Establishment Labs at TD Cowen Healthcare: Strategic Growth and Innovation

On Tuesday, 04 March 2025, Establishment Labs (NASDAQ: ESTA) presented at the TD Cowen 45th Annual Healthcare Conference, highlighting its recent achievements and strategic plans. The company showcased the successful U.S. launch of Motiva implants, noting strong adoption rates. While the U.S. market shows promise, challenges remain in international growth and market dynamics.

Key Takeaways

• Establishment Labs has successfully launched Motiva implants in the U.S., with strong surgeon and patient feedback.
• The company expects significant improvement in gross margins due to higher U.S. prices.
• International business growth is projected at a mid-single-digit rate, with China resuming contributions later in the year.
• The company is focused on minimally invasive technologies and expanding its market reach.
• A celebrity partnership is set to boost brand awareness in the U.S.

Financial Results

• U.S. Launch Impact: The U.S. launch is poised to improve gross margins significantly, with average selling prices more than double those in international markets.
• Revenue Guidance 2025: Establishment Labs has projected $35 million in revenue for 2025.
• International Business Growth: The company anticipates mid-single-digit growth for its core international business.
• EMEA Revenue: Expected to reach between $8 million and $10 million in 2025.
• European Clinics: Revenue for breast procedures grew 50 to 80% due to MIA.

Operational Updates

• U.S. Launch Progress: Establishment Labs is adding an average of five accounts per day, with 650 accounts opened and 450 actively ordering.
• Product Mix: Ergonomic implants make up approximately 60% of U.S. sales, commanding premium prices.
• Social Media Impact: Over 1.8 billion impressions on social media are driving patient demand for Motiva implants.
• Training Center: The Costa Rica headquarters trains 15 to 20 plastic surgeons monthly.

Future Outlook

• U.S. Market Expansion: Continued focus on expanding the U.S. presence with strong patient demand and positive feedback.
• Minimally Invasive Technologies: Plans to launch the Press Survey in the U.S. in 2026.
• Gluteal Enhancement Product: Development underway, with a launch planned in Latin America first.
• China Market: Revenue contributions expected to resume in the second half of the year.

Q&A Highlights

• Tariff Impact: The Costa Rica-based manufacturing mitigates potential tariff impacts.
• Competitive Landscape: The company’s focus on innovation and women’s health provides a competitive edge.
• Celebrity Partnership: A collaboration with a celebrity spokesperson aims to increase brand awareness in the U.S.

For further details, readers are encouraged to refer to the full transcript below.

Full transcript - TD Cowen 45th Annual Healthcare Conference:

Josh Jennings, Analyst, TD Callen: Good afternoon. I’m Josh Jennings from the TD Callen Medical Devices team, and we are moving deeper and deeper down the medical devices track on day two of the forty fifth annual TD Callan Healthcare Conference. It’s with great joy that we we introduced this management team. No pun intended or not pun, but just actually, I guess, there was a reference to your Joy program. But we’d love to introduce the executives from Establishment Labs.

We have Juan Jose Chacon Quiros, Founder and CEO and Chief Financial Officer, Raj Denhoy. Gentlemen, thanks for coming to Boston and great to see you live.

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: Great, Josh. Thanks, Josh.

Josh Jennings, Analyst, TD Callen: Some mixed emotions here. I think this may be our last fireside chat one, Jose. It’s we’re sad to see you depart the CEO seat. It’s been quite a run, but my understanding is that the run won’t end in terms of your involvement with the company. And I know you’ve reviewed this multiple times over the last two months, but maybe just for my personal benefit, explain like what your role will transform to from as you leave the CEO seat.

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: Yeah, absolutely. And I think you might see me again because as founder of this company and you know, at a at a personal level, I’m most likely still the the largest shareholder. I care very much about this company. I started this in my parents’ house twenty years ago, grew it to where it is today. So, you know, I’m going to be doing not only what I love doing, but what I’m best at, which is really focusing on the innovation, making sure that we go from ideation through the entire process.

