even 19 years ago, we want our clients to rank for 100 or more keywords before the end of 12 months. In other words, after working with us, we realized the haves and the have nots. I mean, we talk about the 1% and the 99%, right? The 1% are 100 times better off or 10 times better off than the 99%, just the way the world works. Same thing, if you are in that top 3% to 5% and dominate Google, and you’re going to get all the free traffic. So you’re going to have like a 20, 30 times advantage compared to everyone else who is not in that top three to 5%, who are relying on ads and who are spending literally five, 10 times more money to get the same outcomes. So in the old days, we said 100 keywords. We still say that. But now what we are noticing is because we have leaned into AI search as well, many of our clients are ranking for 200 keywords, 300 keywords. Now, of course, we still keep the original promise of 100 keywords. But when our clients rank for 300, 400 keywords at the top of Google search, page one of Google, which is top 10 results, we don’t complain. That’s awesome, right? Our clients love us even more. Even 19 years ago, we enjoyed 90% of our clients staying with us. Today, that number is around 95%.

Naren: So the more you add value to clients and the more you help them get this unfair advantage and dominate Google and get a lot of new patients, that works for everyone. So definitely focus on ranking for 100 or more keywords on page one, meaning top 10 results. If your marketing is not doing that, something is wrong. You’re not in the top 3% to 5% of Google search and therefore you are going to be in the other bucket having to spend a lot more money. Second is, you know, search is expanded. So regular search, Google Maps and AI search, it’s all one and the same. So when it comes to Google, you have to pay attention to all of them. You can’t say, well, I’m only doing maps. So I’m only doing regular search. Oh, I’m only doing AI search. You have to do all of them. In the Google world, there are two phrases you will come across. One is called AI overview, which is the example I gave you. You know, it summarizes things for you and it’ll give you like a paragraph answer, like an essay answer. And the second one is AI mode. AI mode is like where you want Google to go even deeper. You just click, double click on that paragraph answer and it’ll go even deeper, spend a few more seconds and give you even more thorough answer. So that’s called AI mode. Now, AI mode is a user click, meaning the user has to choose Google to spend that extra few seconds to give you that much more detailed answer. It doesn’t automatically offer that to you, but you can continue to engage with AI mode and go back and forth.

Naren: The other thing I want to also mention is you want to not ignore other AI search engines. What are they? ChatGPT. So of course, you want to make sure A, ChatGPT is giving the correct information about your business. One of the things we noticed is many of these other search engines don’t have the millions of servers that Google has. So a lot of times the information is wrong. So you have to manually check to make sure that when people are looking you up on ChatGPT, even when they type your business name, is it giving the correct information? Same thing for perplexity, another search, you know, AI only search. Gemini, again, Google’s AI-only product that’s competing with chat GPT. So you want to make sure A, all the information is correct. So that’s something we check for our clients on a regular basis. Second, you want to track which keywords are ranking on these platforms. Even though those platforms combined is less than 3% of overall search volume, like that’s so tiny, you never know, right? The world is very unpredictable. Google didn’t even exist 30 years ago.

Adeesha: Absolutely. So the shift really there is not a complete change in how you do show up on search, but rather an evolution and doubling down on the foundations. So Naren, how do I, as a practice owner, really dominate in this AI and zero-click search world?

Naren: Great, great question. So one thing that happened right after AI became popular is people started using AI to write, right? And the problem is AI is putting words together. It doesn’t know if the words are correct or wrong, right? I mean, you’ve heard the phrase hallucination. You may have read stories about how, you know, this is not just one, but multiple cases where the parents are suing OpenAI, ChatGPT, because their kids committed suicide because this stupid ChatGPT kept talking to them. And of course, because it doesn’t know the implications of what it’s doing. It doesn’t know what it’s doing is helpful or hurtful to that human being. So in healthcare, you can’t take that chance, right? Because if Google sends you to a page that has incorrect information and somebody acts on it, there’s going to be headline news. I mean, Google is so big. It’s the outside of NVIDIA, the most valuable company in the world. So they’re under the microscope globally. So they can’t take those kinds of chances. So I think so Google really came down hard on AI content, especially in healthcare. So if you use AI to write content, don’t even go there. You will get blacklisted. You won’t rank. Now, you can use AI for so many other things, summarizing your emails, replying to your clients, all kinds of things. Just don’t use it for content when it comes to websites. It just will backfire on your face.

