Q4 2019 Earnings Call
Greetings and welcome to establish summit last fourth quarter and full year 2019 earnings conference call.
At this time, all participants are in listen only mode.
A brief question answer session will follow the formal presentation.
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I would now like to turn the conference with the host today Mr. Jeremy Feffer. Please proceed sir.
Thank you operator, and thank you everyone for participating on today's call.
Joining me from the company, a one realization cone curios, Chief Executive Officer, and rig I Gotta Chief Financial Officer.
Before we begin I would like to caution listeners the comments made by management. During this call will include forward looking statements within the meaning of federal Securities laws.
These include statements on establishment labs financial outlook and the company's plants in Tommy for product development in sales.
These forward looking statements involve material risks and uncertainties in the company's actual results may differ materially for discussion of risk factors I encourage you to review the Companys annual report on form 10-K that will be filed later today with the S. You've seen.
The content of this conference call contains time sensitive information accurate only as the date of Thislife broadcast March 16th 2020.
Except as required by law establishment labs undertakes no obligation to revise or otherwise update and statements to reflect events or circumstances. After the date of this call.
That said it was my pleasure to turn the call over to the company's Chief Executive Officer, Juan Jose check on Keyless Juan Jose.
Thank you Jeremy and good morning, everyone. Thank you for joining us today.
We are like everybody around the world extremely concerned with the humanitarian and economic crisis caused by the spread of Kobi 19, and we will certainly provide or thoughts on that today.
First and foremost you're working to protect the health of our employees and their families and we are in constant communication with our partners and plastic surgeons worldwide to help our patients however weekend.
Well, we grapple with the effects of Cobi 19, but it's still importantly to discuss the strength with which we finished 2019 the fundamentals that make a business strong in 2020 and the actions we are taking and can take to adapt as our industry and the world economy managed to reduce global challenge.
Yes.
Let's start by discussing our fiscal year 2019.
During the fourth quarter up 2019 revenue was $24.2 million, an increase up 47.9% over the same period of 2018 for the year revenue was $89.6 million, an increase of 46.3% or full year 20.
18.
These financial results or towards the high end of the preliminary revenue ranges, we announced in the press release on January 28, and is another record quarter made possible by the continued global adoption of MACI life plans.
It's shrink for your guidance for a high growth company like ours is challenging enough in the normal environment in an impossible task with the rapidly developing story of the novel Koby 19.
Prior to last week, we were planning to issue formal guidance for 2020, but given world event, you're going to if we go providing formal guidance today.
To help our shareholders think about or 2020 year, we would like to give some visibility into our first quarter results and that's up today, we anticipate revenue to be in the range of $23 million to $25 million.
Please remember that this is based off the best information, we have today and that we have factor in a significant impact to our business from Covey 19 in March.
Assuming a more normalized environment for first quarter, calling may be currently intend to issue formal guidance at that time.
I'm speaking with surgeons daily.
As do all of our commercial team members in plastic surgeons have indicated that they continue to operate as long as there are no restrictions in place by their government.
To date, most patients with schedule surgeries are having to surgeries performed.
Surgeries are seen some slowing however in medical tourism South Korea. For example, does have a portion of patients that come from China as Motiva is not available in the Chinese market and we expect those surgeries to being impacted.
If an increasing number of countries such as Italy need to mandate significant restrictions to get the spread of Cobiz 19 under control that will obviously impact or business more.
The fact that we already more than 80 countries is very important as the world response to Cobiz 19.
The diverse nature of our revenue approximately 30% Asia Pacific and Middle East, 40% Europe, 30% Latin America should provide some level of protection to our revenue as different regions will likely grappled with the worst of the virus at different times this year.
Of course, as I mentioned above we are not reliant on China for any primary aspect of our supply chain.
As we think about forecasting our business I can tell you that are executive team has decades of experience into breast implant industry. One of the core capabilities of our company is that we are agile in adaptable organization that has deep experience dealing with changing situations environments.
