All right, thanks. I think we're gonna kick off day two of the Citizens Life Sciences Conference here with Apyx Medical. I have Charlie Goodwin, CEO. It's a company we've covered for over a decade, and we upgraded the stock late last year, what we think is, you know, potentially a revolutionary new product cycle. You know, Charlie, to start, you know, we've known each other for close to a decade as well, and I think, you know, just listening to the calls over the years and then hearing your tone about what you expect to happen, there's a big change, and it was evident on your call yesterday.
I just wanna start off by kind of getting your high-level thoughts on, you know, your time at the company and why you think now is different than any other, you know, at any other point that you've been there.
I get accused of my tone from my wife. It's kind of nice that you're bringing that up too.
This is positive tone.
Yeah. This is positive tone. Yeah. You know, this is a different company now. I've been the CEO of this company for about eight years, and we've had Renuvion technology, which is an incredible technology to take care of loose and lax skin. There's no question in my mind that it's the best technology to do that on the marketplace. When you're a one technology company, it's always a little bit harder. We looked at how we could add value to the plastic surgery market, and we saw an opportunity on the surgical side of aesthetics. There wasn't really any significant innovation in that area. There wasn't really anything going on. The gold standard at the time was VASER, and quite honestly, it hadn't been improved on in over a decade.
We set out to own the surgical side of aesthetics, and we brought together some of the leading body contouring surgeons in the world, and we had them. We wanted to know what their pain points were, how we could make things better, what we needed to do to make surgery safer, faster, and all of those things. That's what led us down the path of AYON, and that's what led us to AYON. As you know, we got approval for that in May of this last year. We started shipping commercially for the first time in September, and then this fourth quarter that we just announced yesterday, that was our first full quarter of selling AYON. We think AYON is a complete revolution and a complete game changer in surgical aesthetics.
There is not a surgical procedure that the doctors can't do with that. AYON is better in that every single technology that is in AYON on a standalone basis is better than the existing technologies in the marketplace today. We created something that doesn't exist, and that is a fully integrated system to where all a surgeon has to buy is this one system, and they and their staff can do all the surgical procedures. It's not just the technology piece of it's also a workflow piece of it because it has things like simultaneous activation, so the doctor and his team can be doing up to four separate things at the same time.
When you're talking about the tone, and you're talking about the excitement, and you're talking about that, we don't think that there is any surgeon in the world that won't want AYON. Now, will every surgeon in the world buy AYON? No, for a variety of reasons. Everyone will want AYON. That's why we're excited about it, and that's why we think it changes this company.
Do you think that even when you talk about the, you know, some of the other features outside of like, let's say, Renuvion, like the Liposonix UAL and do you think you were able to upgrade all the features because of your history, like as Bovie and Apyx in making these generators for.
Yeah
Decades?
You know, it is amazing 'cause we're a small company, and we have a core competency, and it does, Turk. It stems from our OEM business and our ability to be able to design and manufacture things, and it really is something that this company does well. In fact, so well that we have some of the largest medical device companies in the world that come to us to design.
Yeah
Develop something, and then manufacture it for them under their label, so they sell it. That's why we were able to do that. I've been in the medical device space for over 35 years now. I know it doesn't look like that, Turk.
No, it doesn't.
Most small companies don't do their own R&D and their own development. They outsource it, or they buy it in, or they do all of those things. It's really special with what we've got here, and we've got the ability to keep doing that and to keep adding to that. We're not done with AYON. AYON is that first step for surgical dominance. We think we could be the largest surgical company in aesthetics and own that space.
I like the sound of that. You had that October KOL event and, you know, the KOLs and you as well kind of talked about GLP-1 as a tailwind for the entire sector.
Yeah
If we're, you know, we believe you have the best mousetrap now with the most features, but it's kind of coinciding with, you know, a big problem that people are coming in for. It could be like a perfect storm, but I guess your thoughts on GLP-1.
Yeah. I'd like to say that we were smart enough to know that the GLP-1s were coming when we were designing AYON, but I can't claim that much in foresight. The GLP-1 drugs have dramatically changed the aesthetics market. They've disrupted the marketplace, and they've disrupted it for a whole variety of reasons. It's a huge macro event in the aesthetic space. What it's really done is it's changed the needs of the doctors with the tools and the technologies that they need because it's really changed what the patients need now. The patients have profound skin laxity after they lose these drugs.
