So you are an SEO God. You can effortlessly stream important ingredients like meta, title, keyword density, alt image naming, sitemaps, and fast load. Unless you are optimizing for a business located in the center of a very small town, you've been left behind. The SEO world had become too populated with SEO Jedi Masters all using the same tactics; relevant search results suffered.
Continuing the analogy, an endorsement from the president of United States probably carries more weight than an endorsement from your neighbor. To get placed in the top 10 spots you need to focus on building endorsements (aka, off-page links) to supplement your brilliant on-page SEO techniques. This requires a more creative strategy but when done correctly can show huge results.
The majority of off-page SEO tactics involve techniques focused on social media, blogging, and link building. Basically, you are seeking endorsement and popularity votes from outside websites. The more relevant, the better.