You see this in the market in a way that it benefits women’s health, that it grows the market of, breast aesthetics and solves many of the problems in breast reconstruction. And the other piece is the advocacy piece. You know, talking to plastic surgeons and making sure that they understand why the adoption of this technology is not only going to improve the outcomes for their patients, but also increase their markets. And in a sense, I think, you know, extremely happy to see Pete taking the role of CEO. I think, you know, the the the work that he has already done since he joined us in November of twenty three showcases his capabilities and skills.

And in the evolution of this company, what we need now is the operational excellence to bring us to profitability. So I’m going to be supporting him and working with him. I’ll continue as a board member. And the board decided to do a market check, and I think we’re in that process. But I’ll be very happy once Pete is confirmed.

Josh Jennings, Analyst, TD Callen: Appreciate that. And it’s great to hear that you still be deeply involved with the company, which I think I understood prior to this discussion, but good to reiterate. And I think over the years, I believe that you had one of the best counter consensus calls in the medical device industry for the last ten plus years, just in terms of your conviction that smooth silks surface was a better solution and a safer option for women who were looking to have breast implants, whether it was augmentation or reconstruction. And then you moved on from there with even more innovation with ergonomics and sending out the whole portfolio. And it’s come, you kind of you cross the finish line late last year when your team drove Motiva through The U.

S. Regulatory tape and achieved FDA approval. So loved and one of the things that struck me out of the early this year when in San Francisco when you guys hosted an analyst event was just and reported on The U. S. Launch metrics was just how much momentum you had secured in the very early days.

So maybe you could just review some of the parameters of the strong U. S. Launch and, and and what’s driven the $35,000,000 revenue guidance for 2025?

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: Yeah. I I think when when you look at, you know, the the the launch, I mean, just think about it. We got approved on September twenty six of last year, and we were already in market a couple of weeks later. We were able to secure a first number of accounts. Many of them were our investigators in The US clinical trial.

And some of the surgeons who travel abroad often and had already seen from their peers the potential benefits of Motiva Implants in their practice. The metrics are just through the roof. When you think about we continue to onboard in average five accounts per day. We’ve opened basically six fifty accounts as of last Friday, four fifty of those had already ordered, 88% reordered. And some of the reasoning behind that is also as important.

We have never seen the mix between smooth silk round and ergonomics trend so much to ergonomics so fast. We’re sitting at around 60%. So that’s big news because that that income land comes at a premium to our competitors. And that premium is based on patient choice, which means women are asking for it. It means surgeons are starting to understand the benefits.

And all of that kind of showcases you know, the the things that we are seeing in the market, which is, you know, plastic surgeons are super excited about the technology after, you know, more than twenty five years of not having any innovation in the market.

Josh Jennings, Analyst, TD Callen: Thank you. The Motiva launches definitely created significant buzz in The U. S. Plastic Surgeon community. I think they’ve many have been very active on social media.

Many have been vocal in publications in New York and other major cities. But maybe you could just talk about in terms of those accounts that you’ve opened up, are most of them single plastic surgeon accounts? Or are they multi plastic surgeon accounts? My assumption is that there’s more than one in most of these accounts. And so maybe that those metrics of four fifty active orders is not it’s minimizing just in terms of number of surgeons that are actually engaged in adopting what you

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: Many of these clinics have more than plastic surgeon than one plastic surgeon. In some cases, perhaps our biggest account today is a group of 13 clinics, and that includes more than 20 plastic surgeons. So of course, that’s the type of mix that we’d like to see early on is that a lot of these accounts are some of the best accounts in The United States. As we move forward, of course, we’ll continue gaining share from all of the active competitors. But probably the other really interesting aspect that we are seeing is how organic the communication is about Motiva Implants from these clinics.

Meaning, they’re using our technology to showcase their clinic. They’re talking about Motiva, about the benefits, the potential option of putting the implant above the muscle without having increased capsular contracture or rippling of an implant. I think the recovery rates like softer recovery, something that they are definitely communicating on. This is happening organically. You know?

They’re, of course, using the benefits of the of the devices. But, you know, when you think about more than 1,800,000,000 impressions in social media, that’s what’s driving the other key point of the launch, which is women asking, you know, for Motiva by name because that not only, you know, confirms the choice of the surgeon, it is powering it up because the more women talk about Motiva, the more other women in the word-of-mouth mechanism will be taking place. And these women that are receiving Motiva behave like super consumers, meaning they’re willing to tell their friends about their choice.

