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We have a relatively new site (re: August '10) for a plastic surgeon who opened his own solo practice after 25+ years with a large group. Our current url structure goes 3 folders deep to arrive at our tummy tuck procedure landing page. The site architecture is solid and each plastic surgery procedure page (e.g. rhinoplasty, liposuction, facelift, etc.) is no more than a couple clicks away. So far, so good - but given all that is known about local seo (which is a very different beast than national seo) quite a bit of on-page/architecture work can still be done to further improve our local rank. So here a a couple big questions facing us at present: First, regarding format, is it a given that using geo keywords within the url indispustibly and dramatically impacts a site's local rank for the better (e.g. the #2 result for "tummy tuck" and its SHENANIGANS level use of "NYC", "Manhattan", "newyorkcity" etc.)? Assuming that it is, would we be better off updating our cosmetic procedure landing page urls to "/albany-tummy-tuck" or "/albany-ny-tummy-tuck" or "/tummy-tuck-albany" etc.? Second, regarding structure, would we be better off locating every procedure page within the root directory (re: "/rhinoplasty-albany-ny/") or within each procedure's proper parent category (re: "/facial-rejuvenation/rhinoplasty-albany-ny/")? From what I've read within the SEOmoz Q&A, adding that parent category (e.g. "/breast-enhancement/breast-lift") is better than having every link in the root (i.e. completely flat). Third, how long before google updates their algorithm so that geo-optimized urls like http://www.kolkermd.com/newyorkplasticsurgeon/tummytucknewyorkcity.htm don't beat other sites who do not optimize so aggressively or local? Fourth, assuming that each cosmetic procedure page will eventually have strong link profiles (via diligent, long term link building efforts), is it possible that geo-targeted urls will negatively impact our ability to rank for regional or less geo-specific searches? Thanks!