We Studied 117 Med Spas. AI Cited Every Clinic With 5+ Media Placements

Total Authority analyzed 117 California med spas and found that earned media placements and AI citations move together at a Spearman correlation of 0.58 (permutation test, 10,000 iterations, p = 0.0001). Every clinic in the study with five or more earned media placements was cited by AI — all 19 of them, with a median of 80 citations. Among clinics with no placements at all, 39% were never cited by any AI platform.

This is the full dataset, the full method, and the number that argues against us. You can download all 117 rows and check the math yourself.

What the study found

Six findings, each stated so you can quote it without the rest of the page:

• In Total Authority's 2026 study of 117 California med spas, earned media placements and AI citations correlate at Spearman ρ = 0.58 (p = 0.0001).
• All 19 med spas with five or more earned media placements were cited by at least one AI platform — a 100% citation rate in that group.
• Med spas with zero earned media placements recorded a median of 2 AI citations; those with 5–14 placements recorded a median of 80 — a roughly 40× gap.
• 39% of the med spas with no earned media placements were never cited by any of the six AI platforms studied.
• The relationship held on all six platforms tested, in a narrow band from ρ = 0.47 (Microsoft Copilot) to ρ = 0.54 (Google AI Mode).
• Controlling for total link volume, Domain Rating and organic traffic attenuates the correlation from 0.58 to 0.15 — earned media travels with general authority rather than acting alone.

That last bullet is the one most studies bury. We put it in the summary, and there is a whole section on it below.

Every clinic in this study already ranks on Google

That was the entry requirement, and it is the finding's strongest defense. The sample is drawn from the top 20 organic results for med spa queries across 14 California cities. Nobody in this dataset is invisible on Google — they all cleared that bar before we measured anything.

So the citation gap is not big brands versus small brands, or established sites versus new ones. It is a gap between businesses that are all, by construction, findable in traditional search. Twenty of them are still named by none of the six AI systems — including Google's own AI Overviews, sitting directly above search results those same clinics rank in.

Does earned media actually get you cited by AI?

In this sample, yes — and the relationship is a gradient, not a threshold. As earned media placements rise, both the number of AI citations and the basic odds of being cited at all rise with them.

Split the 117 clinics into four groups by placement count and the pattern is monotonic. The median clinic with no placements collected 2 AI citations. With 1–4 placements, 8. With 5–14 placements, 80. The share of clinics cited at all climbs from 61% to 85% to 100%.

AI citation outcomes by earned-media placement count, across all six platforms combined.

Median AI citations

The midpoint clinic in each group.

Share cited at all

At least one AI citation on any platform.

The second chart is the one worth sitting with. Being cited at all — appearing anywhere in an AI answer, even once, on any of the six platforms — is not guaranteed at the bottom of the distribution. Nearly two in five clinics with no earned media are simply absent. Above five placements, absence stops happening in this dataset.

This is what we mean when we argue that third-party proof is what AI systems actually validate against. The clinic's own website states its claims; the rest of the web decides whether those claims get repeated.

How big is the gap between covered and uncovered clinics?

Roughly 40× at the median. Med spas with 5–14 earned media placements recorded a median of 80 AI citations, against a median of 2 for med spas with no placements.

Medians rather than averages, deliberately: both distributions are severely skewed, and a handful of outliers would otherwise carry the entire result. The plot below shows every clinic in the study on log-log axes, which is the only honest way to display data this lopsided.

Each dot is one med spa. Both axes are log-scaled (+1) because both distributions are heavily skewed. Hover any dot for the clinic.

Scroll the chart sideways to see the full range →

0 placements 1–4 5+

The cloud rises left to right, but it is a cloud, not a line. Plenty of clinics sit well above or below what their placement count would predict. Two of them are worth naming.

The two clinics that break the pattern

FACE Beauty Science recorded 1,104 AI citations from just 10 earned media placements — the most-cited clinic in the entire study, on a modest media footprint. Milk + Honey recorded 50 placements and only 38 citations.

Those two sit at opposite corners of the same argument. Milk + Honey shows the ceiling on media alone: brand-level coverage that is not attached to local search substance does not convert into local AI recommendations. FACE Beauty Science shows the opposite — a relatively small number of placements riding an unusually strong content operation into an enormous citation count.