Disability is the reason multibillion plans have taken a commanding position in such diverse markets, such as Sweden, Colombia in South Korea.
Further our collective experience as a management team has started to following.
Woman interested in Reston Statics go to an extensive thoughtful and deliberate process.
If they had booked or surgery, and then extremist situation develops date may very well, we schedule or cancelled or surgery, but most of these women will ultimately opt to have this procedure once that situation has resolved.
This has not only being true during previous severe economic downturns. It has been true even when there has been a significant sustain negative news headlines about the breast implant industry.
As this situation resolved. We currently believe that we will be positioned to maintain the growth trajectory that we experienced before to spend dynamic start.
Whatever growth initiatives has been to employ a multifaceted marketing strategy, which includes social media engagement online advertising and patient and physician education.
We are taking this opportunity to optimize our digital media communication channels as Amena supporting training and communicating with our plastic surgeons and patients.
We're also pleased to have completed 69 million dollar public offering in January.
This gives us a very healthy cash position when we are managing this very carefully given all of these uncertainties.
During the fourth quarter of 2019, we used to $4 million to fund operations compared to $10.9 million for the third quarter 2019, and $8.5 million for the fourth quarter of 2018, we have done a full review other twentytwenty budget and.
As it's been done it continues to develop we are able to access a number of levers to reduce reallocate or suspend the expenditures. We can continue to manage our business with lower cash burn well into the future on the path to breakeven and cash flow positive.
Most importantly, the underlying fundamentals over business remains strong in our product brand and reputation in the market have significant momentum.
We have a very healthy cash position healthy gross margins and we are in a position to take the necessary steps to come out of this period stronger than others in our industry.
Turning now to the specific drivers of our Q4 performance I.
The increase market share was again driven by balanced growth across all regions of the world along with stronger sales of our ergonomics implants, which generally have higher average selling prices specifically was brilliant columbia outperform their distributor markets in Germany, and France showed strength in our direct.
Because we.
We continue to see this strength across the different regions of the world and are not beholden to a single region to drive for continued success.
The launch of our direct sales force across Europe in Brazil continue to positively impact our performance direct market revenue for the fourth quarter accounted for 45% over total revenue as compared to 41% of our total revenue for the third quarter.
Brazil was the strongest market in Twinkie 19 for the full year, Brazil generated 15.7% upward total revenue.
This was consistent with 2018, meaning that Brazil grew over 45% year over year, a testament to the success of our investments in commercial execution in the second largest global market for rest of settings.
Additionally, as we previously announced two of our new distributor markets last year, where Taiwan in Thailand, with the latter being one of the largest a static markets in Asia. These markets were strong in Q4 and into Q1 2020.
Although we continue to monitor developments closely in Asia in light up the ongoing endemic.
Improvements in gross margins with another highlight of our fourth quarter and food Quickie 19 result, gross margins for the fourth quarter were 67.5% of revenues, which is a significant improvement over 60.2% of revenues in the fourth quarter 2018.
Gross margins for the full year 2019 were 61.3% up revenues compared to 59% of revenues for the full year 2018.
Geographic expansion is a key part of our long term growth strategy as we work to become the global standards in breast aesthetics.
While we expect the U.S. and try not to be significant drivers of our long term growth by tripling. Our total addressable market. It is worth noting that we have a significant opportunity for organic growth into more than 80 countries in which multibank plants are currently commercially available.
Plastic surgeons continue to adopt our products in their practices I spoke to surgeons and patients talk about the benefit of our improved safety and patient outcomes.
Patient preference is one of the key drivers of our market share gains and we are continuing our efforts to reach out directly to potential patients.
During the fourth quarter, we announced the one millionth mckeever implant in market, notably is very significant milestone was achieved in only 10 years and with a complication rate of less than 1% for safety related events in our post market surveillance, which we publish quarterly.
Capsular contracture and implant rupture or two most common reasons for failure associated with breast implants.
