Tales From an UpWork SEO: Breast Augmentation & Tanking Rankings

I responded to an UpWork post for a “One-time On-Site SEO Audit for Website” several weeks ago. Here’s the full post:


We need a one-time SEO audit done for ********plasticsurgery.com, a plastic surgeon’s site in a competitive medical niche. We have already added various aspects to optimize SEO and have the Yoast SEO WordPress plugin installed. We would expect the project deliverable to be a list of recommendations to improve the site including content, link structure, suggestions for new content, structured data, etc for each of the many surgical pages (the page under the headings breast, body, face, for men) and the non-surgical pages.

We are particularly interested in improving our performance on the queries “breast augmentation nyc”, “breast implants nyc”, “breast lift nyc”, “liposuction”, “brazilian butt lift”, and queries involving the word “botox” (“botox nyc”, “botox treatment nyc”, etc) in addition to each of the pages in categories described above.


So I sent my resume and an introduction, to which she replied:


It sounds like it could be a fit, but can you please address some of the specifics of our site that you think might be causing us issues with some of the queries I mentioned to help me evaluate your knowledge. Then, can you also give me a flat fee price to perform the audit? And, can you list more specifically what you would deliver? I would like the output to include that of SEMRush.

So I sent her this (I would say) rather detailed response:


Hi M*****,

After running a rudimentary crawl of your site (***link below), the first things I’m seeing are:

* You have an XML sitemap (good)
* You have a functioning robots.txt file (good)
* The site pages aren’t using H2 tags
* You have an unusually high number of 301 redirects
* 47 page titles are longer than the 600 pixel width that Google will display in search results.
* Page titles aren’t based on competitive keyword research
* Meta descriptions are well-written. However, 156 of them are too long to display in search results.
* You have non-indexable category pages (such as https://www.**************/category/skin-non-surgical/) that could perform well in search
* The 404 page needs links to suggested content to retain users and help them find what they were looking for. It should have a search function (it does) and link to popular content to provide less of a “dead end” experience for the user.

Yoast: I’m well-versed with Yoast (both the free and paid versions). However, I would encourage you to not use Yoast as your benchmark. An automated tool like Yoast won’t address the specific needs of Dr. ********’s practice.

SEMrush: My team made the switch from SEMrush to Ahrefs a couple of years ago because Ahrefs does all of the things you’re looking for at a much more granular level,. If you absolutely require an SEMrush audit I’ll be using the (limited) trial version.

Content: As I mentioned, my background is in journalism, so content is my strength. I can help with market analysis and competitor research to find topics that will bring in new customers. I encourage you to focus on long-tail keyword phrases that include keyword phrases such as “brazillian butt lift” and “botox treatment.” I can help you find the best long-tail phrases around which to build a content marketing strategy.

Structured data: You’ll find this is something important for sites that output news and trends on a daily or weekly basis. That said, I can help you set up the pages that need it with the schema markup they need.

*** link to your crawl: (link to Screaming Frog export with notes)

thank you,

At this point, she goes silent and I think they aren’t interested. No problem, right? Fast-forward about two weeks and I get this:


Hi Marshall, You could be a fit but a lot of your points weren’t very specific. Take a look at the breast augmentation page and tell me 1-3 things that you see that are “wrong”. About 12 months ago we ranked well for “breast augmentation nyc” and then dropped to the 8th, 9th page and now we don’t rank anywhere after the last week or so. These are the kinds of issues I’d like this SEO audit to solve, and some people that have submitted proposals are suggesting what I think are bogus answers (such as keyword stuffing “breast augmentation nyc” everywhere on the page).

At this point, if you’re wondering if this person is drinking while UpWorking … I’m wondering the same thing. So here’s my EVEN MORE detailed reply:

Re: https://www.************/breast-augmentation/

1. This page has 8 backlinks from 3 referring domains. No page in such a competitive industry, in such a competitive market, will ever rank well with so few inbound links. That said, the three domains liking to this page are high domain-authority sites, so it’s a good start.
2. This page scores 11/100 for mobile (!!!) and 57/100 for desktop on Google’s PageSpeed Insights test (link to test). How fast a page loads and how it performs on mobile phones are huge factors in search engine rankings, so fixing this is no doubt your most urgent problem, especially if the rest of your site is experiencing similar problems.
3. The page has no H2 tags. These subheadings are needed to denote a page’s subsections and signal to search engines what these sections are about. They should leverage keywords that have some thematic relation to the focus keyword of the page.

You are correct in recognizing keyword stuffing as a bogus tactic. It worked 15 years ago, but was frowned upon even then. You aren’t going to build trust with potential clients through “tricks”—certainly not through outdated ones that don’t work.

I also highly recommend you don’t simply target “breast augmentation” but also related long-tail keyword phrases with this page.

I work with quite a few doctors who had to retool their strategy in the wake of the Aug. 1 “Medic” update from Google, which greatly impacted health and financial sites: https://www.seroundtable.com/google-medic-update-26177.html

If your experience has been anything like theirs, this isn’t your only site page that has dropped in rankings. Luckily, Google has made its expectations from medical websites quite clear. Refer to page 9 of Google’s Search Quality Guidelines for Doctors: Your Money or Your Life (https://static.googleusercontent.com/media/www.google.com/en//insidesearch/howsearchworks/assets/searchqualityevaluatorguidelines.pdf). Following these to a “t” will help you quite a bit.

Best of luck!


We’ll see if she replies, but at this point I’m starting to wonder if they really even want help?