Q1 2026 Establishment Labs Holdings Inc Earnings Call

May 6, 2026

Operator: Good morning. Welcome to Establishment Labs' Q1 2026 earnings call. At this time, all participants will be in listen-only mode. At the end of this call, we will open the line for question-and-answer session, and instructions will follow at that time. As a reminder, today's call is being recorded. I will now turn the call over to Malavika William, Global Head of Corporate Communications and Marketing. Please go ahead.

Speaker #2: An instructions will follow at that time. As a reminder, today's call is being recorded. I will now turn the call over to Malavika William, Global Head of Corporate Communications and Marketing.

Speaker #2: Please go ahead. Thank you, Operator, and thank you, everyone, for joining us. With me today is Peter Caldini, our Chief Executive Officer and Sandra Harris, our Chief Financial Officer.

Malavika William: Thank you, operator, and thank you everyone for joining us. With me today is Peter Caldini, our Chief Executive Officer, and Sandra Harris, our Chief Financial Officer. Following our prepared remarks, we'll take your questions. Before we begin, I would like to remind you that comments made by management during this call will include forward-looking statements within the meaning of federal securities law. These include statements of Establishment Labs' financial outlook and the company's plans and timing for product development and sales. These forward-looking statements are based on management's current expectations and involve risks and uncertainties.

Speaker #2: Following our prepared marks, we'll take your questions. Before we begin, I would like to remind you that comments made by management during this call will include forward-looking statements within the meaning of federal securities law.

Speaker #2: These include statements of establishment labs as financial outlook and the company's plans and timing for product development and sales. These forward-looking statements are based on management's current expectations and involve risks and uncertainties.

Speaker #2: For a discussion of the principal risk factors and uncertainties that may affect our performance or cause actual results to differ materially from these statements, I encourage you to review our most recent annual and quarterly reports on Form 10-K and Form 10-Q, as well as other SEC filings, which are available on our website at establishmentlabs.com.

Malavika William: For a discussion of the principal risk factors and uncertainties that may affect our performance or cause actual results to differ materially from these statements, I encourage you to review our most recent annual and quarterly reports on Form 10-K and Form 10-Q, as well as other SEC filings which are available on our website at establishmentlabs.com. I'd also like to remind you that our comments may include certain non-GAAP financial measures with respect to our performance, including, but not limited to, sales results, which can be stated on a constant currency basis or EBITDA, which we disclose on an adjusted EBITDA basis. Reconciliations to comparable GAAP financial measures for non-GAAP measures, if available, may be found in today's press release, which is available on our website. The content of this conference call contains time-sensitive information, accurate only as of the date of this live broadcast, 6 May 2026.

Speaker #2: I'd also like to remind you that our comments may include certain non-GAAP financial measures, with respect to our performance, including but not limited to sales results, which can be stated on a constant currency basis or EBITDA, which we disclose on an adjusted EBITDA basis.

Speaker #2: Reconciliations to comparable GAAP financial measures for non-GAAP measures, if available, may be found in today's press release, which is available on our website. The content of this conference call contains time, sensitive information, accurate only as of the date of this live broadcast, May the 6th, 2026.

Malavika William: The content of this conference call contains time-sensitive information, accurate only as of the date of this live broadcast, 6 May 2026.Except as required by law, Establishment Labs undertakes no obligation to revise or otherwise update any statement to reflect events or circumstances after the date of this call. With that, it is my pleasure to turn the call over to Peter.

Speaker #2: Except as required by law, establishment labs undertake no obligation to revise or otherwise update any statement to reflect events or circumstances after the date of this call.

Malavika William: Except as required by law, Establishment Labs undertakes no obligation to revise or otherwise update any statement to reflect events or circumstances after the date of this call. With that, it is my pleasure to turn the call over to Peter.

Speaker #2: With that, it is my pleasure to turn the call over to Peter. Good morning and thank you for joining us. Q1 2026 was a strong start to the year, with 59.9 million in revenue and adjusted EBITDA of 1.2 million.

Peter Caldini: Good morning, thank you for joining us. Q1 2026 was a strong start to the year, with $59.9 million in revenue and adjusted EBITDA of $1.2 million, representing revenue growth of 45% over Q1 2025. The US business continued to outperform with $19.6 million of revenue, a growth of 216% over Q1 2025, and quarter-over-quarter growth of 13.3%. It's worth noting that Q1 is a seasonally light quarter for breast augmentation and reconstruction. To grow quarter-over-quarter is a testament to the strength and acceleration of our US launch. Outside the US, we delivered 15% growth driven by strong execution on both our direct and distributor markets. Our minimally invasive platform is showing immense promise as well, generating $9.1 million in revenue in Q1.

Speaker #2: Representing revenue growth of 45% over Q1 2025. The US business continued to outperform, with 19.6 million of revenue—a growth of 216% over Q1 2025—and quarter-over-quarter growth of 13.3%.

Speaker #2: It's worth noting that Q1 is a seasonally light quarter for breast augmentation and reconstruction, so to grow quarter-over-quarter is a testament to the strength and acceleration of our US launch.

Speaker #2: Outside the US, we delivered 15% growth, driven by strong execution on both our direct and distributor markets. Our minimally invasive platform is showing immense promise as well, generating 9.1 million in revenue in Q1.

Speaker #2: At the same time, we had our third quarter of positive adjusted EBITDA, our gross margin improved by 350 basis points in Q1 2026 to 70.7%, up from 67.2% in Q1 2025.

Peter Caldini: At the same time, we had our Q3 of + adjusted EBITDA. Our gross margin improved by 350 basis points in Q1 2026 to 70.7%, up from 67.2% in Q1 2025. We refinanced our credit facility and expect to reach cash flow positive in the H2 of the year. Our increasing profitability is demonstrating the operational leverage in our business as well as our ability to generate meaningful earnings per share in the coming years. We continue to be conservative as we forecast our business due to the geopolitical landscape as well as our hyper-focus on achieving and scaling a cash flowing positive business.

Speaker #2: We refinanced our credit facility and expect to reach cash flow positive in the second half of the year. Our increasing profitability is demonstrating the operational leverage in our business, as well as our ability to generate meaningful earnings per share in the coming years.

Speaker #2: We continue to be conservative as we forecast our business due to the geopolitical landscape as well as our hyper-focus on achieving and scaling a cash-flowing positive business.

Speaker #2: As such, we are raising our guidance to 266.5 to 268.5 million dollars, up from a previous range of 264 to 266 million. Our confidence comes from the strong start we are having in Q2.

Peter Caldini: As such, we are raising our guidance to $266.5 to 268.5 million, up from a previous range of $264 to 266 million. Our confidence comes from the strong start we are having in Q2. We are setting new weekly highs in our US order counts. We expect our growth to continue throughout 2027 as well. As we've mentioned on our prior calls, there is a good likelihood we may be included in several indices, beginning with the Russell 2000. As we're seeing increased interest from firms that benchmark to these indices, we thought it would be helpful to provide an overview for those being introduced to our company for the first time. The robust growth we reported this quarter is a reflection of our work since 2011.

Speaker #2: We are setting new weekly highs in our US order counts. We expect our growth to continue throughout 2027 as well. As we've mentioned, our prior calls, there is a good likelihood we may be included in several indices beginning with the Russell 2000.

Speaker #2: As we're seeing increased interest from firms that benchmark to these indices, we thought it would be helpful to provide an overview for those being introduced to our company for the first time.

Speaker #2: The robust growth we reported at this quarter is a reflection of our work since 2011. Establishment Labs is a women's health company focused on transforming breast aesthetics and reconstruction through innovation.

Peter Caldini: Establishment Labs is a women's health company focused on transforming breast aesthetics and reconstruction through innovation. Since the moratorium on breast implants in the US was imposed in 1992, this category has seen very little meaningful innovation. As a result, patient behavior, surgeon adoption, and overall market growth has remained relatively static. Establishment Labs was founded on the belief that a deep investment in science could fundamentally improve existing technology and provide better options for women. From the beginning, we reexamined every aspect of the breast implant, from surface technology to manufacturing, leveraging advances in material science, biomedical engineering, and device design. This work is reflected in a robust intellectual property portfolio with more than 200 patents issued and pending worldwide. In 2015, we brought on Dr. Robert Langer to lead our scientific advisory board.

Speaker #2: Since the moratorium on breast implants in the US was imposed in 1992, this category has seen very little meaningful innovation and, as a result, patient behavior, surgeon adoption, and overall market growth has remained relatively static.

Speaker #2: Establishment Labs was founded on the belief that a deep investment in science could fundamentally improve existing technology and provide better options for women. From the beginning, we reexamined every aspect of the breast implant, from surface technology to manufacturing.

Speaker #2: Leveraging advances in material science, biomedical engineering, and device design, this work is reflected in a robust intellectual property portfolio with more than 200 patents issued and pending worldwide.

Speaker #2: In 2015, we brought on Dr. Robert Langer to lead our scientific advisory board. Bob Langer is one of the most accomplished scientists of the 21st century and his contributions are behind the founding of several prominent companies.

