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He`s smart. 1 million hits, if you got that all though adwords (in such an expensive uh "niche" too) you`d be out of business within hours.
In fact, I can only think maybe lawyers or jewelry could actually be more expensive to advertise in. The reason for the expensive-ness is the large profit margin and high-priced services these things provide, hence the high costs of advertising.
You should go natural, it`ll be hard and difficult, but if you do it the right way, it`ll pay off. Since your service is probably local, i`d suggest going after keywords that involve cities and locations near you. (Re: Orange County Big Toe Augmentation Surgery). And try to go after typos as well, i know i misspell Surgery way too often...
A million hits (and by hits, im assuming he means uniques) a month is pretty crazy, you arent gonna get that. Heck, you may not get that even if you were listed #1 for "Plastic Surgery"
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