Josh Jennings, Analyst, TD Callen: And you answered one of my next questions, just that the patient demand is surging and we anecdotally heard plastic surgeons relay that they’re converting almost % of their of the patients in their queue over to Mobitivo or through primarily patient demand, but maybe build on that and and, outside of of surgeons kind of putting forward their experience with Motiva and support of Motiva, I think there’s some, influencers, but and you also announced that there was a celebrity in The United States that was gonna become a, I think, spokesperson. Maybe help talk about the social media expand on your comments about the social media impact to patient demand and and this celebrity spokesperson.

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: Yeah. I think one one of the important things is we wanted to have more than fifth more than 500 accounts before we would do any type of effort like this partnership with a celebrity that is, you know, super high in the popularity index and also very well known by most Americans. So that that makes it a wonderful partnership because also the authenticity of her voice and, you know, the journey that she undertook is fundamental for this. Powering other women who had been considering to say, well, with this technology, I can make the same choice. With the number of of accounts sitting at six fifty, this is an investment that will yield big ROI for us and will power even more the excitement.

And, you know, what we’re looking for is, of course, getting more imbalance into the clinics, but also having the surgeons, you know, use more often in their choice of implants, Motiva, than others.

Josh Jennings, Analyst, TD Callen: Excellent. I wanted to, Raj, ask you just about the the gross margin benefit of The US launch over time. And we’ve talked about this before, but just with one of these comments and you sharing on the fourth quarter call about the mix of ergonomics versus round and so far in The U. S. Launch that could even demand even further, which would, by assumption, drive even a better gross margin expansion contribution from The US franchise.

But can you walk us through how we should be thinking about the profitability of The US business or gross margin and profitability? Thanks.

Raj Denhoy, Chief Financial Officer, Establishment Labs: Yes. It’s significant. When one looks at the average realized price for us outside The United States currently and keeping in mind that right now, the majority of our sales outside The United States are through distributors. Right? So we realize half the typically half the end market economics.

But when one compares our current ASP on a blended basis outside The United States to what it is in The United States, it’s more than two x in The United States. And the cost of making the implant is essentially the same. And so the gross margin, you know, benefit as The US scales over the next several quarters and years is gonna be very significant.

Josh Jennings, Analyst, TD Callen: And I’ve, had the pleasure of of venturing down to Costa Rica to see the the new manufacturing facility and headquarters. And, you guys have capacity to, I think, supply 50% of the annual global breast implant volumes. But just bringing up Costa Rica and all the headlines over the past twenty four plus hours or past number of weeks just on tariffs, maybe help us understand how how establishment is positioned, in the setting of, The US implementing tariffs on Canada and Mexico and and and taking up tariffs on on China.

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: I I think it’s, it’s important to realize the framework at which, this is taking place. And when you think about, like, all of our implants are manufactured in Costa Rica and, you know, basically, the IP is located in Costa Rica. So the country of origin is there. Costa Rica is free trade with The US, doesn’t have any tariffs on US products, and it’s a big ally of The United States. There is no migration problem with Costa Rica or any other issue that make it a reason for a retaliatory tariff.

And I think when you think about the framework that is coming, which is a set of other tariffs, they’re not directly related to our industry. And even after that, you will say, well, why would they single out Costa Rica before so many others? And beyond that, I think the Costa Rican origin allows you to also enter without tariffs into China with a free trade agreement, most countries in The Americas, all of Europe. So it is actually a great place to be with all of this geopolitical uncertainty.

Josh Jennings, Analyst, TD Callen: And so you guys are well positioned. Wanted to build on The US business and I don’t think this has gotten lost, but The US Motiva launch in play, that’s gained a lot of attention. But you guys also have the recon indication that’s brewing and may be get FDA approval in the relative near term. But maybe take us through, you have Flora already launched. Maybe just talk take us through how Flora has kind of set a foundation and some hospital accounts for this U.