You reviewed we prospective study of 2506 patients at up to three years reported complication rates, we must be by implants somewhat silk of zero point, 36% and reported no cases up device related infant rupture no cases of capsular contracture no double capsules in the late.
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Sure happy to see more scientific proof and clinical papers in peer reviewed publications with evidence of the unique safety profile of Multiband less Justine 2019 alone. We saw 11 papers published a multi language further confirmation of the science behind our technology and the clinical outcomes that we have ups.
Sure No quarterly post marketing surveillance since 2010, we expect more papers to be published in 2020, including additional papers on the scientific basis of our technology. The whites unique characteristics result in substantially reduce safety related complications hands on surgeon experience patient feedback.
And these publications are creating a groundswell of interest and adoption of our products and we believe the safety profile of Motiva relative to other implant products in the market is a driving force behind her continued growth in market share gains.
Our regulatory efforts continue to progress with geographic expansion for our current product offerings the path towards the approval of several new products. We have the most comprehensive portfolio of advance with implants worldwide and are continuing to build on these offerings.
We previously announced a five 10-K submission for smooth silk tissue expander in the U.S. and CE Mark registration Indeed, you.
These submissions are important milestone for our company and the tissue expander, we present, a meaningful addition to our product portfolio.
The advanced design upper tissue expander should fuel adoption into breast reconstruction market for all of our products.
We continue to work through the approval process with the respective regulatory bodies as we work to finalize our launch strategy.
As a reminder, or tissue expander is a substantial advanced for the industry as it includes our proprietary smoothed silk surface and is the only tissue expander with an integrated board with no madness, enabling the use of the expander safely alongside in MRI scanning.
This is really innovation that can make a substantial difference to oncologists plastic surgeons and patients and we'll have a real impact on women's health.
Turning to a minimally invasive breast augmentation initiative Motiva me up we began cases in Asia last December.
Similar to the introduction of minimally invasive surgeries in other medical specialties, we believe that bringing and minimally invasive breast augmentation to market has the potential to grow the worldwide total addressable market for breast aesthetics.
For the global plastic surgeon community, we are beginning to see a transition to smooth implants, which will take some time to complete textured and smooth in France have different surgical techniques and responsibly transitioning from one to the other does involve some education.
We have taken this ongoing transition as another opportunity to provide our industry, both surgeons and patients would further scientific details in medical education about our surface technology as we provide considerable medical education around the world. We believe the transition to smooth implants and more specifically multibillion.
Plant with our proprietary smoot silk surface will accelerate.
We are also dedicated to growing our intellectual property portfolio in our protecting the innovations that differentiate us from others in the market.
Last year, we announced that the U.S. patent office allow to keep patent applications covering our unique implant surface technology.
We are pleased to announce today that the patent office will issue that path and within a few weeks, we will continue to dedicate resources to developing innovations that improve patient outcomes and protect those innovations with a robust IP portfolio.
Turning now to or U.S. clinical trial, we are progressing in our F.D.A. pivotal I'd clinical trial for MACI by implants, you know that's up last year, we announced the completion of all surgeries in the aesthetic cohort and during the fourth quarter, we continue to make progress advancing the reconstruction cohort.
Importantly, or U.S. submission timelines for our Pmeight to the FDA remain on track due in large part to the bifurcation strategy that we discussed last quarter in light of the fact that we were able to complete the primary up plantation revision documentation cohorts, we intend to pursue submission for the aesthetic indications I head up our submission.
And for the reconstruction indications.
Recent communications with the FDA give us further confidence in this bifurcation strategy and we continue to take the necessary steps in this process.
With that I'd like to turn the call over to Renee discard the financials in detail Renee.
Thank you Juan Jose.
As long as I stated earlier, our momentum from the third quarter carried into Q4, and we are pleased again to report record revenues.
You can find additional details on our fourth quarter and full year financials in our earnings press release on our form 10-K.
Which we plan to file later today.
Total revenues for the fourth quarter was $24.2 million, which represents a 47.9% increase over the $16.4 million that we reported in the fourth quarter 2018.
