The r/MedSpa post from a marketing specialist managing around nine med spa locations contains its own answer, and the answer is not about which platform is better. The observation is that one platform has been the primary channel, another was tested for a period, and the second produced leads at a higher cost per lead while both platforms delivered roughly the same arrival rate and the same sales rate.
Read that sentence again, because two platforms with the same arrival and sales rates and different costs per lead is a complete decision, stated in one line. If the same proportion of leads show up and roughly the same proportion buy, then a lead that costs more costs more all the way to the sale. The comparison has already been made. What remains is a measurement question, and it is the same one that makes most platform comparisons in aesthetics misleading.
A lead is not a standard unit
Cost per lead is the most widely used metric in paid acquisition and the least comparable across channels, because a lead is not a fixed quantity. One platform's lead is frequently a form fill produced by a compelling offer or a good creative, filled in on a phone, with no particular intention to attend an appointment. Another platform's lead is a person who typed a specific query, which is a different act with a different level of intent behind it.
Two platforms can therefore generate the same number of leads with entirely different quality, and the only way to find out is to track what happens after the lead arrives. Which is precisely what the poster did — and the finding that the arrival and sales rates were similar is more interesting than the cost difference. It means that in this case the cheaper leads were not worse leads; they were the same leads at a lower price. That is a genuinely useful result, and it is also the exception rather than the rule.
The metric stack that actually supports a decision
The decision belongs at the bottom of the funnel, not at the top. For a treatment business the useful sequence looks like this.
Cost per lead. Useful for tracking, misleading for comparing across channels.
Arrival rate. The share of leads who actually attend a consultation or a booked appointment. This is where channel differences usually show up first, and where a practice's follow-up capacity gets tested.
Consultation to treatment rate. The share of arrivals who purchase. This is largely a function of the practice's consultation quality and its price positioning rather than of the channel, which is why it is often similar across platforms — and why the poster's finding of comparable sales rates is plausible.
Cost per sale, and contribution per sale. Cost per sale is the number to compare across channels. But the number that actually decides is the contribution each sale leaves behind: the treatment revenue minus the cost of delivering it, minus the acquisition cost. A channel that produces a slightly more expensive sale of a higher-margin treatment is better than a cheaper sale of a low-margin one.
Return on ad spend against contribution, not revenue. Measuring against gross revenue flatters every channel, because the delivery cost is where the money goes.
Once a practice moves its comparison to the sale rather than the lead, platform questions usually answer themselves, and they often reverse: the channel with the higher cost per lead can be the cheaper channel per sale when its leads arrive more often or convert at a materially higher rate.
The trap in optimising for cost per lead
There is a mechanical problem with managing to cost per lead, and it is worth stating plainly because it is the most common way small practices damage their own acquisition economics.
If the objective is the cheapest possible lead, budget flows to whichever channel produces the most low-friction conversions — and low-friction conversions are easiest to get from people with the least intent. The practice then receives a larger volume of leads it must work. Cheap leads need more calls, more reminders, more rescheduling and more chasing before they become a booking. If the front desk has the capacity to do that work, cheap leads are cheap. If it does not, the practice has bought a queue it cannot process, and the true cost per sale rises while the dashboard shows an improvement.
That is the diagnostic question behind every cost-per-lead comparison: who is working these leads, and how fast are they being contacted? A channel's leads are only as cheap as the practice's ability to convert them. Speed of first contact is one of the most powerful variables in the whole system, and it is entirely within the practice's control — which is why it usually deserves attention before the channel mix does.
Running a fair test between two channels
Most in-house channel comparisons are not actually tests, and the resulting numbers are used to make decisions they cannot support. A comparison that can bear weight has the following properties.
Same offer and creative direction. If one channel ran a strong promotional offer and the other ran a general brand message, the result measures the offer, not the channel.
Same destination. Same landing page or booking path. A different booking experience between the two arms contaminates everything downstream.
Same follow-up process. Same response time, same script, same number of attempts. If one channel's leads were called within minutes and the other's were called the next day, the test measured the front desk.
Same window, and enough volume. Channel comparisons need enough leads for the sale counts to mean something. A dozen leads per arm is not a result; it is a week.
Measurement at the sale, with a consistent attribution window. Long attribution windows will credit the channel that ran earlier, and both channels reaching the same person will double-count unless the practice defines what counts as a sale for reporting purposes.
The value of running it properly is that it turns an argument into an allocation rule, and it can be repeated quarterly as prices, competition and platform products change.
Channel fit is about intent, and intent depends on the service
Setting aside cost, the two broad channels do different jobs, and a practice usually needs both rather than one.
A search channel captures existing intent: the person has already decided something is wrong and is looking for who can fix it. Leads cost more, arrive with a clearer idea of what they want, and often decide faster. It suits services that people search for by name, and it is the natural home for branded terms, competitor terms and high-intent procedure queries.
A social channel creates interest rather than capturing it. Leads are cheaper, and the offer and the creative do most of the work. It suits services that demonstrate well visually, offers with a clear price or bundle, and impulse-friendly treatments — and it is the stronger channel for retargeting people who already visited the site or engaged with an ad.
The sensible portfolio therefore depends on the menu. A practice whose revenue depends on high-ticket device treatments that clients research before booking is likely to find the search channel's higher cost per lead worth paying. A practice whose revenue depends on accessible, repeatable, visually demonstrable treatments can often build volume more cheaply on the social channel. The same practice will usually run both, weighted by contribution per sale rather than by lead cost.
The multi-location complication
The poster's situation, managing nine locations, adds the one factor that most often invalidates a platform conclusion: location differences.
Each market has its own competitive density, its own cost per click and cost per thousand impressions, its own price positioning, its own review profile, and its own staff quality. A channel that wins on cost per sale in one market can lose in another, and the reason is usually the local practice rather than the platform. Averaging nine locations into a single platform conclusion hides this, and it leads to budget being allocated on a portfolio average that applies to none of the individual locations.
The workable approach is per-location reporting against cost per sale and contribution, with a portfolio view used for overall budget and a location view used for channel weight. Where a location underperforms on both channels, the constraint is usually not the channel at all — it is the offer, the price, the consultation, or the local reputation.
What moves the number more than the channel
The honest hierarchy, in a treatment business, puts channel choice below four other variables.
The offer being promoted, which determines whether anyone responds at all. The speed of first contact, which determines whether a lead becomes a booking. The consultation, which determines whether a booking becomes a treatment. And the retention of the client afterwards, which determines whether the acquisition cost is amortised over one visit or over several years.
A practice that improves those four will get more out of any channel. A practice that has not addressed them will find, whichever platform it chooses, that the cost per sale drifts up and the marketing budget looks like the problem when it is not.
The short answer
Both channels can work, and the useful comparison is cost per sale against contribution per sale, per location, measured after the same follow-up process and the same attribution rule. The poster's own data suggests that on the metrics that matter, the two channels are performing similarly, which means the higher cost per lead is the whole difference and the cheaper channel should carry more of the budget — until a properly structured test says otherwise. What should not happen is a switch to whichever platform reports the cheapest leads, because cheap leads are only cheap if someone is working them.