Medical spas buy advertising through agencies compensated for lead volume, while clinic revenue depends on consultations held and treatment packages sold. This study evaluates a performance-based acquisition framework in which a single operator manages the path from a paid advertisement to a deposit-backed appointment and answers for consultations that show. The analysis draws on operational data from 1 commercial platform: 70,079 leads across 50 United States clinics, 20,404 booked consultations, 143,059 outbound calls, 33,036 paid deposits, and 2 randomized landing page experiments. Deposit-backed consultations reached a show rate of 93.4% among recorded outcomes, and 39.7% of attended consultations ended in a package sale with a mean value of $2,058, of which 90.2% was collected during the first visit. Nonattendance increased with the booking interval: the adjusted odds of attendance for intervals above 30 days equaled 0.14 of the odds for bookings within 1 day. Self-serve online booking accounted for 72.2% of deposits, and panel analysis found no positive association between call speed and booking output. A randomized test of photographic content returned a 0.03 percentage point difference on the prespecified primary endpoint (p = 0.95). The framework ties advertising spending to appointment outcomes and offers a reproducible template for accountability in aesthetic medicine.