Our reported fourth quarter revenue was also at the higher end of our preliminary range of 23, and a half million to 24 and a half million, we announced in our press release on January 28.
Total revenue for the year ended December 31st 2018.
With $89.6 million, representing a 46.3% increase compared to the full year of 2018.
I just wonder Jose mentioned revenue growth for this quarter once again, driven by double digit growth in our direct markets along with strong performance in our distributor markets.
Gross profit for the fourth quarter.
$16.4 million were 67.5% of revenues, which is a significant improvement over gross margin of $9.9 million or 60.2% of revenues in the fourth quarter 2018.
Gross profit for the year ended December 31st 2018 was $54.9 million or 61.3% of revenues.
Paired to gross profit of $36.1 million or 59% of revenues for the full year 2018.
The increase in the gross profit margin percentage was driven primarily by increased volumes and cost savings delivered by our manufacturing operations team.
Gross profit percentage was negatively impacted by 4% during the full year due to amortization related to the fair value of inventory recorded from an asset acquisitions of distributors in Q4 2018.
Total operating expenses for the fourth quarter 2018 were $20.8 million, an increase of 12.3% compared to $18.5 million for the fourth quarter 2018.
This was a decrease of 10% from $23 million from the third quarter 2018.
I see an expense increased $2.3 million or 15.5%.
$17.1 million from $14.8 million for the fourth quarter 2018.
The increase in I can't name was primarily due to increase in personnel costs, resulting from hiring additional sales personnel higher commissions and marketing expense.
Our research and development expenses were approximately flat at $3.6 million for the fourth quarter in comparison to the year ago period.
Research and development.
It continues to be a cornerstone for future growth and product portfolio.
For the full year 2018, total operating expenses for $85.8 million, an increase of $25.8 million compared to operating expenses at $69 in the same period in 2018.
<unk> expenses increased 23, and a half million dollars or 49.7%.
It's $70.8 million from $47.3 million in 2018.
Increasing asking is primarily due to an 11.7 million dollar increase in personnel costs from hiring additional sales and administrative employees.
3.7 million dollar increase in consulting and audit fees.
It 2.4 million dollar increase in sales commissions.
2.2 million dollar increase in marketing expenses.
A 1.2 million dollar increase in insurance costs.
And at 400000 dollar increase in freight cost.
Our sales force has grown to 94 employees and contractors from 67 in a year ago period, driven by the addition of our new direct market.
R&D expense.
Was $15 million or 16.7% of revenues as compared to 12.7 $9 were 20.7% of revenues in 2018.
The overall, increasing R&D expenses of $2.3 million is primarily attributable to our I'd. He clinical trial in the last.
Net loss for the fourth quarter, 2018 was $5.5 million as compared to net loss of $10.5 million for the same period in 2018.
Net loss for the full year 2018, $38 million as compared to net loss of $21.1 million in 2018.
Our cash position remains strong.
We held a cash balance of $37.7 million as of December 31st 2018, and in January raised $69 million from a successful public offering of our common stock issuing approximately 2.6 million shares at $26 in 25 cents per share.
During the quarter, we used $4 million to fund operations compared to $10.9 million for the previous quarter and $8.5 million for the fourth quarter 2018.
The year ended December 31st 2018, total cash used in operations for $30 million, a reduction of 11% compared to 2018.
We are focused in further reducing cash burn in 2020 and beyond but that target of at least 20% reduction.
Cash used in operations and 2020.
Especially in light of current events, we've done a full review of our 2020 budget and as the situation develops we had strategies in place to bring this target down further as needed.
We are taking this pandemic very seriously and have developed in number of models and operating plans.
It would allow the company to get to cash flow breakeven with the cash that we have on hand at Cobiz 19, disrupts global Commerce and health care for an extended period of time.
Do I know in a positive now I'd like to tell you that our cash position has never been stronger.
And that our financial position continues to improve and scale in support of our global growth that we've been experiencing.
I'll now turn the call back over to upon Jose for some concluding remarks on Jose.
