Start with the split, because everything else follows from it. Medical dermatology demand arrives through insurance and referral: annual skin checks, a mole someone noticed, persistent acne, eczema, psoriasis. It is largely inelastic, often booked weeks out, and the searcher's real question is whether you take their plan and how soon they can be seen. Cosmetic demand behaves nothing like that. It is discretionary, price-aware, comparison-heavy, and it moves with events and seasons rather than with symptoms.
The competitive picture differs by half as well. On the medical side you are compared with hospital-affiliated groups and other board-certified practices, and credentials genuinely matter to the searcher. On the cosmetic side you are competing with med spas, injector-led studios and aesthetic clinics that advertise heavily, discount openly and are often faster to book. Those competitors bid on the same treatment names, so a practice that leads only with its medical credentials can find itself absent from every cosmetic query in its own city.
Seasonality is real and it is not subtle. Skin check interest climbs as warm weather approaches and again after summer exposure, while injectable and laser interest builds ahead of holidays, weddings and events, with laser resurfacing skewing toward the low-sun months when downtime is easier to schedule. A campaign that publishes the same content year-round misses both curves. Layered on top, ad platforms restrict health-condition targeting, so the medical half in particular has to be won organically and through AI citation rather than through audience buying.