We talk about these drugs, and I don't care whether you're talking about McKinsey, whether you're talking about the CEO of Lilly, or who you're getting your information from, but these drugs today are gonna be about 10x bigger by 2030. As they become cheaper, as they become in the pill form, as they become more readily available, you are going to see this keep broadening, not just in the United States. This is a worldwide phenomena. I was just in Korea last week, and believe it or not, the GLP-1 drugs are big there too. It's everywhere in the world that people are going to be on these drugs. As they take these drugs, they're wonderful drugs for weight loss, but the side effect of that, of rapid weight loss, is skin laxity.
We believe that most of the patients that will have that laxity will need to have some form of surgical intervention, and that's why we think AYON and Renuvion are two wonderful technologies for that. Broadly in the aesthetic space, you are going to see companies that maybe were once winners not do as well because their technologies aren't necessarily geared towards this patient population. You're gonna see other companies that maybe weren't that doing as well, they're gonna start to flip the switch. The aesthetics market has been painted with a broad brush the last few years that a lot of people don't want to be in it because it's been a tough market. It's only been a tough market because of the disruption of the GLP-1 drugs.
They have been a headwind for the market, but they're gonna be a huge tailwind for the right companies as we go forward.
I think you could probably explain this better than I can, but I just wanna leave the audience with sort of a thought of the footprint in the OR. You know, you talk about efficiency and how many different functions you might be able to rattle off, the different ones. I thought the picture of sort of having, you know, 7 or 8 or 6 consoles in an OR versus one that can do it all kinda also, you know, backs up or supports the thought that everyone's gonna want this.
Yeah. For AYON, if you had all the technologies that are in AYON today, you're buying from 5 or 6 different companies, okay? You've got 5 or 6 different pieces of equipment spread around your operating theater. You gotta picture this. This isn't like a hospital operating room. Most of these operating rooms are in the doctor's office, and so they're smaller to begin with, and especially places like this in Miami, Florida, especially places like New York City where rent is really expensive. The ORs are actually small. This integrates everything into one nice, neat package that they see.
Not only that, it is from a workflow perspective for the doctor and their staff. It is just so much easier and so much more efficient for them to operate one machine than the moving of five to six different machines. You've got cords, you've got foot pedals, you've got everything all over the place. It is an absolute mess, and I think you were looking at the picture that one of the doctors posted.
Yeah
on the internet that showed his operating room before, and then it showed his operating room after he acquired AYON and it is night and day, and it is one of the major advantages of the system, for sure.
Yeah, I think it's pretty easy to look at that picture and conclude the same. You know, you talked about power liposuction as being sort of another feature that I think we expect by midyear. I'm just curious, like, is that like a nice to have? Do you need that or how would you kind of tell the audience, you know, the importance of that in that 510(k)?
Yeah. No, it's a really good question, Turk, because it is important. If you look at doctors doing body contouring all over the world, you have doctors that are using ultrasonic liposuction, you have doctors that are using power-assisted liposuction, and then you have a lot of doctors that are using both. Okay? Both, ultrasonic and power. Really simply, what ultrasonic does is it goes in and basically separates the fat from the tissue. It uses ultrasonic energy, and it separates the fat from the tissue. It makes it easier to take the fat out. If the doctor just uses ultrasonic liposuction, they separate the fat. They can take it out with suction, or they can take it out with power liposuction. Think of power.
The difference between power liposuction and just regular suction is power liposuction kind of like scrapes it all out, okay, in there, and it's more of a mechanical movement than just a suction. The power liposuction handpiece is important for us because if there's doctors that only use power-assisted lipo right now, they're gonna hold off on buying AYON until obviously they get the power-assisted handle. It is important for us to bring that in. It will complete the AYON offering. All of the consoles that we've sold are already have power liposuction in them, and so all we need to do is actually just activate that feature remotely, and then they buy the handpiece, and they can start using it right away.
This is post the 510(k).
That's right. The handpiece itself is the part that is going through the 510(k). Once that is approved, then we can just turn it on on the console, and they can buy the handpiece, and away they go.
I just wanted to clarify another thing that I've had questions on, which is, you know, everyone knows the Renuvion historically had the handpieces, you know, single use. AYON has all these other features. It is just the Renuvion still that is single use, correct? Like, you're gonna get a, let's say, an uptick in capital because of all the features of AYON. The handpieces will still be single use for Renuvion.
Yeah
not for the other liposuction and other suction.