Thanks running.
I could not be more pleased with our performance in trajectory.
It is clear to me that the investments we have made in research and development over the last 10 years are now the driving force behind or commercial success and growth.
Committed to continuing this innovation to drive or success for the next decade, and I am confident that we can beat the market leader in bringing unmatched innovation to breast aesthetics and reconstruction.
The very nature of our industry has prepared or management team to manage through challenging an unexpected situations and we are operating our very best in such an unprecedented times with that I would hand, the call over to the operator for today.
Thank you.
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One moment why people for our first question.
Our first question comes from Raj Denhoy with Jefferies. Please proceed with your question.
Hi, good morning.
Maybe I could start with the pace of surgeon training currently you know given the unprecedented times. We're living in are you still seeing interest on the order of surgeons to get trained on look even plants into started adopting there your technologies.
[noise] yeah, good morning, rash and yeah, I think it's a great question because you know we conduct a lot of medical education events month to month, it's one of our core capabilities and you know with everything that is going on around could be 19 of course to protect our employee.
He's and also our surgeon partners, we are having to for go face to face a medical education at this point no. We are switching our medical education to digital online training platforms. We've done this before well just put 'em you know more of an emphasis over the next couple of money.
[laughter] to do this through digital means but definitely I think that it is an opportunity for us to be able to grow our digital platform in medical education. So that into future. We can use is to be able to contact and trained surgeons, even further than just would face to face medical education.
Okay.
Okay and maybe this is a corollary to that are you seeing we'd be interested in a sense no Brazil, you've been doing quite a bit of training insurgent conversion.
Hi, just has the pace at which surgeons are reaching out or which they're agreeing to be trained on motiva implant says that he slowed.
No actually to the contrary would we have seen is that in the international market, where most surgeons were using textured breast implants for all of their careers. What they are doing right now is understanding that they need to learn how to use with implants. So maybe they.
He will continue to use texture implants for quite some time, but having that into back pocket. It's an important thing for them. So we actually are seeing a lot of surgeons contacting us to be part of our medical education strategies.
That's helpful. Maybe Renee to stay in terms of your commentary around your groups. The plans that are in place to reduce.
Cash use spending are there specific areas that you're thinking about targeting the company had outlined potentially expanding capacity I'm supposed to recur building other facility or there is that you're thinking about I'm pulling back in if you need to on spending.
[noise] you know for US, we're certainly focused on making sure that the I'm commercial aspect of our organizational moves forward and focusing on like Juan Jose mentioned on that <unk> medical education, but we're really looking at alternative plans across the board and what that means for US is looking at ways that we.
You can either <unk> or.
Also the plan to still got the end goal.
You know for it as you mentioned with the construction of the new facility you know just simply altering those plants from a cash flow perspective, but ultimately still trying to hit our end target as we watch this pandemic roll through you know if it if it's a shorter timeline, but everyone gets back on pace and then we're gonna be poised to to be able to jump right backend.
Fair enough, maybe just my last question Juan Jose you're not getting I. Appreciate everything is very fluid, but prior to that the covert 19 outbreak in what's happening globally. You know the street had been looking for something around low 20% growth for you. This year I think it was 23% and I. Appreciate you taking guidance off the balance thier, but where would you have been comfortable with it.
Broke rate like that would that have reflected the momentum we've seen in the business.
Yeah. The short answer is absolutely yes.
Okay fair enough. Thank you.
Our next question comes from Josh Jennings with Cowen. Please proceed with your question.
Hi, good morning, Thank you.
Open I understood appreciate the the way you guys have positioned guidance and.
Given the first quarter targets you know the midpoint suggests kind of stable revenue performance sequentially.
And I think it might be helpful. Just this year I know you mentioned in South Korea, and Japan, and probably the longest exposure in Q1.
To to the covert outbreaks talks about medical tourism being down in South Korea, but I mean any other color you can share just in terms of those two markets and now it's impacted establishment and once you so far.
Yeah. Thank you Josh.