Neither case refutes the gradient. Both sharpen what it means: earned media raises the floor, and what your own site does with that authority sets the ceiling. Seven clinics in the study carried at least one placement and still recorded zero citations, which is the same lesson in miniature.

Is this just one AI engine behaving oddly?

No. Total Authority measured the correlation separately on each of the six platforms, and all six land in a band seven hundredths wide: Google AI Mode and Perplexity at ρ = 0.54, Google AI Overviews and ChatGPT at 0.52, Gemini at 0.50 and Microsoft Copilot at 0.47. Every per-platform result carried p = 0.0001.

Spearman ρ between placements and per-platform citations. All p = 0.0001. Bars start at zero — the point is how tight the band is.

Google AI Mode 0.54

Perplexity 0.54

Google AI Overviews 0.52

ChatGPT 0.52

Gemini 0.50

Copilot 0.47

A seven-hundredths spread from top to bottom. No single engine is driving the result.

That consistency matters more than the headline number. A finding that appeared only in Perplexity or only in Google AI Mode would suggest a quirk of one retrieval stack. A finding that reproduces across six independently built systems suggests they are all leaning on something similar about how the open web describes a business.

Does earned media cause AI citations?

This study cannot show that, and we are not going to claim it. It is correlational. What it establishes is a visibility gradient, not a causal mechanism.

Here is the number most likely to be used against the finding. Clinics with more earned media also have more links overall, higher Domain Rating and more organic traffic — and AI engines reward all of it. Hold those constant and the correlation shrinks substantially.

Partial Spearman ρ after rank-residualizing both variables on each control set. Each row adds a control to the one above it.

Raw correlation 0.58

Controlling link volume 0.35

+ Domain Rating 0.25

+ organic traffic 0.15

We publish this because it is the number most likely to be used against the finding. Read on for why the bottom row is conservative.

Read honestly, two things are true at once. Earned media placements are one of the strongest single predictors of AI citation in this dataset. And much of that association runs through the general authority those placements help build, rather than through the placements alone. Earned media is one strand of an authority complex, not a lever you pull in isolation.

One technical caveat cuts in the other direction, and it is why we treat 0.15 as a conservative floor rather than the true effect. Organic traffic is partly a consequence of the visibility that media coverage creates. Controlling for it therefore absorbs part of the very effect being measured — a classic over-control. The honest range is somewhere between the raw 0.58 and the fully controlled 0.15, and this study is not designed to pin it down further.

The result also survives three robustness checks. Excluding blacklisted database domains reproduces ρ = 0.58; restricting to premium-only placements gives 0.492; weighting placements by Domain Rating gives 0.576.

What this means if you run a med spa

The practical read is narrower than "go get press", and more useful.

1. Being uncited is a real, common state. Nearly two in five clinics with no earned media in this study were invisible across all six platforms. If you have never checked, assume nothing.
2. The first few placements matter most. The steepest move in the data is from zero to the 1–4 band, where the share of clinics cited at all jumps from 61% to 85%. You are not competing with SkinSpirit's 108 placements to get on the board.
3. Coverage alone will not carry you. Milk + Honey had 50 placements and 38 citations. Placements need local search substance underneath them — treatment pages, locations, practitioner credentials — or AI has nothing specific to recommend you for.
4. Measure citations, not just mentions. The two are different metrics with different denominators, and conflating them will flatter your reporting.
5. Build the campaign around being quotable. Coverage that earns a citation tends to answer a question a prospective patient actually asks — which is what digital PR designed for AI citations optimizes for.