Yeah. It's a little different than that. Yes, the single-use Renuvion handpiece remains the exact same. It is same price, same everything that standalone Renuvion is. There is about, for AYON, about another $100 in disposables.
Okay
For tubing, canisters, things like that are used in the procedure to help collect the fat and then put the fat back in. There's about another $100 per procedure in disposables there. The liposuction handpieces, both the power-assist and the ultrasonic handpiece, they are reusable, but they have a useful life.
How long is that about?
It's measured in hours.
Okay.
And so-
It's not that long.
Well, it can be thousands of hours. Okay, so
Okay
Most plastic surgeons will go through two or three handpieces a year based on how much body contouring that they do. There will be revenue that comes in from that too.
Got it. I think, you know, on the call, we were talking a little bit about new customers versus kinda repeat orders, and, obviously you would expect both. Just your thoughts on, you know, how that has progressed so far and then maybe what you kind of expect over time.
Yeah. It's interesting because the list price of AYON is $360,000, and we simply got that list price by taking the Apyx One generator and then all the competitive stuff that is in there, and we added it all together to get to the list price of $360,000. It was really that scientific for us to develop the list price for this. We'll be able to bring it to the market in one package at a much greater value than that list price, and that is one of the value that we'll be able to bring with AYON too. In doing that, right now our Apyx One generator has a list price in the U.S. of $165,000.
There were a lot of doctors that were hesitant to potentially just bring skin tightening in for that, for the $165,000 to do that. Now that we package everything in AYON, we think that there's a much greater value proposition to have everything together from a body contouring perspective. The interesting thing is there are doctors that potentially were using a competitive device for skin tightening, but are obviously now interested in AYON, and there is not a doctor in the world that is doing body contouring that won't be interested in AYON. They'll all be interested in AYON. We're having conversations now with some of the top body contouring doctors all over the world that we weren't basically talking to before. It incredibly changes the game for us to be able to bring in new customers.
So far in the four months that we've been selling it's been about 80% of our existing customers that have upgraded to AYON, and about 20% that are brand new to us as an organization.
The 80%, like I don't know if you can really comment on this, but do you see the sales force? Have they seen these guys kinda clear out the old stuff and put in AYON, like, get rid of some of the other consoles and all the clutter that they had in the past?
In some cases, we've traded it out in some cases and are getting some of this old stuff back. If anybody wants a used VASER or a used MicroAire, let me know. I can make you a heck of a deal on one if that's what you want.
I could use one.
We'll work with the practice to see what makes sense for them. There is also, you know, third parties that actually buy that equipment from the doctors. Some of the doctors are just choosing to do that themselves and that. We're just working with the practice to make sure what is best for them to be able to acquire the equipment.
I think, you know, historically, handpiece consumable growth, you know, they kinda trend together. I imagine with AYON being new that for a while we're gonna expect to see, you know, kinda your capital sales probably grow faster, and then over time the handpieces catch up. I guess any thoughts on, you know, that pattern or how soon maybe the handpiece pickup comes along?
Yeah. As I mentioned in the first part about the 80% were already Renuvion customers. Obviously, we're not gonna see an increase in those. They're still gonna consume the same amount that they were consuming before. As we keep adding those new customers and bring on new doctors for the body contouring, that's where we'll start to see the increase in that. We had said last year, I believe, that 60% of our revenue was from the disposable portion of our business. You will see that percentage obviously come down as we sell more and more AYONs. It's just a function of math. You will see years to come that the overall numbers of disposables will continue to keep growing.
I think your forecast is for aesthetics growth close to 17%-19% for the year, so getting close to that 20% bogey that we like to see. You know, I think maybe you left yourself some room. We'll see how the year progresses. It's still early, but I guess your thoughts on, you know, what this cycle could look like and what the growth could look like.
Yeah
You know, for years to come.
Yeah. Look, we're incredibly excited. You mentioned in my tone, we guided to 17% and 19% and we feel very confident in that guide for the year. In the fourth quarter, I think we grew the overall surgical aesthetics market by 38%, and it was nearly 50% growth in the United States, and right now the United States is the only place that we are currently selling AYON. You know, we've got a lot of work to register AYON outside the United States in a lot of markets. Turk, you're exactly right. We would expect to be a growth company for many years to come.
Yeah, I think you said also you're still selling Renuvion alone in Europe. I guess talk about OUS a little bit and what your plan is for AYON. Like, is it to just continue to sell Renuvion standalone in some of those OUS territories, or where will you bring AYON in and what are the gating factors to that?