Peter Caldini: Robert Langer is one of the most accomplished scientists of the 21st century. His contributions are behind the founding of several prominent companies. His work at MIT continues to impact science at the highest levels. Our partnership resulted in a seminal paper for plastic surgery. Published in Nature Biomedical Engineering in 2021, this paper focused on breast implant surface technologies and highlighted that the 4-micron surface, which was intentionally designed to enhance biocompatibility, consistently demonstrated low inflammation. These results explain how Motiva implants outperform the category. The US FDA clinical trial matched both our research findings and clinical data from around the world and is, quite frankly, game-changing. All these data points show device-related complication rates at new industry lows, including capsular contracture rates of less than 1%.

Speaker #2: His work at MIT continues to impact science at the highest levels. Our partnership resulted in a seminal paper for plastic surgery, published in Nature Biomedical Engineering in 2021.

Speaker #2: This paper focused on breast implant surface technologies and highlighted that the 4-micron surface, which was intentionally designed to enhance biocompatibility, consistently demonstrated low inflammation.

Speaker #2: These results explain how Motiva implants outperform the category. The US FDA clinical trial matched both our research findings and clinical data from around the world and is quite frankly game-changing.

Speaker #2: All these data points show device-related complication rates at new industry lows, including capsular contraction rates of less than 1%. To put this in perspective, the FDA trials for competitive products have device-related complications rates that are upward to 20%, and in some cases, the complication rates far exceed 20%.

Peter Caldini: To put this in perspective, the FDA trials for competitive products have device-related complications rates that are upward to 20%, and in some cases, the complication rates far exceed 20%. Perhaps most interesting is our extended global warranty data. With over 49,000 warranties sold and only 377 claims submitted, the resulting complication rate is less than 1%. We publish this data annually on our post-market surveillance report and are the only company in the industry that publicly shares this information, which you can find readily available on our company website. Fear of complications are one of the top barriers for patients when considering a breast augmentation. Having a product that has an outstanding safety profile helps to diminish that concern and provides extra peace of mind for both patients and surgeons.

Speaker #2: Perhaps most interesting is our extended global warranty data, with over 49,000 warranties sold and only 377 claims submitted, the resulting complication rate is less than 1%.

Speaker #2: We published this data annually on our post-market surveillance report and are the only company in the industry that publicly shares this information, which you can find readily available on our company website.

Speaker #2: Fear of complications are one of the top barriers for patients when considering a breast augmentation. Having a product that has an outstanding safety profile helps to diminish that concern and provides extra peace of mind for both patients and surgeons.

Speaker #2: Fewer complications lead to a happy patient and more referrals, which is the lifeblood for any plastic surgery practice. The significant technology moat that has been established is enhanced by our R&D pipeline of continuous innovation.

Peter Caldini: Less complications leads to happy patients and more referrals, which is the lifeblood for any plastic surgery practice. The significant technology moat that has been established is enhanced by our R&D pipeline of continuous innovation. Not only do we believe that we can take a substantial majority of breast implant market in time, we also believe we can significantly expand the market from where it is today. That is best evidenced by the launch of our Motiva minimally invasive platform. We have 2 minimally invasive procedures in market right now, Mia and Preservé. A 3rd is currently in development called GEM and is a revolutionary advancement for gluteal augmentation that should offer a safer, more predictable alternative to the Brazilian butt lift. Both Mia and Preservé are available outside the United States with a presence in more than 45 markets globally.

Speaker #2: Not only do we believe that we can take a substantial majority of breast implant market in time, we also believe we can significantly expand the market from where it is today.

Speaker #2: That is best evidenced by the launch of our Motiva minimally invasive platform. We have two minimally invasive procedures in market right now: MIA and Preserve.

Speaker #2: A third is currently in development called GEM and is a revolutionary advancement for gluteal augmentation that should offer a safer, more predictable alternative to the Brazilian butt lift.

Speaker #2: Both MIA and Preserve are available outside the United States, with the presence in more than 45 markets globally. While MIA is not yet available in the United States, we recently introduced Preserve to the US market.

Peter Caldini: Both Mia and Preservé are available outside the United States with a presence in more than 45 markets globally.

Peter Caldini: While Mia is not yet available in the US, we recently introduced Preservé to the US market. Both are built on tissue-preserving practices, which Establishment Labs has pioneered. They allow for the use of minimal anesthesia while preserving the patient's native breast tissue, nipple sensation, and chest muscles. Mia features the Motiva Ergonomix2 diamond-shaped implant, which has a unique shape that allows for greater projection than a conventional round implant as the shape creates more projection with less volume. It also includes a proprietary shell which allows insertion through the smallest incision possible within the Motiva portfolio. These characteristics make for a true scarless breast augmentation done by a small incision in the underarm. This procedure is meant for patients looking for a subtle enhancement with 1 to 2 cup size increase.

Speaker #2: Both are built on tissue-preserving practices, which establishment labs as pioneered. And they allow for the use of minimal anesthesia while preserving the patient's native breast tissue nipple sensation and chest muscles.

Speaker #2: MIA features the Motiva ergonomics 2 diamond-shaped implant, which has a unique shape that allows for greater projection than a conventional round implant as the shape creates more projection with less volume.

Speaker #2: It also includes a proprietary shell which allows insertion through the smallest incision possible within the Motiva portfolio. These characteristics make for a true scarless breast augmentation done by a small incision in the underarm.

Speaker #2: This procedure is meant for patients looking for a subtle enhancement with 1 to 2 cup size increase. Preserve can feature either the Motiva ergonomics 1 or 2 implants and accommodates both primary breast augmentation and primary breast augmentation mastopexy, offering patients smaller scars tucked under the breast crease and allows for larger sizes to be used.

Peter Caldini: Preservé can feature either the Motiva Ergonomix One or Two implants and accommodates both primary breast augmentation and primary breast augmentation mastopexy, offering patients smaller scars tucked under the breast crease and allows for larger sizes to be used. The launch of minimally invasive techniques into any specialty almost always dramatically increases the market. For example, there were approximately 95,000 total knee arthroplasty procedures in 1991. Between 2000 and 2005, minimally invasive knee procedures became the standard, and by 2010, there were approximately 250,000 procedures annually. In 2025 alone, this number rose to approximately 1.3 million, an increase of close to 14 times. This kind of growth exists in other major procedure types as well, such as LASIK eye surgery and fat reduction.

Speaker #2: The launch of minimally invasive techniques into any specialty almost always dramatically increases the market. For example, there were approximately 95,000 total knee arthroplasty procedures in 1991.

Speaker #2: Between 2000 and 2005, minimally invasive knee procedures became the standard, and by 2010, there were approximately 250,000 procedures annually. In 2025 alone, this number rose to approximately 1.3 million, an increase of close to 14 times.

Speaker #2: This kind of growth exists in other major procedure types as well, such as LASIK eye surgery and fat reduction. In the United States, our minimally invasive technologies command a premium over two times higher than traditional breast augmentation.

Peter Caldini: In the United States, our minimally invasive technologies command a premium over two times higher than traditional breast augmentation. If our overseas growth is any indication, we can expect that minimally invasive will create significant market expansion and be a meaningful driver of growth. The value proposition for patients is well-defined. Smaller scars, minimal anesthesia, preservation of tissue and sensation, and a faster recovery, combined with the safety and performance benefits of Motiva. Our initial three-year study on Mia was published in the Aesthetic Surgery Journal in October 2025 and showed no device-related complications. Like our FDA trial data, this is game-changing. It's clear that this procedure is fundamentally different from what has come before. Many women no longer view this as the traditional breast augmentation they once knew, but rather as a more accessible, almost lunchtime procedure where they can return to normal social activities within hours.

Speaker #2: And if our overseas growth is any indication, we can expect that minimal invasive will create significant market expansion and be a meaningful driver of growth.

Speaker #2: The value proposition for patients is well-defined, smaller scars, minimal anesthesia, preservation of tissue and sensation, and a faster recovery, combined with the safety and performance benefits of Motiva.

Speaker #2: Our initial three-year study on MIA was published in the Aesthetic Surgery Journal in October 2025 and showed no device-related complications. Like our FDA trial data, this is game-changing.

Speaker #2: It's clear that this procedure is fundamentally different from what has come before. Many women no longer view this as the traditional breast augmentation they once knew, but rather as a more accessible almost lunchtime procedure where they can return to normal social activities within hours.

Peter Caldini: Many women no longer view this as the traditional breast augmentation they once knew, but rather as a more accessible, almost lunchtime procedure where they can return to normal social activities within hours.

Speaker #2: Women that have never considered breast augmentation before are now getting the procedure, and we are expanding the market. RealSelf, a popular online platform for aesthetic patients, published last week that breast augmentation page views were up 45% from Q4 and that breast implant revision page views were up 89%, indicating that patients' interest in the category is surging.

Peter Caldini: Women that have never considered breast augmentation before are now getting the procedure, and we are expanding the market. RealSelf, a popular online platform for aesthetic patients, published last week that breast augmentation page views were up 45% from Q4, and that breast implant revision page views were up 89%, indicating that patients' interest in the category is surging. Not only do our patients benefit, our minimally invasive platform also has the potential to increase surgeon productivity, allowing surgeons to run 2 operating rooms, 1 where the patient is being prepped or the room is being cleaned, and the other where the surgeon is operating. We had 1 plastic surgeon that started surgery at 6:00 AM, and by 10:30 AM, he had completed 10 minimally invasive surgeries.

