Increase in SERP for local keyword

Hi, guys!

I first want to thank BHW for everything it has done for me. In the past 9 months, I have been making money with local SEO thanks to a few success stories and WSO's I downloaded from here.

I have one client, a plastic surgeon, who pays me just under $2k monthly to do SEO on his site. The problem is, I have been stagnant at position 5 for the entire 8 months of working for him. I also redesigned his site with a template I found, and I've recently made youtube videos to help with promotion. He seems very pleased with my work, but him being at position 5 for so long scares me. I promised him that I could get him to position 1. I know that wasn't the best idea, but I believed(and still believe) that I can deliver on that promise. I've bought some .gov links from here, as well as a web 2.0 link pyramid from fiverr.

How can I get my client to a higher position on the first page? I'm starting to look for new clients, and I want to use him as a reference. Any ideas? I seem to have gotten to the position I'm at strictly based on my onpage optimization.

Any help would be great, and again I thank BHW and all its members for my success!

Bump.

1st ypu must Setting your Offpage and Onpage SEO
next. built good contents and title.
next. go blog walking and cooment it with your blog [relevan blog]

PIng IT

Do onpage first then of page
ONPAGE

1. 
   [*=1]Title: Begin with keyword, at least 3 words, at most 65 chars
   [*=1]URL: permarlink contains keyword
   [*=1]Meta Tag: contains keyword, maximum 160 chars, try to begin meta tag with keyword and have 2 keywords in it.
   [*=1]Using Heading tag: one h1 tag in your article (h1 contains keyword), using h2, h3, h4 with keywords in them
   [*=1]Content: at least 600 words (for me 800 words), keyword density is 1,0-2,5%, try to insert your keyword in the first 100 chars. Your article must has at least 1 pic, and pic must has alt tag (alt="your keyword ....."). YOur article must has at least 1 bold keyword, 1 italic keyword, 1 underline keyword, Anchor text contain keyword has at least 1 External link (try to link to webpage has high authority like wiki....) , Anchor text contain keyword has at leat 1 Internal link (for me: 4 or 5 ). Keyword must appeare in the last 100 words.

OFPAGE
Blog commenting with ******** blog, you can get this list by using google. Comment with your keyword and your url.
Let try with pyramid link building. Try this list http://www.blackhatworld.com/blackh...79104-do-follow-list-web-2-sites-pr9-pr2.html