Methodology

Total Authority collected the data in July 2026. The full method:

1. Sample. Top-20 organic results from Ahrefs for "med spa", "medical spa" and "best med spa {city}" across 14 California cities: Los Angeles, San Diego, San Francisco, San Jose, Sacramento, Irvine, Long Beach, Oakland, Fresno, Beverly Hills, Santa Monica, Palm Springs, Newport Beach and Walnut Creek. Directories, aggregators and media results were excluded. Nine ambiguous businesses were adjudicated by inspecting their websites: six admitted, three excluded — one of them for being in Long Beach, New York. Final N = 117 unique clinic domains.
2. Earned media (X). Each clinic's complete live referring-domain profile, spam-filtered via Ahrefs, was matched against a proprietary media placement database of 6,119 publication domains vetted for journalist-written coverage. X is the count of distinct referring domains present in that database. 422 placements matched across the sample.
3. AI citations (Y). Ahrefs AI-citation counts per platform — ChatGPT, Perplexity, Gemini, Google AI Overviews, Google AI Mode and Microsoft Copilot — measured at domain plus subdomains. 4,528 citations counted in total.
4. Controls. Total live referring domains, Domain Rating and monthly organic traffic, via Ahrefs batch analysis.
5. Statistics. Spearman rank correlations, chosen because the data is zero-inflated and heavily skewed — 43.6% of clinics have zero placements and 23.1% have zero AI citations. The headline p-value comes from a 10,000-iteration permutation test. Partial correlations were computed by least-squares residualization of ranks.

Limitations

Five, stated plainly:

• "Earned media" here means presence in a proprietary database of publications tracked for PR outreach. That is a curated definition, not an exhaustive one.
• The sample conditions on ranking in organic search. Clinics invisible in search never enter it, so this is not a study of all med spas.
• For multi-location brands, both media and citations are measured at brand level.
• Correlation is not causation. The controls narrow the size confound; they cannot eliminate it.
• AI citation counts reflect Ahrefs' crawl of AI answers over its coverage window, not a census of every answer ever generated.

The full dataset

All 117 clinics, sorted by earned media placements. Nothing is held back — the outliers that complicate our argument are in here alongside the ones that support it.

Sorted by earned media placements. Ref. domains are live and spam-filtered. Scroll within the table.