Naren: So the second thing, second thing that, you know, you need to really pay attention to outside of human written content is EEAT. Again, the same reason why human written content became important, especially in healthcare. Something goes wrong. Google needs to be able to say, oh, this information came from this particular doctor who went to this university who has this kind of certification and therefore he’s qualified to talk about it. So you highlighting that information the way Google wants is very powerful. So continue to highlight your experience, your expertise, your authority, why you are trustworthy in the form of a bio. Again, I don’t want to get technical in this, but make sure every page has that bio written the right way and include it in because that will help you rank because Google is like, I have this content, could be AI written or whoever, who knows who wrote it versus here is a page tied to a particular provider who has the necessary qualifications to chime in on that particular topic. So they’re going to rank that higher. So human first content, EAT, those become important.

Naren: The other thing that you really have to pay attention to is Google is a mission-driven company. They want to really help people find the best answers as quickly as possible. So they want people who are focused on that. So Google used to do what’s called a lighthouse score, which is like a score they gave on a page-by-page basis. They replaced that focus from lighthouse score to what’s called CRUX. So CRUX, think of it like version two. So it still has the lighthouse score components, but it’s much more advanced. Now they’re looking at the entire website and saying, okay, is this website used to the reader? Does it have the right information? Is it formatted properly? Is it loading on every device properly? So they’re looking at the entire website and saying, if you have a good website, and also it’s kind of, if I were to be honest, Google wants to not give you free traffic. So they make it harder and harder for you to get free traffic. Why? Because then you will buy ads from them, right? That’s how they make money. They don’t make any money from free traffic. So they still need the SEO, like I mentioned before, because regular free search, because otherwise nobody will use Google, but they make the pool smaller.

Adeesha: Check. And now, Naren, when AI tools summarize what patients see, reviews and reputation may matter even more. So how should a practice manage its reputation so that it stands out over nearby competitors?

Naren: Great question. I’m going to give you two answers. One is continue getting, I already kind of alluded to you, these what I call paragraph love letter reviews. So these are reviews where somebody would write two, three, four sentences, and we have a whole methodology around it. Don’t use automated tools because they are very impersonal and they go when the patient is at home versus talk to them. Like when they’re happy, that’s the time to give you a QR code and ask them to write that review right then and there, and encourage them to share what they told you verbally in that review. Because you can say something like, hey, we love taking care of you for these reasons. You’re so kind and so we look forward to it. You really appreciate us and we appreciate you. So you appreciate them. And then they’ll say, oh, I love you guys too. You guys treat me like family. You have awesome technology. Jenny is like the best. So they start ranting about why they love you. Now you say something like, thank you so much for sharing this. This made my day. Can I ask you for a tiny favor? They’re like, of course, they’re in a happy place. They just told you how wonderful they feel and how appreciative they are. Can you take two minutes or three minutes to write what you just told me in the form of a review? Here is our Google My Business page. You give them the QR code so they can directly go there. And the reason is we want to help people just like you. So when you talk about the reasons why you love us, that will help others just like you also discover us.

Naren: So give them a reason, give them a purpose. Like, I mean, one of the things that Cialdini talks about is when you give people a purpose, they’re much more likely to, you know, do well. Like, for example, I used to work, this is 30 years ago when I was at Illinois Institute of Technology, IIT. I used to work at the Alumni Association phone bank. So we would call the old alumni and ask them for money. And of course, when we asked about specific projects, like, OK, let’s say there’s a person we are calling from the aeronautical school. And the aeronautical school is trying to raise $3 million to buy this wind tunnel. I’m just making this up. I remember that that was happening at that time. People in Aeronautical are like, oh, yeah, I want to support this. I love the wind tunnel that I had when I was working there, and so I want to help. So, hey, let me give you a, so give them a reason, give them a purpose that’s tied into something that they already believe in. Here, they just gave you how wonderful you are. So, try to get those reviews, those paragraph reviews, build that methodology, talk about those reviews in your morning huddle. So, everyone in your team gets behind it, even celebrate it, whether it’s everybody goes out as a team for lunch, if you get that 10 love letter reviews. Now, 10 is just a starting point. If your practice is bigger, of course, you have to like, maybe once you add a 10, go to 15 and so forth. So don’t push them too hard when it breaks. Just pick the right goal and celebrate those successes.

Naren: So I think that’s one key thing, like getting those paragraph love letter reviews and making it part of your culture. The second piece I would advise is remember, I talked about EAT is becoming more important. So if you’re getting extra qualification or certification, and it’s tied to a university that Google knows, like Stanford or any university, it’s going to mean a lot more than Joe Smith taught me this. Who is Joe Smith? How can Google trust Joe Smith to be the expert? Other than the fact that Joe Smith called himself the expert. So getting certifications that are linked to universities, linked to these name brand institutions, I think is also powerful. So if I were to give you an advice, spend money on those kinds of things. And then, of course, tell your marketing people to leverage those qualifications and those information correctly in your EEAT bio.