Yeah. We still sell Renuvion standalone in the United States also.
Okay.
Okay? You can still add Renuvion to your body contouring on a standalone basis. We think that most doctors, though, that bring it on in the U.S. with AYON will bring it on through AYON. But we still do sell it on a standalone basis in the U.S. too. Outside the United States, obviously we don't have AYON registered yet, and we are currently selling it in all the markets that we're registered in outside the United States, which is over 80 countries. The two most recent that we added were China, and then we just got Korea in the fourth quarter of last year, and we expect Korea to be a really big market for us.
I'm gonna use that.
That's important.
'Cause I mean, I think you've talked in the past about Brazil and Colombia and other places that would be big, but that's kind of surprising to me.
Korea?
Yeah.
It's in a different way. You're right when you talk about Brazil and Colombia. Brazil and Colombia are all about the body. The body is king and queen in those countries. Everybody wants to have the really snatched waist and then the voluptuous buttocks on the backside, and that's what you see out there. In Korea, it is all about the face.
Hmm.
The face is the area in Korea that everybody has treated. It was amazing. I was over in Korea at these clinics, and I walked into one clinic that had 14 hyperbaric oxygen chambers.
Wow.
That's how big the clinic was. They do their own stem cells there. They have their own labs. They're big in regenerative medicine. We think that the face and the neck and the submental area are gonna be really big in Korea, and Renuvion's gonna do really well over there in that for that reason.
You also mentioned the other day that, you know, the Salesforce talent is high caliber. You're bringing in some good folks. I guess talk a little bit about, you know, I guess they're excited as well. They see the proposition here. Where are they coming from, and is this easy to train? You know, reps and I mean, docs I know you already have an installed base, but like, is it easy to get these guys up and running?
Turk, I'm an ex-hockey player in college, and I can learn this. If a hockey player can learn this stuff, almost anybody can learn it. I trust you with that. One of the things that we're most excited about is I've been a sales rep all. That's how I started out in the medical device industry. One thing about a sales rep is we're all kind of always looking for that next great thing to go sell because that's how we make our living. It's no different in what industry that you're in.
Right now if you are an aesthetic sales rep and you're looking around at what you can go sell and where you can make the most amount of money, I think that we've got the best technology and the best product that is out there. We've always had this mentality from paying our sales reps, is we're kind of like the reverse Robin Hood. We take from the poor and give to the rich. The reason for that is. You laugh, but the reason for that is the reps I can't afford to lose are my best ones. The ones I can afford to lose are the ones that aren't selling as much, and that's why we've always kind of had that philosophy. Right now when you ask where they're coming from, everywhere.
Everywhere in the aesthetic space because they can see AYON, they can talk to doctors about AYON. They can see the excitement. For the first time since I have been here as the CEO of this company, we're in a position of strength to be able to go out and get the best talent that we possibly can and bring them in here selling AYON. I would put selling AYON up against anything in the industry to be able to go sell.
There's that tone again. I like it.
That tone.
I like it.
Yeah, you like that tone.
It's different, I'm telling you.
Yeah.
We upgraded. There was a reason.
Yeah
I think, you know, I'm happy to hear that.
Yeah.
Now I'll grill you on the financials. No, I won't do that. I know Matt's here. You know, you did guide the cash flow positivity, I think, by the end of this year. Maybe talk about how if you can, talk about some of the, you know, levers that you're using to get there, and, you know, how you think sort of the sales growth you're projecting will help you get there that quickly.
Yeah. One of the things that, I'm most proud of with the team is, for this last year, is not only did we launch AYON and get approval and launch the most significant product that we have in a year, we did it and we spent the least amount of money that we spent in the last, many years. Matt has come on and done a very good job to help us with that. Our operating expenses three years ago were $53.8 million, I believe. They went down to $48.5 million or something like that last year, and this year they were $39.5 million. This last quarter, not only were we EBITDA positive, but we were actually, on an operating basis, positive. Matt says we were essentially break even. $11,000 is still positive.
Take it.
As you said, you'd take it, right, Turk?
Sure.
It is still positive, so I'm very happy that we were able to do all of this and to get our bottom line at that point, because getting to profitability is incredibly important for us, and we're gonna get there as quickly as we possibly can.
Well, with that, you can't hit the beach yet. You gotta do these one-on-ones. You got a great story. Thanks for coming.
Thanks, Turk.
Thanks for talking.
Appreciate it.
Yeah. Thank you.