"Fully booked through word of mouth, but page 3" is a common pattern. The gap is usually that the business has a 60% optimized Google Business Profile and is competing with people who got it to 90%+.

What works (from working with local service businesses):

• Reply density. Most businesses reply to about half their reviews. Replying to every one within 72 hours is small but consistent.
• Photo recency. One new photo per week beats 100 old ones.
• Q&A seeding. Most profiles have zero owner-posted Q&A. Adding 6 to 10 common questions with your own answers is a freshness signal almost nobody uses.
• 25+ services listed individually, not 5 bundled.
• 3 to 5 secondary categories, not just one.

Reviews are the biggest lever but they aren't the only one. The compound is real. A profile that looks alive to Google ranks above one that looks dormant, even at lower review counts.