International patients now ask ChatGPT first: why a top Google ranking is no longer enough

AI mentions in cosmetic surgery and skin care Reddit communities rose tenfold in two years

growly collects and analyzes posts and comments from 15 Reddit communities on cosmetic surgery, skin care and travel to Korea. Of 4.33 million posts and comments from January 2023 to September 2026, mentions of AI tools such as ChatGPT and Perplexity rose from 1.6 per 10,000 in 2023 to 15.7 in 2025. The rate held at the same level through September 2026.

Texts mentioning AI together with clinics, doctors or recommendations grew from 19 in 2023 to 524 in 2025. Patients preview post-surgery results with AI, or ask ChatGPT how to choose a clinic and then verify on Google. AI answers have moved to the early stage of choosing a clinic.

The same shift appears beyond Reddit. More than 1.2 billion people use ChatGPT each week, and Google's AI Overviews, shown at the top of Search, has more than 2.5 billion monthly users.¹²

A first-ranked clinic drops out of the comparison if AI leaves it off the shortlist

Instead of listing ten links, an AI answer selects a few clinics and explains why it recommends them. When patients start comparing from that shortlist, a clinic missing from the answer is left out of the first comparison even if it holds the top Google link. The higher the spend per patient, as with many English-speaking patients, the larger that loss.

This is not an argument to stop managing rankings. AI search still reads web documents to answer, so weak SEO fundamentals make AI recommendations harder to earn. We add two columns to the ranking report: whether the clinic appears in AI answers, and whether patients move from the first screen to a consultation request.

After SEO come AIO and SXO: the five stages international marketers describe

International marketers describe the evolution of search in five stages: SEO → AEO → GEO → AIO → SXO. The goal has moved from appearing in results to being recommended by AI and chosen by patients. Usage varies: AIO is sometimes used interchangeably with GEO and AEO, and sometimes as shorthand for Google AI Overviews.³⁴

For a clinic, the work matters more than the label. The five stages below are not completed in sequence; check them together in the same period.

AIO: Reddit was the most-cited site in US AI answers

AIO is the work of getting ChatGPT, Gemini and Google's AI search to find a clinic and include it among recommended candidates. AI assembles answers from many sources rather than relying on one website's description.

Peec AI analyzed 30 million citations in US AI answers in March 2026, across ChatGPT, Google AI Mode, Gemini, Perplexity and AI Overviews. The most-cited sites were Reddit, YouTube and LinkedIn, in that order. When a US patient asks AI about Korean clinics, conversations among real patients on Reddit are likely to shape the answer.⁵

Suppose a website promises a dedicated English-speaking coordinator while Reddit reviews describe difficult consultations in English. AI has little basis to present either claim with confidence. AIO starts by aligning services, practitioner credentials, location and consultation languages across the website, Google Maps, reviews and Reddit.

AI answers checked in Korean from Seoul do not show what US patients see

AI answers change with the language, location and wording of the question. A clinic that checks its name in Korean from Seoul may not notice that it is missing when a US patient asks in English. Build test questions from sentences real patients would type, such as “best lifting clinic in Gangnam for foreigners.”

We run the same English questions from a US vantage point in ChatGPT, Gemini, Perplexity and Google AI Mode, and record the date. Answers vary even for identical questions, so we treat the results as repeated observations across dates rather than as market share.

Record four things: whether the clinic appears, why it was recommended, whether the description contains errors and which sources were cited. When an answer misstates facts, correct the source material before working to increase exposure.

SXO: visitors from AI search were worth 4.4 times an organic visit

SXO, or search experience optimization, is the work of getting patients who arrive from search or AI to actually request a consultation. Yoast describes SXO as SEO combined with user experience design.⁶

In a 2025 study, Semrush estimated that the average visitor from AI search sources such as ChatGPT was 4.4 times as valuable as the average traditional organic search visit, based on conversion rate. Semrush attributes the difference to AI answers that give users the information they need to decide before they click.⁷

For one plastic surgery clinic, growly researched demand by treatment and designed the website, content and external visibility together around high-intent searches. By month three after launch, monthly AI-attributed inquiries from the US alone had grown from zero to 74. The project treated AI recommendations and the website as one plan.

Higher-value visits also mean larger losses on the first screen. If AI introduces a clinic as a lifting specialist with English consultations and the first screen shows only a Korean-language promotion banner, the patient cannot confirm what AI said and moves on to the next candidate.

Start SXO with the first-screen answer, 2.5 seconds and one consultation button

Answer the patient's question on the first screen. The strengths an AI answer highlighted, such as English consultations, a specialty treatment or an accessible location, should appear in the first heading and paragraph of the English website so patients know they have arrived at the right place.

Show the main content within 2.5 seconds on mobile. Google rates Largest Contentful Paint, the time until the largest content element appears, as good at 2.5 seconds or less. Patients far from servers in Korea can easily exceed that threshold when the first screen carries heavy video or large images.⁸

Use one consultation button and keep it visible on every screen. When KakaoTalk, WhatsApp, email and a booking form are all listed together, patients have to work out which route gets the fastest reply.

If Google has not indexed your pages, fix SEO fundamentals before AIO

If English pages are missing from Google's index or treatment pages are thin, fix SEO fundamentals before AIO and SXO. Google states that to be shown as a supporting link in AI Overviews or AI Mode, a page must be indexed and eligible to appear in Search with a snippet.⁹

If rankings are already near the top but English inquiries are flat, the priority changes. Before spending to climb one more position, check the AI-answer shortlist and first-screen drop-off. We compare the cost of defending a top ranking with the cost of fixing AI recommendations and the first screen in the same table.

For clinics whose patients arrive mainly through referrals or domestic platforms, AI-answer checks are a lower priority. The value of making the AI shortlist grows when targeting English-speaking patients who compare several clinics before booking. The same applies to Korean brands entering the US, which need to appear when US consumers ask AI to compare products.

Five checks to add next to this month's ranking report

One person at a clinic can complete a first pass of the five checks below in a day. Sorting the results into “not mentioned,” “mentioned with errors” and “mentioned, but patients leave on the first screen” shows what to fix next month.

Keep reviewing rankings. Placing AI shortlists and first-screen drop-off in the same table as rankings shows in numbers why a first-place page may not be producing inquiries from international patients.