Naren: Those are the two tips I would give when it comes to what can you do to really help your practice. Like everything else I talked about, EEAT, lighthouse co and when CRUX, you need some technical people who know what they’re doing. Of course, you can have them show you reports and show you like, okay, yeah, according to Google, I’m doing well, I’m not doing well. And so there are lots of tools that Google provides. Also, the best answer is, you know, how many keywords are you ranking for? Are you ranking for 100 or more keywords, top 10 results of Google? And that’s a black and white answer. Again, you can use Google Analytics and you can pull that data directly from Google Analytics. And we, for example, provide that data. Any given time, our clients know exactly which keywords are ranking at what position and how many. So that way they have a comprehensive list of like hundreds of keywords. So like if your team, if your marketing company says trust me, we are doing a good job, don’t take their word for it. Ask for proof.

Adeesha: Now, Naren, for the owner who feels that their marketing is out of date, what are the first steps that they should be taking?

Naren: I think going back to where we started this podcast, which is AI search and zero-click search is real. People are getting all their information on Google more and more and more. It is what it is. So find the right partner who is getting you to rank for hundreds of keywords, like minimum 100. If you’re not ranking for 100 or more keywords at the moment, in the top 10 results, and your marketing company can’t show that to you directly from Google Analytics, you have the wrong marketing firm. I’m not saying they don’t have any strengths. They probably are leaning into Google Ads, and that means your marketing budget is a lot, lot more than what it could be with SEO-driven campaigns. So I do think if you are retiring in one or two years, then don’t bother. Who cares? But if you are going to stay here for the next few years or five or 10 years, then you don’t want to spend five to 10 times as much money when you don’t need to.

Naren: This doesn’t work for everyone. It only works for the top 3% to 5%. So, of course, try to get into the 3% to 5%. Find a partner who can get you into that 3% to 5%. We offer what we call a marketing strategy review, and it’s our gift to you. We spend six hours worth of research, and we give you comprehensive data on how well you are doing, what keywords are ranking, what keywords are not ranking. How are your top competitors doing? You know, are they better than you, worse than you? What are they doing right? What are they doing wrong? What are you doing right? What are you doing wrong? So we look at the technical pieces of why things are the way they are, right? There’s always a reason. Somebody is, you know, having a heart attack. It just doesn’t show up. There’s some reason, whether it’s genetic or whether it’s their diet or something that created it, right? So get to the root cause because once you start understanding the root cause, okay, you’ve had that scary heart attack, but at least you can stop it from happening a second time or a third time or a fourth time. So I think what we, what this marketing strategy meeting is going to give you is a report card on where you are and every key component and also a plan. The link is www.businessofaesthetics.org/msm.

Naren: I gave you a lecture on health, so to speak. And of course, there’s AI search and zero-click search health. Now, every situation is different. So by having that personalized meeting, you really find out what’s going on with you. What are your strengths? What are your weaknesses? What do you need to lean into more? What do you need to fix? What do you need to just not touch and just let it go? Let it be because it’s working for you. So I think it’s a good use of your time. I always believed my father always told me, like, you know, what doesn’t kill you makes you stronger. Even if you’re getting bad news, the fact that you know about it and the fact that now you know what to do about it makes you stronger. So just don’t be afraid. I know a lot of people, they just close their eyes hoping that, you know, the longer they keep their eyes closed and things are going to be okay. But unfortunately, the world is getting more and more competitive and harder and harder. We all know this. You know, everybody’s cost of living is going up and all kinds of things are happening. So you have to start moving into that top 3-5% if you want to do well in this world. Same thing happened in 2008. There was a recession, and then the strong got stronger, and the weak got left behind. Thousands of practices were shuttered in 2008. It’s just the way the world works. So you have a choice to make. If you want to be in the strong camp, find out what the strong are doing, and then do more of it versus waste your time doing the things that the weak people are doing.

Adeesha: Thank you very much, Naren, for that critical look at the future of patient acquisition. Now, to connect with Naren’s team and take advantage of the complimentary one-on-one digital strategy session he just outlined, simply head on over to www.businessofaesthetics.org/msm to book your time. That’s www.businessofaesthetics.org/msm. I’m Don Adeesha and this has been the Business of Aesthetics podcast. Thanks for listening. Keep on leading.