Establishment Labs Holdings Inc. (NASDAQ:ESTA) Q4 2023 Earnings Call Transcript

I think the U.S. market is starting to pick up again from what we hear from different indicators. And yeah, of course, as we look into the expansion of Flora, this provides for an opportunity for us to be able to bring our fully differentiated tissue expander to U.S. Centers of Excellence.

Joshua Jennings: Great. Thanks. And then just I know you haven’t detailed in this little bit premature to detail of the U.S. commercial launch strategy, but just in terms of the initial spend, the investments that have already been made versus the investment that are required as you move closer to launch and then execute the launch, and just considering the updated status of your balance sheet, anything you can share just on terms of investments made versus investments to be made in the coming months in front of the launch? Thanks a lot.

Raj Denhoy: Yeah, sure. We have been investing in the U.S., I think, as we’ve been building the infrastructure here to be a commercial organization, if you think about finance, logistics, the things you need to be commercial, so that spending has been taking place, and we’re actually leveraging that now as they’ve launched Flora in the United States and are starting to see traction with that product. When we get closer to the approval of the implants in the United States, we will start to see a pick-up in spending relative to commercial activity. But given the higher ASPs in the U.S., the higher margin here, the ability we have to leverage the spending we’ve already done as well as the infrastructure we had outside the United States, a period of time which we’re loss-making in the U.S. should be relatively short.

And, I think, as we noted in the prepared remarks, he amendment to the Oaktree facility also gives us additional capital should we need it to fully fund the U.S. launch strategy. So we are feeling pretty good about where we are in terms of getting ready for being commercial with their entire portfolio in the U.S.

Joshua Jennings: Right. Thanks, Raj.

Operator: Our next question is from George Sellers with Stephens Incorporated. Please proceed.

George Sellers: Good afternoon, and thanks for taking the question. Two-parter here on Flora. Just curious, first of all, what your guidance assumes, if any, for Flora contribution in 2024? And then, could you also just speak to the commercial process for flora and breast reconstruction in the hospital as compared to commercialization in the breast augmentation market?

Juan José Chacón Quirós: Yeah. Thanks, George. When you launch products, especially products that have such differentiation, a lot of your focus at the beginning is on the qualitative parts. Still, you heard our numbers. We have 15 centers that are working through the VAC [ph] process. That process is you know takes time, but you’re already seeing us getting into these hospitals in the first half of this year and we’ll continue adding to that. But it’s early on to be able to give you precision on what we expect for Flora. Now, overall, it is $180 million market and we are selling our tissue expander that our premium. So we do expect this to eventually be an important contributor over the next few years to our growth and definitely it has the highest ASPs in the world and highest gross margins for any market for tissue expanders.

George Sellers: Okay. That’s really helpful. And then maybe shifting to Mia, could you give some additional color on what Mia contributed in the quarter and then also your expectations. I believe you’ve said there’s another 30 or so potential clinics that you may add to the Mia clinics, but just curious your expectation for that progression in 2024 as well.

Juan José Chacón Quirós: Look, just like everyone we are super excited with Mia, particularly, because we see the amazing results and the differentiated experience. The fact that these women are just going back to their daily lives minus the exercise the same day is just an amazing thing to see. And that’s why we’re so confident on the growth of Mia. But just like I said before, when you’re launching these type of products, you focus first on a qualitative. What we did today though is give you a lot of color on number of centers. So just with the list we provided, it seems that we should be in about 70 centers this year, at least. So, the network of Mia certified centers is increasing and what we are seeing is in the first group of clinics that launched in second half of last year we were seeing increasing demand every month.

And, as we get through the capillarity in these cities with more centers getting there, then we’re going to see more demand. So, eventually, I think what we will try to do is, on top of all the information we gave today on the number of centers, is also give you an idea in the future of how that ramps up in terms of the numbers of procedures, but still a little bit early to go ahead in that and do that.

George Sellers: Okay. Thank you all for the time.

Operator: Our next question is from Marie Thibault with BTIG. Please proceed.

Sam Eiber: Hey, good afternoon, everyone. This is Sam Eiber on for Marie. Thanks for taking the questions. Maybe I can start, Raj, on just an operating expense question, and maybe your thoughts for 2024, if any of these cuts that you made in the back half of last year, is there anything left to be recognized in Q1, or is that all behind us at this point?

Raj Denhoy: Yeah, so I think there will be some additional spending in first quarter relative to the fourth quarter in terms of cash used, again, around severance cost and we do have heavier costs usually in the beginning of the year. And I think it’s also important to note that we’re continuing to look for efficiencies across the business, right, so in terms of getting to the stable position we are not there yet and we will continue to looked again at ways to make our business more efficient. We did take a lot of cost out of the base, so if you look at operating expenses last year versus this year they will be down something around $25 million or $30 million from where we were in 2023. So I don’t know if that answers your question, but in terms of cash used we could see a little bit of a tick up in the first quarter again on some of the severance costs and the restructuring costs we’ve undertaken.