Clinic	Placements	AI citations	Ref. domains	DR
SkinSpiritskinspirit.com	108	356	1,139	63
milkandhoneyspa.com	50	38	767	53
Alchemy 43alchemy43.com	32	20	425	34
Revive Med Sparevive.md	18	165	257	40
beyouthful.com	14	80	168	17
BW Aesthetics Medical Spabwaesthetics.com	13	192	889	47
FACE Beauty Sciencefacebeautyscience.com	10	1,104	293	37
Esthetics Centerestheticscenter.com	10	114	455	35
Beverly Hills Med Spabeverlyhillsmedspa.com	9	113	514	32
Kalologie Santa Monicakalologie.com	9	4	229	26
Dermacaredermacaresandiego.com	7	698	195	26
Contour Dermatologycontourderm.com	7	218	294	38
Aesthetic Envyaestheticenvy.com	7	32	194	14
Destination Aestheticsdestinationaesthetics.com	7	13	166	31
BioSpa Medical Spamybiospa.com	6	19	115	22
Advanced Dermatology Specialistsadvanceddermspecialists.com	6	2	220	48
Laser Cliniquelaser-clinique.com	5	99	249	29
NassifMD Medspanassifmdmedspa.com	5	23	147	24
Revay Aestheticsrevayaesthetics.com	5	7	46	3
Hayes Valley Medical Estheticshayesvalleymed.com	4	96	216	41
The Skin Agencytheskinagency.com	4	53	163	23
Kare Plastic Surgery & Medical Spakaresurgery.com	4	49	59	15
Cosmetic Surgery Institute MediSpacsipd.com	4	10	105	17
Beauty & Body Medloungebeautyandbodylounge.com	4	7	111	7
Epi Center MedSpaepicentermedspa.com	4	7	145	29
South Coast MedSpasouthcoastmedspa.com	4	6	160	5
Newport Beach MedSpanewportbeachmedspa.com	4	5	159	32
The Practice Healthcare Medspathepracticehealthcare.com	3	114	97	26
La Jolla Cosmetic Medical Spaljcmedspa.com	3	86	178	12
Self Care LAselfcarela.com	3	35	145	8
B Medical Spa And Wellness Centerbmedspa.com	3	34	116	28
Biomed Spa by Dr. Garth Fisherbiomedspa.com	3	5	54	15
Aura Skin Spaauraskinspa.com	3	3	111	16
Savage Serenity Spasavageserenityspa.com	3	0	132	11
R+H Aesthetic Medicinerhmedicine.com	2	56	83	14
Cienega Medicalcienegaspa.com	2	31	259	34
Eko Plastic Surgeryekoplasticsurgery.com	2	14	50	19
Palm Desert Plastic Surgerypalmdesertplasticsurgery.com	2	10	61	9
Desert Med Aestheticsdesertmedaesthetics.com	2	8	78	9
Elineaelineasf.com	2	8	48	5
True You Aesthetic (Dr. Thang Tran)trueyouaesthetic.com	2	8	79	8
Marina Medspamarinamedspa.com	2	4	62	27
The Cosmetic Surgical Centerthecosmeticsurgicalcenter.com	2	3	60	7
Beauty Boost Med Spabeautyboostmedspa.com	1	46	548	25
ELin Medical Spaelinmedicalspa.com	1	44	42	0
Nob Hill Aestheticsnobhillaesthetics.com	1	35	80	50
San Diego Aesthetics and Medspasdamedspa.com	1	31	87	8
Skin Medical Spaskinmedicalspa.com	1	30	74	5
Grey Aestheticsgreyaestheticsoc.com	1	23	43	1
Los Feliz Med Spalosfelizmedspa.com	1	16	136	7
Concierge Aestheticsconciergeaesthetics.com	1	12	76	10
SVIA / Liu Plastic Surgery Med Spaliuplasticsurgery.com	1	12	108	14
Nubo Spanubospa.com	1	11	77	4
Clarity Medical Spaclaritymedicalspa.com	1	6	113	8
Aesthetica Medical Spaaestheticamedspasd.com	1	5	162	6
Beverly Hills Med Spa (bhmedspas)bhmedspas.com	1	3	26	2
Medspa of Sacramentomedspaofsacramento.com	1	3	64	20
Ocean Avenue Aestheticsoceanavenueaesthetics.com	1	1	44	2
thegspasf.com	1	1	81	11
Zen ReGenzenregen.com	1	1	57	14
BeWell MedSpabewellmedspa.com	1	0	45	2
Complete Care Medical Spacompletecaremedicalspa.com	1	0	34	2
Novel U Wellness and Med Spanoveluwellness.com	1	0	46	4
Beverly Hills Plaza Medi Spa and Wellnessplazamedspa.com	1	0	61	3
roxspanewportbeach.com	1	0	36	5
Sente Bella Spasentebellaspa.com	1	0	67	5
Walnut Creek Aestheticswalnutcreekaesthetics.com	0	35	71	20
Aspire Medispa (Valley Institute of Plastic Surgery)medispafresno.com	0	29	366	28
San Diego Skin Medical Spasandiegoskin.com	0	29	61	6
Encore MedSpaencoremdspa.com	0	22	60	0
Birmingham Med Spabirminghammedspa.com	0	20	76	2
Sheena Kong MD Medical Spasheenakong.com	0	20	83	1
Dr. Maya Katodrmayakato.com	0	18	48	6
Dr. Quardt Medical Spadrqmedicalspa.com	0	16	33	1
Revive Wellness Centersrevivecenter.com	0	15	84	6
Rejuvify Med Sparejuvifymedspa.com	0	14	37	0
Deluxe Med Spadeluxemedspa.com	0	9	58	6
Desert Glow Med Spa & Wellness Centerdesertglowspa.com	0	7	27	1
Masters Medspamasters-medspa.com	0	7	32	2
Medspa Deluxe LAmedspadeluxela.com	0	7	45	20
SkinCeuticals SkinLab Santa Monicaskinlab-la.com	0	7	25	12
Enve California Aestheticsmyenve.com	0	6	66	5
artful-aesthetics.com	0	5	50	7
NuBella Med Spanubellamedspa.com	0	5	54	5
thespaatfgv.com	0	5	93	7
The MedSpa At Beverly Hillsthemedspaatbeverlyhills.com	0	4	41	1
The Med Spa Boutiquetheboutiquespa.md	0	3	8	3
Diba Med Spadibamedspa.com	0	2	21	2
ME Medical Spamemedicalspa.com	0	2	33	5
Mystique Medical Spamystiquemedicalspa.com	0	2	115	3
NuVie MD Medspanuviemd.com	0	2	11	0
Pretty Please Aestheticsprettypleaseaesthetics.com	0	2	109	23
San Jose Medical Spasanjosemedspa.com	0	2	68	6
Lounge of Beauty Medical Spaloungeofbeautymedicalspa.com	0	1	73	2
Reddy Aestheticsreddyaesthetics.com	0	1	91	1
Santa Monica Medical Aestheticssantamonicamedicalaesthetics.com	0	1	16	1
Santa Monica MedSpasantamonicamedspa.md	0	1	2	4
Alamo MD Medical Spaalamomdmedspa.net	0	0	328	6
Angilee Med Spaangileemedspa.com	0	0	30	0
Avant MedSpaavant-medspa.com	0	0	22	16
Beyond Beauty Medical Spabbspamed.com	0	0	41	3
Bellissima Medical Spabellissimamedicalspas.com	0	0	26	0
Bhanot MedSpabhanotmedspa.com	0	0	28	3
Elyssium Advanced Skin Careelyssiumskincare.com	0	0	70	7
Everything Estheticseverythingestheticsmed.com	0	0	40	0
Glam Labglamlabmedspa.com	0	0	24	4
HealthBay Med Spahealthbaymedspa.com	0	0	50	6
JPO Aestheticsjpoaesthetics.com	0	0	22	0
La Quinta Medspalaquintamedspa.com	0	0	46	11
Lotus Aestheticalotus-aesthetica.com	0	0	15	0
Refyned Aestheticsrefynedaesthetics.com	0	0	48	0
Sacramento Med Spasacramentomedicalspa.com	0	0	40	3
Sea Glass Med Spaseaglassmedspaoc.com	0	0	32	1
Smooth Skin Loungesmoothskinlounge.com	0	0	52	4
STHETICS MED SPAstheticsmedspa.com	0	0	16	1
Synerchi Medical Spasynerchimedspa.com	0	0	76	7
WellCulture MedSpawellculturemed.com	0	0	20	1