Really Stuttgart too early to tell the full impact I think one of the you know strengths that we haven't establishment labs is that you know the fact that we are present in over 80 countries. So that you know mitigates the magnitude of or the ongoing pandemic.
In a place like South Korea of course deal synergies have been really good at acting quickly to contain the spread of the virus. So we are hopeful that this will result in a rapid resolution of the situation and everything couldn't go back to normal in in South Korea, but I think the more important thing.
Is that you know we do have unimportant situation ongoing but you know we are a flexible agile organization and we you know we've been adapting to complex environments way before just happened.
In the 80 countries that we are in so we feel pretty strongly that you know we will be able to use that that spread of revenue to our favre and that's one of them most important things as we get through this.
Understood. Thanks, and then just was hoping that we could talk about the regional competitive landscape and specifically competitor companies outside of our again and mentor and maybe the polytech since you see a six of the world.
Maybe just understand what percentage international market. They represent and then second with respect to Cobi 19 related downturn. It seems as if establishment, especially after this capital raise is best positioned relative to its regional players to manage through all the others may be vulnerable I'm up you have any thoughts on on that.
Yeah actually post the Allergan global recall outdoor textured implants.
These regional players would present roughly 40% of the world market.
But I would I would say is that for us. The important thing is that you know we have a singular focus on breast surgery. So this is something that will allow us to move faster than our bigger global competitors.
And yes, I think D. The regional competitors are dealing with many challenges like you know in the increased regulatory scrutiny that brings about a lot of increased cost and scare asking scarce access to capital as always you know it establishment labs, what we will do is continuing to work hard to get as much ahead from the situation.
So we think that you know we are poised to come out of this crisis with potential larger market shares games.
Great and then lastly from me just on me.
I understand you guys have been number procedures under your belt any incremental details you can share just one of these early experience in Japan, and then whether or not plans to expand or have been put on pause just because of this cope at 19 pandemic Oh, thanks for taking all the questions.
Yes, Thank you Josh.
Well, we're very happy with the results from the first cases.
That were performed a with me and Asia and a you know we are looking ahead to new cases being done and and you know so far the results are very encouraging for us.
Now as you just mentioned of course, you know could be 19 does slow down practices in several countries and that includes of course, you know our ongoing clinical work. So definitely we think that as Japan gets out of this situation, we will see more cases happening, but the proof of concept is done.
And then you know we're very happy to do you see this as an opportunity for the expansion of the market and I think as we come out of this pandemic, what's gonna be important to surgeons is how can I grow my practice, how can I get you know patients to my office and things like me a are you know long term drivers.
Market expansion. So we think about you know deep total addressable market and how we can expanded into future me. A is definitely you know at the top of our list.
Our next question comes from a read the ball with BTI Ji. Please proceed with the question.
Hi, Good morning, Thank you for taking the questions [noise].
I would just love a reminder, I you had some strong progress on the gross margin front can you remind us kind of high level geography is where gross margin you know I've been very strong versus very weak sort of as we think about the potential impact that cover 19.
Sure. Thanks, sorry, Yeah definitely you know we tend to see higher gross margins of course in markets, where were direct and that would be have more heavily weighted towards Europe, just given that our direct presence there and ask piece that those regions are those countries can generate.
But we do have a pretty healthy mix I would say across the board in our distributor markets sort of a wide range, but I would say, it's more heavily weighted towards direct markets in Europe.
Okay. Thank you for that detail and then I guess my other question as you know I know that Costa Rica. Unlike many countries across the world are getting prepared for you know larger outbreak can you tell us a little bit about how might that might impact some of your.
Manufacturing operations there on the ground in Costa Rica.
Yes, absolutely no one of the key things for US is to protect our employees. During this period, while we continue to serve the plastic surgery community and our distribution partners worldwide. So it is important to balance those two at the you know the current time, we have full management.
Crisis mode here at the facilities in Costa Rica to make sure that if there was any outbreak in into facility. We can contain it immediately now one of the key things is that we have various no healthy socket products in our distribution centers worldwide. So we can if we weren't you have a disk.