S. Recon effort, and when you could start to see contributions?

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: The first thing to say is that Flora is first and only commercially available issue expander that allows for MRIs, PPE, during the expansion process of the reconstruction. And that is such a huge difference for women undertaking these procedures. Just a couple weeks ago, MD Anderson, an interdisciplinary group there, published this paper in which they talked very clearly about how this is changing the complete journey of, you know, the patient leading to better clinical outcomes. So it’s the fact that you can pinpoint the radiation, the symmetry levels to the right place. It’s also that the amount of time that they have to spend making the calculations for radiation oncology, all of that is being reduced and that is positive for that team.

Right now, we’re focused on this launch into aesthetics. But this summer, we’re going to achieve the three year mark in our breast reconstruction cohorts. This will allow us to potentially provide the supplement to the FDA this fall and think about nine months in average to be able to get that supplement approved. The other part of that is that once you have the tissue expander and the implant, you can start, you know, putting together the benefits of our smooth silk surface because that will allow many hospitals to do things in a very different way. Also, how often they use ADMs, how often they use meshes, that can provide savings for those institutions.

So I think as as we get closer to that, that’s gonna be pretty exciting. And, you know, the the market for breast reconstruction is is very, very attractive because you’re recognizing, you know, revenue per implant at almost double than in the aesthetic market. The tissue expanders also, I mean, we’re recognizing already about tripled in what we recognize in Europe. That has huge effects in the gross margin differentials that we’re gonna see in the future. So, of course, for all of this year, we have so much to grow into with aesthetics, but next year is going to be pretty exciting with the launch into breast reconstruction.

Josh Jennings, Analyst, TD Callen: So I think you’ve had a vision on driving augmentation aesthetic outcomes in reconstruction procedures. And I think you guys have been successful in that initiative internationally. But maybe just talk about that effort and what you’re seeing on the aesthetic outcome side as well as maintaining the safety profile in recon.

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: No. Absolutely. I think this aesthetic breast recon initiative that we’ve been working on for many years, it’s getting closer and closer to something that can be applied in countries like The United States. And it is not only the things that you can do with our tissue expander that changes the standard for that, softer breast augmentation, but also softer breast reconstruction now that we are seeing the clinical results. Beyond that, we’re starting to use our minimally invasive technologies in breast reconstruction to treat the contralateral size and deescalate therapeutically the breast reconstruction, but also in terms of using single port mastectomies and also robotic mastectomies then do a better breast reconstruction.

And actually in June in Paris, we have the first ever minimally invasive breast summit. And that will include an entire day on robotic and single port using conjunction with Medeva Ambulance. So these are great developments. It shows you really where this aesthetic breast recon initiative is going for us.

Josh Jennings, Analyst, TD Callen: That’s exciting. The last question on, well, maybe not the last one, but another layer of growth for The U. S. In the out years is the introduction of the MiaFemtek or Femtek Technologies, Millevasu offerings. And you have Preserve now in the mix and Mia.

Maybe talk about the strategy both on the regulatory front and the commercial front in terms of bringing those two, well, I guess they’re part of the same platform but two different offerings into The U. S.

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: Well, our minimally invasive platform is something we’ve been working on for over a decade and now we’re starting to see the benefits of all the work that our amazing R and D team has done with the clinical evidence that we’ve been able to gather as well. And as you see for The United States, most likely, we will have tools necessary for the press survey less invasive breast procedures taking place throughout this year, which will allow us potentially for a launch of Press Survey in The United States in 2026 with the Ergonomics one line. Beyond that, we have the Ergonomics two line, which is what allows for the injectable implant and full minimally invasive. And I think that’s a couple of years out, but also super exciting to see that it’s not only what the current approval has, you know, has meant to plastic surgeons in The United States, you know, the complete change in in, in technology, but also what’s coming ahead, you know, to less invasive procedures. With Preserve, you can do, you know, breast augmentations of more than two sizes up, with a very controlled environment, preserving the breast tissue for a stable result over time, and then moving into minimally invasive.

So it’s a super cycle of innovation that will take place, and it’s going to be a big benefit to the surgeons also to expanding the market in

Josh Jennings, Analyst, TD Callen: The U. S. And should investors be thinking that supplemental PMA pathway is potentially open for those two products, Preserve and Mia in The United States? Or is that still TBD? And when will you be able to share the final ruling on the pathway that’s open for establishment?