Download the data: CSV or JSON. Released under CC BY 4.0 — reuse it freely, with attribution.

How to cite this study

Total Authority (2026). Earned Media and AI Visibility in Local Healthcare: A Study of 117 California Med Spas. Dataset TA-MEDSPA-AIC-2026-v1. https://totalauthority.com/earned-media-ai-citations-study

Frequently asked questions

Does earned media improve AI visibility?

In Total Authority's 2026 study of 117 California med spas, earned media placements and AI citations correlated at Spearman ρ = 0.58 (p = 0.0001), and every clinic with five or more placements was cited by AI. The study is correlational, so it demonstrates a strong association rather than proof of cause.

How many media placements does a med spa need to get cited by AI?

In this dataset the sharpest change came early: clinics with 1–4 placements were cited at all 85% of the time versus 61% for clinics with none, and all 19 clinics with five or more placements were cited. Five placements is where absence stopped occurring in the sample, not a guaranteed threshold.

Which AI platforms were measured?

Six: ChatGPT, Perplexity, Gemini, Google AI Overviews, Google AI Mode and Microsoft Copilot. The correlation between earned media and citations held on all six, ranging from ρ = 0.47 on Microsoft Copilot to ρ = 0.54 on Google AI Mode.

Does the correlation survive statistical controls?

Partly. Controlling for total link volume, Domain Rating and organic traffic reduces the correlation from 0.58 to 0.15, which shows that earned media travels with general authority rather than acting alone. Because organic traffic is itself partly a consequence of media visibility, the 0.15 figure is best read as a conservative floor.

Can I get the raw data?

Yes. All 117 rows are published as CSV and JSON under a CC BY 4.0 license, covering placements, AI citations, referring domains and Domain Rating for each clinic.

About the Author

Chris Panteli is the founder of Total Authority and Linkifi, host of the Market Movers Pod, and an AI visibility researcher. His work focuses on repeatable methods for understanding brand discovery, citation and recommendation in AI answers.

Find out where your clinic sits

This study measured 117 clinics. The same measurement runs on one. Grade a priority page free, or take the LLM Visibility Audit for a repeated-sample baseline across all six platforms — including which sources AI is citing instead of you.