Speaker #2: Not only do our patients benefit, our minimal invasive platform also has the potential to increase surgeon productivity. Allowing surgeons to run two operating rooms, one where the patient is being prepped or the room is being cleaned, and the other where the surgeon is operating.

Speaker #2: We had one plastic surgeon that started surgery at 6:00 AM, and by 10:30 AM, he had completed 10 minimal invasive surgeries. Scheduling a minimally invasive procedure day like this.

Peter Caldini: Scheduling a minimally invasive procedure day like this can generate more than two times additional revenue for a practice. The introduction of our minimal invasive platform enhances the Motiva portfolio, creating a clear good, better, best framework. This allows the plastic surgeon to address a broader range of patient needs across the aesthetics outcomes, lifestyle consideration, and price points. This portfolio approach is not just about product breadth, it enables us to expand the category, increase procedure volumes, and drive higher value per procedure while giving surgeons the flexibility to tailor their solutions to each patient. Patients are now engaging with surgeons very differently than before. In a category where it was historically very unusual for patients to ask about implant brands, 78% of surgeons now report being asked for a brand by name, and in those cases, 93% of the time that brand is Motiva.

Speaker #2: Can generate more than two times additional revenue for a practice. The introduction of our minimal invasive platform enhances the Motiva portfolio, creating a clear good, better, best framework.

Speaker #2: This allows the plastic surgeon to address a broader range of patient needs across the aesthetics outcomes lifestyle consideration and price points. This portfolio approach is not just about product breadth; it enables us to expand the category increase procedure volumes and drive higher value per procedure while giving surgeons the flexibility to tailor their solutions to each patient.

Speaker #2: Patients are now engaging with surgeons very differently than before. In a category where it was historically very unusual for patients to ask about implant brands, 78% of surgeons now report being asked for a brand by name and in those cases, 93% of the time, that brand is Motiva.

Peter Caldini: In a category where it was historically very unusual for patients to ask about implant brands, 78% of surgeons now report being asked for a brand by name, and in those cases, 93% of the time that brand is Motiva.

Speaker #2: And now, just 18 months into our US launch, we are seeing the next step: patients are not only asking for Motiva, they are actively seeking out surgeons who are trained in minimally invasive procedures.

Peter Caldini: Now, just 18 months into our US launch, we are seeing the next step. Patients are not only asking for Motiva, they are actively seeking out surgeons who are trained in minimally invasive procedures. We expect to see a similar dynamic as we enter breast reconstruction in the United States, an opportunity that is equal in size to the breast augmentation market. We submitted Motiva implants to the US FDA for approval in primary and revision breast reconstruction in December 2025 and are currently progressing through the review process. I hope that reintroduction to our business was helpful and that the context explains our success to date. The US remains the most important driver for our growth. Motiva continues to be one of the fastest launches in the history of breast aesthetics, and we continue to expand our footprint, recently surpassing 1,700 accounts.

Speaker #2: We expect to see a similar dynamic as we enter breast reconstruction in the United States, and opportunity that is equal in size to the breast augmentation market.

Speaker #2: We submitted Motiva implants to the US FDA for approval in primary and revision breast reconstruction in December 2025, and are currently progressing through the review process.

Speaker #2: I hope that reintroduction to our business was helpful and that the context explains our success to date. The US remains the most important driver for our growth.

Speaker #2: Motiva continues to be one of the fastest launches in the history of breast aesthetics and we continue to expand our footprint recently surpassing 1,700 accounts.

Peter Caldini: Motiva continues to be one of the fastest launches in the history of breast aesthetics, and we continue to expand our footprint, recently surpassing 1,700 accounts.

Speaker #2: We are seeing increased adoption from higher volume surgeons who have moved beyond initial evaluation and are now fully committed to Motiva. This is reflected in our order growth where we have experienced 30% increase in average orders since the end of Q4.

Peter Caldini: We are seeing increased adoption from higher volume surgeons who have moved beyond initial evaluation and are now fully committed to Motiva. This is reflected in our order growth, where we have experienced 30% increase in average orders since the end of Q4. We officially launched our minimally invasive platform in the United States in March, and the response has been exceptional. While we initially trained surgeons on Preservé in our campus in Costa Rica, early demand was so strong we began training in the United States as well. This has allowed us to train surgeons at a much faster rate, and we have now certified more than 260 surgeons in the US. For context, our goal was to train 200 surgeons by the end of 2026, and we soared past that number by the end of Q1.

Speaker #2: We officially launched our minimally invasive platform in the United States in March, and the response has been exceptional. While we initially trained surgeons on preserve in our campus in Costa Rica, early demand was so strong we began training in the United States as well.

Speaker #2: This has allowed us to train surgeons at a much faster rate and we have now certified more than 260 surgeons in the US. For context, our goal was to train 200 surgeons by the end of 2026 and we soared past that number by the end of the first quarter.

Speaker #2: Those trained have shown a strong intent to purchase and we have seen relatively quick adoption with the first procedures being performed shortly after training.

Peter Caldini: Those trained have shown a strong intent to purchase, and we have seen relatively quick adoption with the first procedures being performed shortly after training. A surgeon in the Northeast recently shared that he began offering Preservé after being trained and promoted the procedure on social media. He now has 50 Preservé cases scheduled in Q2 at a 30% premium to his traditional breast augmentation price. Another surgeon in Southern California was thrilled that Preservé has completely changed her practice and that she is consistently seeing patients that had previously deferred surgery due to the concerns around anesthesia and recovery. When you remove historic barriers, you bring new patients into the market. A recent Preservé patient who is a Pilates instructor got her procedure done on a Saturday, went to dinner with friends that night, and was back teaching Pilates on Monday.

Speaker #2: A surgeon in the northeast recently shared that he began offering preserve after being trained and promoted the procedure on social media. He now has 50 preserve cases scheduled in Q2 at a 30% premium to his traditional breast augmentation price.

Speaker #2: Another surgeon in Southern California was thrilled that preserve has completely changed her practice and that she is consistently seeing patients that had previously deferred surgery due to the concerns around anesthesia and recovery.

Speaker #2: When you remove historic barriers, you bring new patients into the market. A recent preserve patient who has applied his instructor got her procedure done on a Saturday went to dinner with friends that night and was back teaching Pilates on Monday.

Peter Caldini: A recent Preservé patient who is a Pilates instructor got her procedure done on a Saturday, went to dinner with friends that night, and was back teaching Pilates on Monday.

Speaker #2: This kind of recovery is traditionally unheard of and for the first time, patients are truly returning to normal activity with the minimal downtime. In a recent survey conducted with 94 preserve patients, three months post-surgery, 98% stated that they experienced minimal disruption to their daily lives with 95% satisfied or extremely satisfied with the results.

Peter Caldini: This kind of recovery is traditionally unheard of, and for the first time, patients are truly returning to normal activity with a minimal downtime. In a recent survey conducted with 94 Preservé patients, 3 months post-surgery, 98% stated that they experienced minimal disruption to their daily lives, with 95% satisfied or extremely satisfied with the results. In addition, 15% of patients said they were new to the category and had not considered breast augmentation until they learned about Preservé. 84% of the Preservé patient survey said they were willing to pay a premium for the benefits of the procedure, with 99% saying that they would choose this procedure again. Outside the US, our business continues to perform well. We delivered approximately 15% growth with strong performance across our direct markets, which continues to be a major focus area for us.

Speaker #2: In addition, 15% of patients said they were new to the category and had not considered breast augmentation until they learned about preserve. 84% of the preserve patients surveyed said they were willing to pay a premium for the benefits of the procedure with 99% saying that they would choose this procedure again.

Speaker #2: Outside the United States, our business continues to perform well. We delivered approximately 15% growth with strong performance across our direct markets which continues to be a major focus area for us.

Speaker #2: Our minimally invasive platform continues to be a key driver for growth globally. It is interesting that surgeons generally view the two procedures as complements to each other and all me accounts are offering preserve.

Peter Caldini: Our minimally invasive platform continues to be a key driver for growth globally. It is interesting that surgeons generally view the two procedures as complements to each other, and all Mia Femtech accounts are offering Preservé, showcasing the value of a minimally invasive portfolio approach that provides patients options to meet their aesthetic goals. Preservé continues to attract surgeons to the overall Motiva portfolio. In our OUS markets, we are seeing strong growth across European direct markets, including the UK, Germany, Nordics, and our newly acquired Benelux affiliate. Continued stabilization in Latin America, with solid performance in Argentina due to the adoption of the Motiva minimally invasive platform, as well as steady demand across all our distributor markets.

Speaker #2: Showcasing the value of a minimally invasive portfolio approach that provides patients options to meet their aesthetic goals. Preserve continues to attract surgeons to the overall Motiva portfolio.

