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First  question. Tummy tuck is a unique procedure in itself i am guessing, so using NY in the title would benefit you a lot. For example just speaking generally, if you use a deep target keyword such as , albany-ny-tummy-tuck , You might be limited on the traffic you get but will be good traffic. Vs using ny-tummy-tuck. My personal experience, specially dealing with unique niche items, I think a person from manhattan would want to go to albany to get a tummy tuck. So that being said a broader net for that keyword would be awesome. Side Notes: A. you need to use your company info " full address " on every page. Either site wide footer to be indexed or text on every page. B. To benefit best for that local based seo signal you need to make sure all your citations are in order. Use yext.com. AWESOME time saving and a must if you want to compete locally. Or you can manually make the changes but does take a lot of time. Second question, i would recommend looking at what is the most traffic driven long tail or medium size keyword that would benefit you and put that as close to the main directory as possible. ie: Home/ Procedure / Tummy Tuck . It would awesome if you can post your current Site structure and maybe we can help you structure it better, Hope it helps Hampig M Bizdetox.