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: So, actually, very, very important because for Preserve, we can do Preserve with ErgonomicsONE, and some of the tools that we use already for EMEA. And this is, this is what allows, you know, the launch potentially for 2026 ahead of our expectations. But then, you know, I think a little bit of a of a more of an unknown, you know, exactly when we will have the Ergonomics two line, which is what allows for EMEA. You know, but it it it makes you think that, you know, even if that took a couple of years from now, you know, Preserve is going to be a nominal move into less invasive procedures and and that and that will happen.

Josh Jennings, Analyst, TD Callen: I would love to transition over to Mia in the international. You guys have built opportunity, you’ve built out the foundation. It seems like there’s some inflection in terms of number of accounts that are being added and then just utilization rates at these accounts. I think you talked about maybe $8,000,000 to $10,000,000 in EMEA revenue in 2025. Maybe just relay the drivers of the assumptions baked into that?

And then two, how big can Mia be internationally?

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: Yeah. I think it’s the idea this year is to more than double the number of clinics, more than double the number of, of procedures, organic procedures taking place, in the countries where we have launched, add, you know, more and more cities, of course, in the countries where we have launched. And, if if you think of it to understand, Mia, in in what a what a big shift it is for the clinics that have launched is, you know, take, you know, clinics in Europe last year. You know, if you take the assumption that in most European markets, revenue was flat for breast and in some countries down, in the MIA clinics, revenue for breast grew 50 to 80% based on MIA. Why?

Because it’s attracting a new group of customers. And, you know, we’ve given some of those numbers. It’s, you know, more than 40%, you know, women. We’re not considering at all a breast augmentation, and that’s what we wanna hear. This industry has been, you know, pretty much stagnant for, you know, the last ten years, so this is going to provide a wave of growth.

Our calculations is that, you know, the market of women who are using padded bras, push up bras, who become acquainted with Mia and would eventually, you know, at full awareness level, be, be willing to do it is 11 times the current market for breast aesthetics. But we’ve seen this before, you know, before, you know, fillers and and and toxins and, you know, energy devices for the face and, you know, the facelift. The change has been a hundred x in the last twenty years. So, you know, we’ve seen it before in aesthetics, and I think, you know, you just have to be patient of how that builds. And the first couple of years are the most difficult for a new category.

You just have to be patient. But already, putting out there eight to ten million gives you an understanding of where it could go after that.

Josh Jennings, Analyst, TD Callen: Understood. And maybe to stick with the minimally invasive portfolio, you guys have a development program for for gluteal enhancement, Jim. Any updates there? And how should we think about timing of any international launch?

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: So gluteal ergonomic modeling addresses, I would say, almost like an orphan indication in aesthetics. There’s you know, about 800,000 procedures a year and most of them being done with BBLs, elastomeric implants, fillers, and the complication rate is through the roof. There’s even a mortality rate. As a woman’s health company, it’s something we wanted to solve. And gluteal ergonomic modeling basically allows for this procedure to take place in about twenty minutes without general anesthesia.

Recovery time is completely different. Safety. So we finished our feasibility study, you know, now finishing the enrollment of our pivotal study. And with that, we will seek approval first, most likely in Latin America, and then we’ll move to the other areas of the world. We haven’t put out an exact date, but we’re working on this.

I think we will update later on this year on what a go to market could be.

Josh Jennings, Analyst, TD Callen: And ultimately, you will bring that into United States is our understanding. Just, I mean, timelines and and the regulatory pathway or TBDs is how we

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: For now, this is something that we are already working on. But I think further along in this year, we’ll have more information on this.

Josh Jennings, Analyst, TD Callen: Okay. And 2025, revenue guidance, you guys have relayed that you’re assuming mid single digit growth for the core international business, which includes Mia. And just wanted to get a better sense of assumptions. I think you were clear on China just in terms of the first half. All the inventory stocking from last year will work through and you’ll start to see return of revenue contributions in the second half.

But really wanted to talk about Central And Southern America and Brazil and how those markets are trending, any stabilization and anything that’s baked in the guidance in terms of improvement or is it really stability in 2025?