Speaker #2: In our OUS markets, we are seeing strong growth across European direct markets, including the UK, Germany, Nordics, and our newly acquired Benelux affiliate. Continued stabilization in Latin America with solid performance in Argentina due to the adoption of the Motiva minimally invasive platform, as well as steady demand across all our distributor markets.

Speaker #2: Our exposure to the Middle East remains less than 5% of total revenue limiting risk from regional volatility. In our US and OUS markets, we expect growth to continue to accelerate into 2027.

Peter Caldini: Our exposure to the Middle East remains less than 5% of total revenue, limiting risk from regional volatility. In our US and OUS markets, we expect growth to continue to accelerate into 2027. We also expect to continue the innovation pipeline by expansion in breast reconstruction in the United States, which effectively doubles our addressable market, gaining CE mark for Zenº, marking our entrance into biosensing capabilities, introducing smaller sizes to our US product matrix, and thus expanding our reach within existing counts, continue to develop our pipeline, including GEM, our gluteal augmentation solution. We also plan to submit for Health Canada medical device license for expansion in the Canadian market. As part of our overall strategy, we are taking steps to secure our future growth. This includes our signed agreement with Oaktree that refinances our debt and enhances our financial flexibility.

Speaker #2: We also expect to continue the innovation pipeline by expansion in breast reconstruction in the United States which effectively doubles our addressable market. Gaining CE mark for Zen temperature marking our entrance into biosensing capabilities.

Speaker #2: Introducing smaller sizes to our US product matrix and thus expanding our reach within existing counts. Continue to develop our pipeline including Gem, our gluteal augmentation solution.

Speaker #2: We also plan to submit for health Canada medical device license for expansion in the Canadian market. As part of our overall strategy, we are taking steps to secure our future growth.

Speaker #2: This includes our signed agreement with Oaktree that refinances our debt and enhances our financial flexibility. And finally, we are an active conversations with New Cell.

Peter Caldini: This includes our signed agreement with Oaktree that refinances our debt and enhances our financial flexibility.Finally, we are in active conversations with NuSil, our silicone supplier, as we both look to establish a long-term agreement. We've had strong working relationship with NuSil for the last 15 years, and our ongoing conversations are very focused on what we can accomplish together as partners. I will now turn the call over to Sandra.

Peter Caldini: Finally, we are in active conversations with NuSil, our silicone supplier, as we both look to establish a long-term agreement. We've had strong working relationship with NuSil for the last 15 years, and our ongoing conversations are very focused on what we can accomplish together as partners. I will now turn the call over to Sandra.

Speaker #2: Our silicone supplier as we both look to establish a long-term agreement. We've had strong working relationship with New Cell for the last 15 years and our ongoing conversations are very focused on what we can accomplish together as partners.

Speaker #2: I will now turn the call over to Sandra. Thank you, Peter. We delivered an exceptional start to 2026 with nearly 45% revenue growth. Growth margin expansion over 70% and our third consecutive quarter of positive adjusted EBITDA.

Sandra Harris: Thank you, Peter. We delivered an exceptional start to 2026 with nearly 45% revenue growth, gross margin expansion over 70%, and our 3rd consecutive quarter of positive adjusted EBITDA, demonstrating the strength, scalability, and operating leverage of our business. Total revenue for Q1 was $59.9 million, an increase of 44.7% from Q1 2025. Starting with our geographic performance, our business outside the United States remains the largest contributor to revenue and continues to perform well. In Q1, OUS revenue grew approximately 15% over Q1 2025, driven by strength across our distributor and direct markets, with direct markets delivering double-digit growth. Our exposure to the Middle East remains limited at less than 5% of total annual revenue. In the United States, we see strong momentum early in our expansion.

Speaker #2: Demonstrating the strength, scalability, and operating leverage of our business. Total revenue for the first quarter was 59.9 million dollars and increase of 44.7% from Q1 2025.

Speaker #2: Starting with our geographic performance, our business outside the United States remains the largest contributor to revenue and continues to perform well. In the first quarter, OUS revenue grew approximately 15% over Q1 2025 driven by strength across our distributor and direct markets.

Speaker #2: With direct markets delivering double-digit growth. Our exposure to the Middle East remains limited at less than 5% of total annual revenue. In the United States, we see strong momentum early in our expansion.

Speaker #2: US revenue reached $19.6 million in the quarter and now represents 32.7% of total revenue, up from 26.8% in Q4 2025 and higher than the 15% from Q1 2025.

Sandra Harris: US revenue reached $19.6 million in the quarter and now represents 32.7% of total revenue, up from 26.8% in Q4 2025 and higher than the 15% from Q1 2025. This growth reflects both continued adoption of Motiva and the March launch of our minimally invasive platform, which is contributing to higher realized price points. Our gross profit for Q1 was $42.3 million, or 70.7% of revenue, a 350 basis point increase compared to 67.2% of revenue in Q1 2025. This expansion was primarily driven by the increasing contribution of our higher margin US business, along with the growing impact of our minimally invasive platform, which carries higher average selling prices and margins.

Speaker #2: This growth reflects both continued adoption of Motiva and the March launch of our minimally invasive platform, which is contributing to higher realized price points.

Speaker #2: Our gross profit for the first quarter was 42.3 million dollars. Our 70.7% of revenue a 350 basis point increase compared to 67.2% of revenue in Q1 of 2025.

Speaker #2: This expansion was primarily driven by the increasing contribution of our higher margin US business along with the growing impact of our minimally invasive platform, which carries higher average selling prices and margins.

Speaker #2: SG&A expenses increased 3.9 million dollars to 43.6 million compared to 39.7 million in the first quarter of 2025. The increase was primarily driven by variable cost associated with higher sales including freight as well as the impact of foreign exchange with continued investment in the US business.

Sandra Harris: SG&A expenses increased $3.9 million to $43.6 million compared to $39.7 million in Q1 2025. The increase was primarily driven by variable costs associated with higher sales, including freight, as well as the impact of foreign exchange with continued investment in the US business. Excluding a one-time item, adjusted SG&A was $41 million or 68.4% of revenue, representing approximately 50 basis points of leverage versus the prior year as we begin to scale the business. R&D expenses for Q1 were $5.2 million, consistent with prior quarters. Adjusted EBITDA was +$1.2 million in Q1 compared to a loss of $12.1 million in Q1 of last year. This is our third consecutive quarter of positive adjusted EBITDA.

Speaker #2: Excluding a one-time item, adjusted SG&A was 41 million or 68.4% of revenue representing approximately 50 basis points of leverage versus the prior year as we began to scale the business.

Speaker #2: R&D expenses for the first quarter were 5.2 million consistent with prior quarters. Adjusted EBITDA was positive 1.2 million in the first quarter compared to a loss of 12.1 million dollars in the first quarter of last year.

Speaker #2: This is our third consecutive quarter of positive adjusted EBITDA. During the quarter, cash decreased 7.5 million to 68.1 million from December 31, 2025. The decrease was primarily driven by investments in the US market.

Sandra Harris: During the quarter, cash decreased $7.5 million to $68.1 million from 31 December 2025. The decrease was primarily driven by investments in the US market. We recently completed a refinancing of our debt, which enhances our financial flexibility, improves our liquidity profile, and introduces PIK interest that supports our path to cash flow generation. We have enough cash on hand to reach cash flow positive and have no needs or plans to do any type of equity financing. Following our strong performance in Q1, we are increasing our full year revenue guidance to $266.5 to 268.5 million, up from our prior range of $264 to 266 million. This represents growth of approximately 26% to 27% over 2025.

Speaker #2: We recently completed a financial flexibility improves our liquidity profile and introduces PIC interest that supports our path to cash flow generation. We have enough cash on hand to reach cash flow positive and have no needs or plans to do any type of equity financing.

Speaker #2: Following our strong performance in the first quarter, we are increasing our full-year revenue guidance to 266.5 million to 268.5 million up from our prior range of 264 million to 266 million.

Speaker #2: This represents growth of approximately 26 to 27 percent over 2025. We expect our OUS business to grow in the single digits while the US is expected to exceed 30% of total revenue for the year up from approximately 22% last year.

Sandra Harris: We expect our OUS business to grow in the single digits, while the US is expected to exceed 30% of total revenue for the year, up from approximately 22% last year. At $9.1 million in the quarter, our minimally invasive business is above expectations, and we now expect to exceed $35 million in 2026, up from the $30 million we guided to in February. We expect gross margins in the range of 71.2% to 72.2% for the full year. Operating expenses are expected to remain between $195 million and $200 million, with some variability in quarterly spending based on timing. We also expect to be adjusted EBITDA positive in each quarter of 2026.

Speaker #2: At 9.1 million in the quarter, our minimally invasive business is above expectations and we now expect to exceed 35 million dollars in 2026 up from the 30 million dollars we guided to in February.

Speaker #2: We expect gross margins in the range of 71.2% to 72.2% for the full year operating expenses are expected to remain between 195 million dollars and 200 million.

Speaker #2: With some variability in quarterly spending based on timing. We also expect to be adjusted EBITDA positive in each quarter of 2026. As it relates to cash flow, we are on track to achieve cash flow positive in the second half of the year driven by improved profitability and greater working capital efficiency.

