Generative engine optimization · Medical aesthetics
AI names $22 billion of Botox and fillers by brand. Your med spa's name splits what's left over.
The first AI visibility index built specifically for medical aesthetics came out this year, and it puts a number on something our own testing had already hinted at: brand names are taking almost all of the AI citation share in this category, and individual local practices are splitting whatever remains.
The Medical Aesthetics AI Visibility Index 2026, a joint project from 5WPR and Haute MD, ran more than 60 consumer-intent questions through ChatGPT, Claude, Perplexity, and Google AI Overviews, covering neurotoxins, dermal fillers, energy-based devices, medical-grade skincare, and surgical procedures. It ranks the top 25 brands in a $22 billion market by how often the AI engines mention them. Botox, Juvéderm, CoolSculpting, SkinCeuticals, and Morpheus8 lead the ranking.
The figure that caught our attention wasn't who came in first. It was how much of the total the top group takes before anyone else gets a share. The top 15 ranked brands account for about 62% of AI citation share in the category. The remaining 38% splits between lower-ranked and unranked brands and, mixed into that same portion, provider-specific citations tied to individual dermatologist and plastic surgeon practice names.
Read that from the other direction. If you run a med spa and an AI engine ever says your practice name out loud, you're competing for room inside a slice that's already shared with brands most patients have never heard of. The injectable and device makers with a decade of clinical journals, editorial coverage, and trade press behind them get first pick of the answer. Your practice gets whatever space is left after that.
We wanted to know what this looks like for a med spa with no national brand and no celebrity dermatologist attached, so we checked our own numbers.
What our own testing showed
Back in July we ran 10 independent med spas in Los Angeles through GPT-4o and Perplexity, using the kind of question a real patient types in: "best med spa near me." Zero out of ten came back named by either engine, and we ran the check twice on every one to be sure. These were active businesses with Google Business Profiles and genuine review counts, tested a full two months before the brand index existed.
Widen the view and the pattern holds. Across 50 wellness and spa businesses in five categories, 66% came back invisible to both models. Med spas scored worst of the group, at zero out of ten. Day spas did a little better, with five out of ten getting a mention from at least one engine. Boutique salons landed in between, three out of ten from GPT-4o and none from Perplexity.
Two separate datasets, collected two months apart, looking at different sides of the same category, point at the same wall. A $22 billion market with real advertising budgets and clinical research behind it still hands most of its answer space to a small group of names. An independent med spa without that budget isn't starting at zero exactly, but it's starting from a small share of an already small share.
Why brand names take the larger cut
The 5WPR index credits clinical authorities, peer-reviewed journals, luxury and beauty editorial, and practitioner-facing trade media for shaping which brands get cited. A solo or small-group med spa doesn't have access to any of that. Nobody is publishing a peer-reviewed paper about your Tuesday appointment slots, and Vogue isn't running a feature on your injector.
What you do have access to is the same layer that got a handful of independent practices into that 38% slice to begin with: RealSelf reviews, a treatment page written for the specific procedure someone is asking about, and provider credentials stated somewhere an AI engine can actually read them instead of buried in a PDF bio. Those are close to the same signals that separated the day spas we saw get cited from the ones that didn't, just held to a higher bar because medical aesthetics is a category where the model has more to lose by getting it wrong.
What this means if you run a med spa
Outspending Botox or CoolSculpting for AI citation share isn't realistic, and it's the wrong fight to pick. The fight worth having sits inside that 38% slice, against other independent practices likely making the same mistakes: no treatment-specific pages, credentials that exist somewhere but aren't stated plainly, and a thin or missing RealSelf presence.
The 5WPR index is vendor research from a PR firm rather than a peer-reviewed study, and this is the first year they've covered this category, so we'd treat the 62/38 split as directional rather than exact. Our own zero-out-of-ten result has its own limits too. Ten businesses in one city is a small sample, and it was measured before this brand index existed, so we can't say the market shifted between the two. What we can say is that a vendor benchmark and our own independent testing, done months apart and looking at different halves of the same industry, arrive at the same conclusion: brand names crowd the answer, and local practices divide up what's left.
Finding out which side of that split your own med spa sits on takes about thirty seconds, and it beats guessing which slice you're fighting for.