Conversion pixels are never 100% accurate (and are becoming increasingly inaccurate due to browser/OS changes) and shouldn't be used to say "This ad generated exactly X sales that wouldn't have happened otherwise!", but you can examine the relative rates from people who saw or didn't see your campaign.
I've also seen companies who don't trust FB/G to grade their own homework on a known lift study, so they measure the effect by running PSA ads. Their ad campaign will be something like "Donate to charity XYZ!" but will be set to measure purchases on their website. That lets them establish the baseline purchase rate of the customers in their audience.