Raj Denhoy, Chief Financial Officer, Establishment Labs: Yeah. I think it’s really, as you described, that, you know, we saw in really starting in the middle part of ’20 ’20 ’3 that the markets, a lot of places around the world, really softened fairly dramatically, and that continued into 2024. As we’re exiting 2024, a lot of the markets feel more stable. Certainly, Latin America, we feel in the latter part of last year, we’ve sort of, touched some sort of bottom, and it seems to be a bit more stable. We’re not assuming any sort of growth or recovery next year, but the market feels a bit more stable at at the current level.

And I offer similar, you know, views in Europe and really APAC outside of, as you described, China, the phenomenon there we’re we’re describing for next year, but the markets overall feel relatively stable. And when we think about the the guidance we provided for next year, we’re not assuming anything heroic in terms of market acceleration or any sort of underlying improvement. But for us to achieve mid single digit growth, you know, with Mia, with with Preserve, with all the things where we’re bringing to market along with just the benefits of our technology, we feel very comfortable with that outlook.

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: Yeah. And I think in addition to that, there’s a halo effect that we’re starting to see OUS on the FDA approval. Remember, there’s many, many clinics, OUS, that use the slogan, only FDA approved products. Before that approval, J and J was the only other one that was approved. In Q4, just to give you a metric in our direct markets, we gained over 100 accounts that came from that group.

So that is also going to provide you a new source of market share gains.

Josh Jennings, Analyst, TD Callen: Thanks for sharing that. And just to touch on the competitive landscape and how it’s evolving or not evolving, It doesn’t seem as if the major the larger competitors have really had a response to Motiva in international markets. Anything on your radar in terms of the strategy from Johnson and Johnson or have theallergan in The United States as you guys are launching Motiva? What is just counter marketing or anything in their pipeline that you’re concerned about? Of course, they’re defending this market.

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: But, I think the other thing to understand is that these companies are distracted. We’re not focusing on this, and we are absolutely focusing on this because we’re focused on the end consumer. We’re focused on women’s health, and we’re focused on one really important thing to plastic surgeons, bringing up plastic surgery thanks to this technology. And, if you think about the products that those companies sell, they’re not exclusive to plastic surgeons. And our ability to do that is giving a lot of surgeons the opening to say, you know what?

I don’t care if I got all these perks from this company. I’d rather stick with what’s best for my patients, and this will have, you know, a positive effect for the number of women who will access, breast augmentation. And I think that’s one of the other big things from this launch is that, you know, the the use of a bundle against that has been, you know, of no detriment for efforts. And, it was perhaps one of our biggest risk factors these days, I would say. It’s becoming clear that technology is changing what used to be a commodity market.

Josh Jennings, Analyst, TD Callen: Maybe the last question for you guys. And going back to the visit down to the new manufacturing facilitynew headquarters, super impressive to see how you guys had set up a training center there. And I was imagining at that time and I’m betting now that as you bring surgeons down to go through some of those training exercises and it’s such an impressive effort and structure, I was hoping you could share something anything about the conversion rates of surgeons coming down to Costa Rica, getting trained, seeing the technology, seeing all of your capabilities and the infrastructure and how that translates into surgeon adoption?

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: Yes. We’re having an average about 15 to 20 plastic surgeons per month from The US coming to our headquarters. We’re also having delegations from other countries with key surgeons, academics, and and people who matter, in that sense. So, you know, it’s a complete experience change because, they see the innovation in our manufacturing, the innovation in our r and d pipeline, the innovation in the techniques because they witness in our global training center the new surgical techniques to simplify, you know, some of the situations that may they may have experienced in the past and make for better outcomes. We’re doing also a new type of modality in which we’re doing live from the Suryaon to also broadcast to an online audience.

So we’re getting even more ROI out of this. So it’s, it’s really becoming a big factor for this next generation because we’re not only giving the new technology, we’re teaching techniques that will make the procedures better and simpler.

Josh Jennings, Analyst, TD Callen: Well, I think we’ll we’ll stop there and just end with a, you know, congratulations on the long journey you’ve been on and getting the company to U. S. Approval and the commercial era globally. It’s fantastic and thank you guys for spending time with us today.

Juan Jose Chacon Quiros, Founder and CEO, Establishment Labs: Thank you, Josh. Thank you.

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