Sandra Harris: As it relates to cash flow, we are on track to achieve cash flow positive in H2 of the year, driven by improved profitability and greater working capital efficiency. In the near term, we expect higher cash usage in Q2 compared to Q1, primarily due to the final $4.7 million payment related to the Benelux acquisition, the normal timing of the short-term incentive payouts, and continued investment to support the US commercial expansion, partially offset by $6 million of proceeds from our recent debt refinancing. We expect cash performance to improve meaningfully in Q3 and Q4, supported by increased profitability and the benefit of PIK interest of more than $5 million per quarter. Historically, Q2 and Q4 are the strongest quarters in the industry, with Q4 being the largest, while Q3 is typically softer due to summer seasonality.

Speaker #2: In the near term, we expect higher cash usage in the second quarter compared to the first quarter primarily due to the final 4.7 million dollar payment related to the Benelux acquisition, the normal timing of the short-term incentive payouts, and continued investment to support the US commercial expansion partially offset by 6 million of proceeds from our recent debt refinancing.

Speaker #2: We expect cash performance to improve meaningfully in the third and fourth quarters supported by increased profitability and the benefit of PIC interest of more than 5 million per quarter.

Speaker #2: Historically, Q2 and Q4 are the strongest quarters in the industry, with Q4 being the largest, while Q3 is typically softer due to summer seasonality.

Speaker #2: Operating expenses will be elevated in Q2 as we continue to invest in the US business. Despite this, we expect Q2 EBITDA to be approximately double that of Q1 reflecting the underlying operating leverage in the business.

Sandra Harris: Operating expenses will be elevated in Q2 as we continue to invest in the US business. Despite this, we expect Q2 EBITDA to be approximately double that of Q1, reflecting the underlying operating leverage in the business. With respect to index inclusion, 30 April marked the Russell reconstitution rank date. Based on our current market capitalization, we believe we are well positioned to qualify for inclusion in the Russell indices, with final membership to be confirmed in the coming months. With that, I'll turn the call back to Peter.

Speaker #2: With respect to index inclusion, April 30 marked the Russell reconstitution rank date and based on our current market capitalization, we believe we are well positioned to qualify for inclusion in the Russell indices with final membership to be confirmed in the coming months.

Speaker #2: With that, I'll turn the call back to Peter.

Speaker #1: Thank you, Sandra. As you think about our business, we hope we get a chance to interact with you at one of our many events we attend throughout the year.

Peter Caldini: Thank you, Sandra. As you think about our business, we hope we get a chance to interact with you at one of our many events we attend throughout the year. If you're interested in learning more, we selectively invite investors to visit us in Costa Rica at our innovation campus alongside our US plastic surgeon delegations. Investors have found this trip very useful in validating our business and the overall opportunity. We're also hosting a small dinner in Boston around The Aesthetic Meeting from 14 May to 17 May. If you're interested in either of these, please reach out as space is limited. I appreciate you taking the time to listen, and I hope to see you on the next call soon. Operator, we're ready to take questions.

Speaker #1: If you're interested in learning more, we selectively invite investors to visit us in Costa Rica at our Innovation Campus alongside our US Plastic Surgeon delegations.

Speaker #1: Investors have found this trip very useful in validating our business and the overall opportunity. We're also hosting a small dinner in Boston around the aesthetic meat plastic surgery conference for May 14 to May 17.

Speaker #1: If you're interested in either of these, please reach out as space is limited. I appreciate you taking the time to listen and I hope to see you on the next call soon.

Speaker #1: Operator, we're ready to take questions.

Speaker #3: Thank you, sir. Ladies and gentlemen, we will now be conducting the question and answer session. Please note for participants making use of speaker equipment, it may be necessary to pick up your handset.

Operator: Thank you, sir. Ladies and gentlemen, we will now be conducting the question and answer session. Please note, for participants making use of speaker equipment, it may be necessary to pick up your handset before pressing the star keys. If you'd like to ask a question, please key in star and then one on your telephone keypad. A confirmation tone will indicate that your line is in the question queue. You may key in star and then two to leave the question queue. We further request that you limit yourself to one question, and if time allows, you're welcome to rejoin the question queue for follow-up questions. Our first question comes from Anthony Petrone of Mizuho Group. Please go ahead.

Speaker #3: Before pressing the star keys. If you'd like to ask a question, please key in star and then one on your telephone keypad. A confirmation turn will indicate that your line is in the question queue.

Speaker #3: You may key in star, and then two, to leave the question queue. We further request that you limit yourselves to one question, and if time allows, you're welcome to rejoin the question queue for follow-up questions.

Speaker #3: Our first question comes from Anthony Petrone of Missouri Group. Please go ahead.

Anthony Petrone (Mizuho Gro: Thanks. Congratulations, Peter, Sandra Harris, and to the team on a strong start to the year here. You know, maybe the US momentum here, it looks like an inflection. You have really, you know, almost two simultaneous launches, if you will, ongoing. It's the US Motiva platform in and of itself. There's still a push into new accounts. Of course, we have the Preservé launch. Maybe, you know, how much was just new accounts bringing in Motiva as a platform versus the Preservé go-live counts? I mean, by our estimate, you know, you're probably approaching somewhere between 75 and 100, you know, go-live Preservé accounts. I'll start there, and I'll have a quick follow-up. Thanks.

Speaker #4: Thanks. And congratulations, Pete, Sandra, and to the team on a strong start to the year here. Maybe the US momentum here it looks like an inflection and you have really almost two simultaneous launches if you will ongoing.

Anthony Petrone: Thanks. Congratulations, Peter, Sandra Harris, and to the team on a strong start to the year here. You know, maybe the US momentum here, it looks like an inflection. You have really, you know, almost two simultaneous launches, if you will, ongoing. It's the US Motiva platform in and of itself. There's still a push into new accounts. Of course, we have the Preservé launch. Maybe, you know, how much was just new accounts bringing in Motiva as a platform versus the Preservé go-live counts? I mean, by our estimate, you know, you're probably approaching somewhere between 75 and 100, you know, go-live Preservé accounts. I'll start there, and I'll have a quick follow-up. Thanks.

Speaker #4: It's the US Motiva platform in and of itself. There's still a push into new accounts and then, of course, we have the Preserve launch.

Speaker #4: So maybe how much was just new accounts bringing in Motiva as a platform versus the Preserve go live counts? I mean, by our estimate, you're probably approaching somewhere between 75 and 100 go live Preserve accounts I'll start there and I'll have a quick follow-up.

Speaker #4: Thanks.

Speaker #5: Yeah, thanks, Anthony. As you highlighted, I mean, the progress in the US has been tremendous. I mean, it's exceeded all our expectations. And you see that with all the different metrics that we look at.

Peter Caldini: Yeah. Thanks, Anthony. As you highlight, I mean, the progress in the US has been tremendous. I mean, it's exceeded all our expectations. You see that with all the different metrics that we look at. I mean, we've increased the number of accounts. We continue to grow the base Motiva business. You know, a lot of that is driven. It shouldn't be a surprise. I mean, we've come to the market with what we believe to be the best implants from a performance as well as a safety standpoint, and we couple that with a best-in-class organization. That's really helping to drive that growth.

Speaker #5: I mean, we've increased the number of accounts we continue to grow the base Motiva business and a lot of that is driven and it shouldn't be a surprise.

Speaker #5: I mean, we've come to the market with what we believe to be the best implants from a performance, as well as a safety, standpoint.

Speaker #5: And we couple that with the best in class organization. So that's really helping to drive that growth. And a lot of that currently is still based off of expanding and the Motiva-based Motiva business and getting into more accounts.

Peter Caldini: You know, a lot of that currently is still based off of expanding the Motiva business and getting into more accounts, but we're also driving utilization in the accounts that we're in. Clearly, Preservé is a significant, will be a significant driver for us in the future. I mean, it's not a surprise as well. I mean, there's very clear patient benefits. You know, with minimal anesthesia, with smaller scars, quicker recovery. I think it's creating a lot of interest and excitement from a patient as well as a surgeon standpoint. We're seeing good growth opportunities just on our base as well as on the Preservé launch.

Speaker #5: But we're also driving utilization in the accounts that we're in. And clearly, Preserve is a significant will be a significant driver for us in the future.

Speaker #5: I mean, it's not a surprise as well. I mean, there's very clear patient benefits with minimal anesthesia, with smaller scars, quicker recovery, and I think it's creating a lot of interest and excitement from a patient as well as a surgeon standpoint.

Speaker #5: So we're seeing good growth opportunities just on our base as well as on the Preserve launch.

Speaker #3: The next question comes from Josh Jennings of TD Cohen. Please go ahead.

Operator: The next question comes from Josh Jennings of TD Cowen. Please go ahead.

Speaker #6: Hi. Good morning. Great to see the strong start to the year. I wanted to ask about the minimum invasive platform follow-up to Anthony's question and clearly gaining more and more traction.

