This is for a cosmetic surgeon office.

I would like to set up campaigns by Geographic location, like east side, west side north or other city but at the same time is it better to structure a campaign by services offered ?

I would think Geographic location may be more important ?

I would suggest organizing the campaign structure by Services and then using the Geographic location settings to show your ads where you want to.

The only problem that can arise with such a structure is when you are offering different services depending upon which geographic location it is.

If you have the same services for all locations- then you can simply duplicate the Ad groups for each region and use a customize Ad text for that region
to increase the CTR.

I'd arrange my account by setting up different campaigns for each region and then subdividing each region into different services via different ad groups. Reason being, at ad group level you can not setup geographical targeting.

Do let us know how you finally set them up very interesting thread, this one!