No. It production shutdown, we can still be very flexible in you know with all the stock of product that we have it did this friend distribution centers, but so far you know situation here in Costa Rica is progressing we have a very strong health system in this country. So it is very important to us to work with the authorities as we prepare.
After employees.
Thank you, so much where that detail and good luck.
Our next question comes from Chris Cooley with Stephens. Please proceed with your question.
Good morning, and thank you for taking the questions.
At this point, maybe if you wouldn't mind just going back on the regulatory pathway could you, maybe just update us a little bit more a little bit more detailed recording of the reconstructive cohort I realize that was.
Framework in which the company was pursuing.
Just just kind of curious, but how far along you mentioned you continued to make progress, but we're now obviously moving forward with anesthetic filing for so just any additional color you could provide they're not have a quick follow up thanks. So much.
Thank you Chris Yeah, I think one of the most important things here is to remind everyone that we finished older surgeries in the aesthetic cohort back in August of 2019, So given our bifurcation strategy, we do plan to get approval for Statics, which represents you know over 80% of yours.
Market ahead of our reconstructive indication now of course, we continue to focus on getting that reconstructive indication cohorts done quicker.
But eventually you know this could be 19 is catching up with you know the many hospitals that do perform to reconstructive surgery.
So I I, perhaps can give you a little bit of an update of things that we will do during this period. So you know one of the things that we are doing is to actively assessing and developing a plan with immediate implementation to minimize the impact and maintain the study goals. So we are have developed the.
Virtual follow up visits plan in collaboration with.
I or B and this has been already communicated to the FDA and this has done to uphold our patient safety, but also to minimize the impact on enrollment during this period and on Pollo up.
So you know I think that by next call, we will be able to give you more color on on the impact, but I would say that before this started you know are we construct imports were continuing to enroll nicely.
Appreciate that color and then just for my follow up I think during the last unfortunate financial crisis. We were all certainly myopic looking at results of mentor and then about here in the United States, but whats called the 19 being a global pandemic can you just remind us.
How the international markets responded.
More specifically I'm looking for that large referrals for the patients to.
But to postpone other surgeries what was that was sort of sort of one quarter. It wasn't a two quarter phenomenon can you just maybe talk to that are kind of returned to the market that we saw after the whilst prices are outside of the United States and I'm sure. There a region. So just any additional color you have about us.
Most beneficial thanks again.
Yes. Thank you.
I think one of the key things and you know as it goes back to the 20 always prices. It goes back to all the situation around be a LCL and the negative news cycle and that is it you know the patients that go for you know breast augmentation they tend to be very committed.
Good to talk to this procedure and they have done an extensive you know amount of research. They usually have gone through an entire process with the plastic surgeons and several different consultations and they have taken a decision. They may put phone that decision given you know the current situation, but you're basically.
Stockpiling you know do use cases for you know for them to happen. After this situation is resolved during the 20 opioid crisis the impact in the international market. It was actually mild you could call. It you know that the market stayed flat, but it certainly did not come down.
So I think that it is important to remind everyone that you know there's a difference between static elective surgery and other elective surgeries that we see like knee surgery or spine surgery that people may access.
You know what difference in the Statics is that no number one most of these procedures get done at specialized static surgery centers a lot of these sensors are owned by the plastic surgeons. So they have the ability to scale up these procedures. They don't have to be an waiting list to have these operations happen. So I think.
You know what we are looking for is to support our plastic surgeons and getting back to business as quick as possible. Once the situation is resolved, but we're very mindful that in previews situations.
He is static breast surgery market has stayed very healthy.
Thank you.
Thank you at this time I would like to turn the call back over to management for closing comments.
Thank you and thank you everyone for joining us today in our earnings call. We look forward to providing our next quarterly update in May we wish you a very good day in good health.
Thank you. This does conclude today's teleconference. You may disconnect. Your lines at this time and thank you for your participation have a great day.