Josh Jennings: Hi. Good morning. Great to see the strong start to the year. Wanted to ask about the minimum invasive platform, follow-up to Anthony's question, clearly gaining more traction. I'd love to just hear you build out more, Peter, on just how Preservé is not cannibalizing the Motiva business or Motiva cases, but is actually, you know, incremental to kind of the traditional augmentation patient. Then maybe do the same for Preservé and Mia and just help us understand how they may be complementary and how the Preservé launch internationally may be even boosting Mia traction as well.

Speaker #6: I'd love to just hear you build out more Peter on just how Preserve is not cannibalizing the Motiva business or Motiva cases but is actually incremental to kind of the traditional augmentation patient and then maybe do the same for Preserve and Mia and just help us understand how they may be complementary and how the Preserve launch internationally maybe even boosting Mia traction as well.

Josh Jennings: If you could tie it all into just, it sounds like you're optimistic that the breast implant market globally, especially in the United States, can actually see stronger growth here in the coming quarters, years, and then how this all ties in. Sorry for the multilayer question, but appreciate you taking it.

Speaker #6: And if you could tie it all into just it sounds like you're optimistic that the breast implant market globally, especially in the United States, can coming quarters, years and then how this all ties in.

Speaker #6: Sorry for the multilayer question but appreciate you taking it.

Speaker #5: Yeah. Thanks, Josh. As you highlighted, the minimally invasive platform, we're seeing a lot of very strong growth. When you look at our OUS markets where we have both Mia and Preserve, what we've seen and we've been very pleased to see this is they operate very complementary.

Peter Caldini: Thanks, Josh. You know, as you highlighted, you know, the minimally invasive platform, we're seeing a lot of very strong growth. When you look at our OUS markets where we have both Mia and Preservé, what we've seen, and we've been very pleased to see this, is they operate very complementary. In all the accounts that we currently have, Mia, which is close to 150 accounts, we have Preservé. There's clear distinction between the two where Mia is much more of in the premium segment, smaller scars to no scars under the armpit. It's somewhat restrictive in terms of the number of or the type of patients and the type of surgeons that would use that.

Speaker #5: So in all the counts that we currently have Mia, which is close to 150 accounts, we have Preserve. There's clear distinction between the two where Mia is much more of in the premium segment, smaller scar to no scar, it's under the armpit.

Speaker #5: But it's somewhat restrictive in terms of the number of or the type of patients and the type of surgeons that would use that. While Preserve is much more day-to-day and it's a premium versus our base, but it's less lower priced than Mia.

Peter Caldini: While Preservé is much more day to day, and it's a premium versus our base, but it's less lower priced than Mia. They work very complementary. What we've been able to see in a lot of markets in OUS is just with the minimally invasive rollout with Preservé as well as Mia, we've been able to expand our account base in a number of markets, that's really helped to drive that. To answer your last question, we're seeing this, you know, with some of the market research that, you know, in the US with Preservé, you know, 15% of women that have used the procedure were not currently considering breast augmentation.

Speaker #5: So they work very complementary. What we've been able to see in a lot of markets in OUS is just with the minimally invasive rollout with Preserve as well as Mia, we've been able to expand our account base in a number of markets.

Speaker #5: That's really helped to drive that. And then to answer your last question, and we're seeing this with some of the market research that in the US with Preserve, 15% of women that have used the procedure were not currently considering breast augmentation.

Speaker #5: So we believe that the minimally invasive both Mia and Preserve has a real opportunity to drive category growth. And I think there's just increasing a lot more interest in the area of transparency with not only with the Preserve and Mia but as well as just more openness and interest in breast augmentation.

Peter Caldini: We believe that the minimally invasive, you know, both Mia and Preservé, has a real opportunity to drive category growth. You know, I think there is just increasing a lot more interest in the area of transparency with, not only with the Preservé and Mia, but as well as just more openness and interest in breast augmentation, and we feel that we're a big part of that.

Speaker #5: And we feel that we're a big part of that.

Speaker #3: The next question comes from Sam Eber of BTIG. Please go ahead.

Operator: The next question comes from Sam Eiber of BTIG. Please go ahead.

Speaker #4: Hi. Good morning. Thanks for taking the questions here. Maybe I can stay on Preserve for a moment. Peter, would love your thoughts on if you think Preserve can eventually become standard of care over traditional breast augmentation, at least here in the US.

Sam Eiber: Hi. Good morning. Thanks for taking the questions here. Maybe I can stay on Preservé for a moment. You know, Peter, would love your thoughts on, you know, if you think Preservé can eventually become standard of care, you know, over traditional breast augmentation, at least here in the US. Then maybe you can help explain why Preservé is something that, you know, beyond the tools, is something that can only be done with Motiva, whether it's, you know, the implant surface, whether it's the low complication rates. Would love if you can explain that in a little bit more detail. Thank you.

Speaker #4: And then maybe you can help explain why Preserve is something that beyond the tools, is something that can only be done with Motiva, whether it's the implant surface, whether it's the low complication rates, would love if you can explain that in a little bit more detail.

Speaker #4: Thank you.

Speaker #5: Yeah. I mean, I think it in terms of the Preserve, not only in the US, but I think globally, it really makes sense. If you look at different types of procedures, surgical procedures, everything is minimally invasive.

Peter Caldini: I mean, I think in terms of the minimally invasive and Preservé, not only in the US, but I think globally, it really makes sense. If you look at, like, different types of procedure, surgical procedures, everything is minimally invasive. I think bringing that technology and that capability, I think it's, you know, I think patients, that's what they're looking for. I mean, it's very clear what the benefits are for patients. You know, smaller scars, quicker recovery, minimal anesthesia, which is very important for a number of women. It really has the opportunity to be a significant growth driver, but it's the standard of care, I think, in the industry.

Speaker #5: And I think bringing that technology and that capability I think it's I think patients, that's what they're looking for. I mean, it's very clear what the benefits are for patients.

Speaker #5: Smaller scars, quicker recovery, minimal anesthesia, which is very important for a number of women. So it really has the opportunity to be a significant growth driver, but it's the standard of care, I think, in the industry.

Speaker #5: And I think in some respects, because of the lack of innovation, we've seen in the US prior to our entry, I think a lot of the categories behind.

Peter Caldini: I think in some respects, because of the lack of innovation we've seen in the US prior to our entry, I think, you know, a lot of the category is behind. We do believe that that's gonna be, you know, more standardized in the industry. I think it's really our innovation with the unique implants that we have is very specific and beneficial for this type of procedure. You know, we'll continue to look at and continue to drive innovation that really shapes the category, and I think this is just the starting point for us.

Speaker #5: So, we do believe that that's going to be more standardized in the industry. And I think it's really our innovation with the unique implants that we have that is very specific and beneficial for this type of procedure.

Speaker #5: And we'll continue to look at and continue to drive innovation that really shapes the category. And I think this is just the starting point for us.

Speaker #3: The next question comes from Mason Carico of Stevens. Please go ahead.

Operator: The next question comes from Mason Carrico of Stephens. Please go ahead.

Speaker #7: Hey, guys. Thanks for taking the question here. I assume that most, if not all, Preserve users were already Motiva users, but was curious to hear if that launch is actually linked to increased conversation or maybe even conversion of accounts that previously hadn't adopted Motiva.

Mason Carrico: Hey, guys. Thanks for taking the question here. I assume that most, if not all, Preservé users were already Motiva users.

Mason Carrico: Hey, guys. Thanks for taking the question here. I assume that most, if not all, Preservé users were already Motiva users.Was curious to hear if that launch has actually led to increased conversation or maybe even conversion of accounts that previously hadn't adopted Motiva. Question is, do you think that launch could actually accelerate the onboarding of new accounts moving forward?

Mason Carrico: Was curious to hear if that launch has actually led to increased conversation or maybe even conversion of accounts that previously hadn't adopted Motiva. Question is, do you think that launch could actually accelerate the onboarding of new accounts moving forward?

Speaker #7: Maybe just simpler way the question is, do you think that launch could actually accelerate the onboarding of new accounts moving forward?

Speaker #5: Yeah. So Mason, I mean, we're pretty early in the launch, but what we've seen outside the US is that the minimally invasive, specifically Preserve, has brought in a number of new accounts for us in our direct markets in Western Europe.

Peter Caldini: Mason, I mean, we're pretty early in the launch, but what we've seen outside the US is that the minimally invasive, specifically Preservé, has brought in a number of new accounts for us in our direct markets in Western Europe. It has had that benefit. You know, bringing new technology, bringing a new procedure, I think has really resulted in, you know, our ability to drive account growth in a lot of our Western European markets. In the US, I mean, it's, you know, it's still early. I believe you're gonna see the same type of trend in the US, but, you know, we're kind of in month 2 right now and there's significant demands with the accounts that we do have. You know, we're very focused on getting the training done.

Speaker #5: So it has had that benefit. Bringing new technology, bringing a new procedure, I think, has really resulted in our ability to drive account growth in a lot of our Western European markets.

Speaker #5: In the US, I mean, it's still early. I believe you're going to see the same type of trend in the US, but we're kind of in month two right now.

Speaker #5: And there's significant demands with the accounts that we do have, and it's very we're very focused on getting the training done. But I do believe to your question, I think has the potential to drive certainly account acquisition.

Peter Caldini: I do believe, to your question, I think has the potential to drive, you know, certainly account acquisition.

Speaker #3: The next question comes from Cateson Roberts of Canaccord Genuity. Please go ahead.

Operator: The next question comes from Caitlin Cronin of Canaccord Genuity. Please go ahead.

Speaker #8: Hi. Congrats on the quarter and thanks so much for taking the questions. Just a quick one. Have you added all of the reps that you plan to add for Preserve in the US?

Caitlin Cronin: Hi. Congrats on the quarter, thanks so much for taking the questions. Just a quick one. Have you added all the reps that you plan to add for Preservé in the US? Just appreciate the guidance on MIS, could you break out potentially Preservé and Mia, and any updates on the timeline for you guys to bring Ergo II into the US and eventually Mia?

Speaker #8: And just appreciate the guidance on MIS, but could you break out potentially Preserve in Mia and any updates on the timeline for you guys to bring Ergo2 into the US and eventually Mia?

Speaker #5: Yeah. So thanks, Caitlin. The split between the Preserve and Mia a bulk of that is really driven by Preserve is the key driver for us.

Peter Caldini: Yeah. Thanks, Caitlin. The split between the Preservé and Mia, you know, a bulk of that is really driven by, you know, Preservé is the key driver for us. You know, we expect that to be a significant growth driver for us moving forward. You know, as it relates to Ergo II, I mean, currently, we've had good discussions with the FDA. You know, we're trying to really align on what the appropriate regulatory requirements are for us to get that approved with the FDA. We don't see that as a significant driver for us until probably around 2028. I mean, we have a lot of growth opportunities as it relates to Preservé currently.

Speaker #5: We expect that to be a significant growth driver for us moving forward. And as it relates to Ergo2, I mean, currently, we've had good discussions with the FDA.

Speaker #5: We're trying to really align on what the appropriate regulatory requirements are for us to get that approved with the FDA. But we don't see that as a significant driver for us until probably around 2028.

Speaker #5: I mean, we have a lot of growth opportunities as it relates to Preserve, currently. As you asked, I mean, we are expanding our Salesforce currently.

Peter Caldini: As you asked, I mean, we are expanding our sales force. Currently, we're at 50 reps, but we're going to continue to expand that opportunistically when there's a geographical opportunity, but also more importantly, getting the right talent. You know, I think we've been very successful in what I consider to be a best-in-class organization. In this industry, bringing over high-quality sales reps that have this established relationship, and that makes a big impact, and we've been able to do that.

Speaker #5: We're at 50 reps but we're going to continue to expand that opportunistically when there's a geographical opportunity. But also more importantly, getting the right talent.

Speaker #5: I think we've been very successful in what I consider to be a best-in-class organization. And in this industry, bringing over high-quality sales reps that have the established relationships, that makes a big impact.

Speaker #5: And we've been able to do that.

Speaker #3: The next question comes from Joanne Winch of Citibank. Please go ahead.

Operator: The next question comes from Joanne Wuensch of Citigroup. Please go ahead.

Speaker #8: Good morning and thank you for taking the question. I've got a big picture one. What are you seeing in the macroeconomic environment? And specifically, I'm concerned or thoughtful of the consumer and the impacts to the Middle East as it might relate either to sales or resin or oil prices or anything on the bigger landscape, which would be helpful.

Joanne Wuensch: Good morning. Thank you for taking the question. I've got a big picture one. What are you seeing in the macroeconomic environment? Specifically, I'm concerned or thoughtful of the consumer and the impacts to the Middle East as it might relate either to sales or resin or oil prices or anything on the bigger landscape would be helpful. Thank you so much.

Speaker #8: Thank you so much.

Speaker #5: Yeah. Hi. Thanks, Joanne. I think that's a great question. I mean, obviously, that's top of mind for anybody that's running a company. And I think as you look at what's going on in the Middle East, I think first off, just looking at the Middle East as we highlight in the Prepared Remarks, it represents 5% of our total sales.

Peter Caldini: Yeah. Hi. Thanks, Joanne. I think that's a great question. I mean, obviously that's top of mind for, you know, anybody that's running a company. You know, I think, you know, as you look at what's going on in the Middle East, I think first off, just looking at the Middle East as we highlight in the prepared remarks, it represents 5% of our total sales. You know, not surprising in Q1, we didn't have any orders. We do have orders in the system in Q2, and we expect to be shipping to the Middle East this quarter. There is some demand there. I think the key question is what you highlighted. You know, what is the potential overall macro impact?

Speaker #5: Not surprising in Q1, we didn't have any orders. But we do have orders in the system. In Q2, we expect to be shipping to the Middle East this quarter.

Speaker #5: So there is some demand there. But I think the key question is what you highlighted. What is the potential overall macro impact? And so far, Joanne, we have not seen an impact on the global demand for the number of procedures.

Peter Caldini: You know, so far, Joanne, we have not seen an impact on the global demand for the number of procedures. You know, that's something that we're gonna continue to closely monitor. As it relates to areas in terms of, you know, costs, I think we've seen some, and I can let Sandra answer this, but we've seen some impact in terms of outward freight. There has not been an impact in terms of our, you know, silicone costs because those are locked in for the full year. I would say in general, we haven't seen a significant impact, but that's something we're gonna monitor very closely. Sandra?

Speaker #5: And that's something that we're going to continue to closely monitor. As it relates to areas in terms of cost, I think we've seen some and I can let Sandra answer this.

Speaker #5: But we've seen some impact in terms of outward freight. There has not been an impact in terms of our silicone cost because those are locked in for the full year.

Speaker #5: So I would say, in general, we haven't seen a significant impact. But that's something we're going to monitor very closely. Sandra.

Speaker #9: Yeah. No, I think Peter hit it. We're seeing some initial surcharges on outbound freight, but at this time, we've been able to navigate through and hold our margin profile.

Sandra Harris: Yeah. No, I think Peter hit it. We're seeing some initial surcharges on outbound freight, at this time, we've been able to navigate through and, you know, hold our margin profile. Our silicone provider, we recently have, you know, locked in volumes, and we have a contract with them through the end of the year. We'll monitor the situation and look to protect our margins with any type of price as it progresses.

Speaker #9: Our silicone provider, we recently have locked in volumes, and we have a contract with them through the end of the year. And we'll monitor the situation and look to protect our margins with any type of price as it progresses.

Speaker #3: Thank you. The next question comes from Allen Gong of JPMorgan. Please go ahead.

Operator: Thank you. The next question comes from Allen Gong of J.P. Morgan. Please go ahead.

Speaker #10: Hi, team. Thanks for the question. I just had a quick one on the guidance and just the momentum that you're seeing. You talked about how orders are up 30% from 4Q to 1Q.

Allen Gong: Hi team. Thanks for the question. I just had a quick one on, you know, the guidance and just the momentum that you're seeing. You know, you talked about how orders are up, you know, 30% from Q4 to Q1. I guess, you know, first quick one, is that a US comment? Also, you know, given that kind of momentum, how should we feel about, you know, the cadence for the balance of the year, and particularly what you're seeing in Q2 given the reiterated guide or, you know, guide by just the beat in Q1? Thank you.

Speaker #10: I guess first quick one, is that a US comment? And also, given that kind of momentum, how should we feel about the cadence for the balance of the year and particularly what you're seeing in second quarter given the reiterated guide or guide by just the guide by just the beat in the first quarter?

Speaker #10: Thank you.

Speaker #5: Yeah. And Alan, I'll kick it off. But just to clarify that, I mean, when we talk about the orders, that was specific to the US.

Peter Caldini: Yeah. Allen, I'll kick it off. Just to clarify that, I mean, when we talk about the orders, that was specific to the US. You know, we're, you know, as we highlighted the prepared remarks, we're increasing the number of accounts, but also we're increasing the utilization rate, you know, as the surgeons work through their schedule. It's a combination and it's reflected in the average daily orders. We see very strong momentum going into Q2 as well. That's not just in the US. I think in overall, you know, globally in a lot of markets we've, you know, the demand has been stable.

Speaker #5: We're as we highlighted in the Prepared Remarks, we're increasing the number of accounts but also we're increasing the utilization rate. As the surgeons work through their schedules, so it's a combination.

Speaker #5: And it's reflected in the average daily orders. So we see very strong momentum going into Q2 as well. And but that's not just in the US.

Speaker #5: I think overall, globally, in a lot of markets, we've the demand has been stable. And I think the one outstanding question that we had going into as we're managing business, like a lot of different companies, is what's the impact of the Middle East?

Peter Caldini: I think the one outstanding question that we had going into as we manage the business like a lot of different companies is, you know, what's the impact of the Middle East? As I mentioned before, you know, it is a small part of our business. We do have orders in the system for Q2, so there is demand there. We have not seen the impact, you know, in terms of global demand, but that's something we're going to monitor. Based on that, you know, gave us the comfort to raise the guidance. You know, we had a strong Q1 and then, you know, we're off to a good start in Q2, so that gave us the comfort around that.

Speaker #5: And as I mentioned before, it is a small part of our business. We do have orders in the system for Q2, so there is demand there.

Speaker #5: And we have not seen the impact in terms of global demand, but that's something we're going to monitor. So based on that, it gave us the comfort to raise the guidance.

Speaker #5: We had a strong Q1. And then we're off to a good start in Q2. So that gave us the comfort around that.

Speaker #3: The next question comes from Matt Baylor of Jeffrey's. Please go ahead.

Operator: The next question comes from Matthew Taylor of Jefferies. Please go ahead.

Speaker #11: Hi. Good morning. Thanks for taking the question. I wanted to follow up on the silicone supply comments. I know that this year, the contract set in stone.

Matthew Taylor: Hi. Good morning. Thanks for taking the question. I wanted to follow up on the silicone supply comments. I know that this year the contract's set in stone, but could you address the potential for cost increases beyond that?

Matt Taylor: Hi. Good morning. Thanks for taking the question. I wanted to follow up on the silicone supply comments. I know that this year the contract's set in stone, but could you address the potential for cost increases beyond that?Sure.Maybe give us an update on how negotiations are going and when we could expect an update.

Speaker #11: But could you address the potential for cost increases beyond that, maybe give us an update on how negotiations are going and when we could expect an update?

Peter Caldini: Sure.

Matthew Taylor: Maybe give us an update on how negotiations are going and when we could expect an update.

Speaker #5: Yeah, thanks. Thanks, Matt. It's a good question. I mean, we have a very good relationship with Newcell. I mean, it goes back for a number of years.

Peter Caldini: Yeah. Thanks. Thanks, Matt. It's a good question. I mean, you know, we have a very good relationship with NuSil. I mean, it goes back for a number of years. You know, obviously as we continue to grow as a company, we become, you know, a more valuable customer to NuSil. We've had very productive conversations with NuSil, and we consider them very good partners. In fact, that we've aligned or we agreed on volume commitments for this year, just about a month ago. You know, so the prices are locked in for this year. We've made that commitment. Obviously, you know, that's an increase in volume versus last year.

Speaker #5: And obviously, as we continue to grow as a company, we become more valuable customers to Newcell. And we've had very productive conversations with Newcell.

Speaker #5: I mean, we consider them very good partners. In fact, we've aligned or we agreed on volume commitments for this year, just about a month ago.

Speaker #5: So the prices are locked in for this year. We've made that commitment. Obviously, that's an increase in volume versus last year. And we've started conversations around a long-term agreement.

Peter Caldini: We've started conversations around a long-term agreement and, you know, there's interest on the NuSil side to have an agreement as well as for us to have an agreement five years or more. A lot of the conversations are less about pricing. It's much more about, you know, co-development work. They're, you know, interested in exclusivity with us and looking at the length of the agreement. Generally around the price is more volume driven. The conversations are very productive and, you know, as I mentioned before, we are, you know, continue to be a bigger part of their business. They've been good partners for us in the past, and we expect that to continue moving forward.

Speaker #5: And there's interest on the Newcell side to have an agreement as well as for us to have an agreement five years or more. And a lot of the conversations are less about pricing.

Speaker #5: It's much more about co-development work. They're interested in exclusivity with us. And looking at the length of the agreement. Generally, around the price is more volume-driven.

Speaker #5: But the conversations are very productive. And as I mentioned before, we are continuing to be a bigger part of their business. And they've been good partners for us in the past.

Speaker #5: And we expect that to continue moving forward. So we haven't finalized the conversation on the discussions on the agreement. But there's strong intent to have a very long-term agreement for with Newcell.

Peter Caldini: You know, we haven't finalized the conversation, the discussions on the agreement, but there's strong intent to have a very, a long-term agreement for, with NuSil.

Speaker #3: The next question comes from Mike Merton of Needham & Co. Please go ahead.

Operator: The next question comes from Mike Matson of Needham & Co. Please go ahead.

Speaker #12: Yeah. Thanks. I just wanted to ask one on the refinancing. So by our math, it seems like without the additional $35 million draw, there could be a slight increase in interest expense of maybe like a million dollars a year.

Mike Matson: Yeah. Thanks. I just wanted to ask one on the refinancing. By our math, it seems like there without the additional $35 million draw, there could be a slight increase in interest expense of maybe like $1 million a year. Is that right? Thanks.

Speaker #12: Is that right? Thanks.

Speaker #9: Yeah. Thanks, Mike. So yes. So on the new debt agreement, we've increased it from $225 million in the current draw as $265 million. There is a lower interest rate at 8.75%.

Sandra Harris: Yeah. Thanks, Mike. Yeah, on the new debt agreement, we've increased it from $225 million, and the current draw is $665 million. There is a lower interest rate at 8.75%. There's ability to PIK, which gives us some near term, you know, cash availability, which we take. Net, net, there is, you know, neutral to slightly up on the increase in the availability of the funds, with the lower interest rate and then the exercise of the PIK.

Speaker #9: There's ability to pick, which gives us a near-term cash availability, which we take. So net, net, net, there is mutual to slightly up on the increase in the availability of the funds, with the lower interest rate.

Speaker #9: And then the exercise of the pick.

Speaker #3: Thank you. The next question is a follow-up from Anthony Petrone of Meso Group. Please go ahead.

Operator: Thank you. The next question is a follow-up from Anthony Petrone of Mizuho Group. Please go ahead.

Speaker #12: Thanks. One for Sandra, just on gross margin here. Guidance 71.2 to 72.2. How much of that is just kind of reflection of preserve at higher prices?

Anthony Petrone (Mizuho Gro: Thanks. One for Sandra, just on gross margin here. You know, guidance 71.2 to 72.2. You know, how much of that is just, you know, kind of reflection of Preservé at higher prices? Have you baked in an FDA clearance for reconstruction and just what, you know, that can bring to the table in terms of gross margin momentum? Thanks.

Anthony Petrone: Thanks. One for Sandra, just on gross margin here. You know, guidance 71.2 to 72.2. You know, how much of that is just, you know, kind of reflection of Preservé at higher prices? Have you baked in an FDA clearance for reconstruction and just what, you know, that can bring to the table in terms of gross margin momentum? Thanks.

Speaker #12: And have you baked in an FDA clearance for reconstruction and just what that can bring to the table in terms of gross margin momentum?

Speaker #12: Thanks.

Speaker #9: Yeah. And the good question. So our gross margin improvement, and we do expect that it'll continue to contribute, is the growth of the US.

Sandra Harris: Yeah, Andy, good question. Our gross margin improvement, and we do expect that it'll continue to contribute, is the growth of the US. You know, with the US business being a direct account, it improves our margin profile, and you're seeing that in our numbers. Obviously with OUS being further along in the journey on minimally invasive, its growth in the direct business, and then the launch of minimally invasive in the US, that also is a big contributor to the margin. As we look forward, we do expect that we will continue to improve that margin based upon the mix of that business, both US and OUS, as well as the minimally invasive.

Speaker #9: With the US business being a direct account, it improves our margin profile. And you're seeing that in our numbers. And then obviously, with OUS being further along in the journey on minimally invasive, its growth in the direct business, and then the launch of minimally invasive in the US, that also is a big contributor to the margin.

Speaker #9: So as we look forward, we do expect that we will continue to improve that margin based upon the mix of that business, both US and OUS, as well as the minimally invasive.

Sandra Harris: At this juncture, we do not, you know, we can't necessarily time the FDA approval, so we've made no assumptions in regard to reconstruction.

Speaker #9: And at this juncture, we do not we can't necessarily time the FDA approval. So we've made no assumptions in regard to the reconstruction.

Sandra Harris: At this juncture, we do not, you know, we can't necessarily time the FDA approval, so we've made no assumptions in regard to reconstruction.

Speaker #3: Thank you. Ladies and gentlemen, that is all the time we have for questions today. I will now turn the call back over to Peter Caldini for closing remarks.

Operator: Thank you. Ladies and gentlemen, that is all the time we have for questions today. I will now turn the call back over to Peter Caldini for closing remarks.

Speaker #5: Thank you, everybody, for joining the call this morning. I appreciate the time and really having everybody get to hear more about the progress we're making with ESTABLISHMENT LABS.

Peter Caldini: Thank you, everybody, for joining the call this morning. You know, I appreciate the time and really having everybody get to hear more about the progress we're making with Establishment Labs. As we highlighted there, as I highlighted in the commentary, you know, it's a great opportunity. I hope to see you at some of the events, but also, you know, please take us up on the offer about visiting us in Costa Rica, and you really get an opportunity to really see the uniqueness of this company and the strengths that we have and just to build that partnership. Thanks again, everybody, for joining the call, and look forward to seeing you soon. Thank you.

Speaker #5: As we highlighted or as I highlighted in the commentary, it's a great opportunity. I hope to see some of the events, but also please take us up on the offer about visiting us in Costa Rica.

Speaker #5: And you really get an opportunity to really see the uniqueness of this company and the strengths that we have. And just to build that partnership.

Speaker #5: So thanks again, everybody, for joining the call. And look forward to seeing you soon. Thank you.

Operator: Thank you, sir. Ladies and gentlemen, that concludes this event. Thank you for attending. You may now disconnect your lines.