My name is Balaji Prasad. I'm the Senior Analyst for the Barclays Specialty Pharmaceuticals coverage. Kickstarting the spec forum track for the day, I have the pleasure of having the management team from Evolus with me, David Moatazedi, the CEO, and Rui Avelar, Chief Medical Officer and Head of R&D. Also in the audience, we have Sandra, the Chief Financial Officer, and Nareg, IR . So David, I think one of the things, thank you so much for taking the time to be with us here today, and Rui. One of the things that I appreciate the most whenever I have a chat with you on the back of quarterly earnings and all is the color and the broader market that you provide, which I think tells me you guys are very much on top of the market and I really look forward to it.
So maybe to kick things off, I would love to get your thoughts on the market tone in general. 2023, there was a lot of concern around slowdown in the market. That doesn't seem to be a concern anymore. So can you set out the lay of the land for us in terms of what you're seeing on the filler side for you specifically and on the toxin side, on the filler side?
Sure. Well, as you saw last year, the back half of the year in this category saw meaningful inflection in terms of procedural volume. Overall, on the year, we think 2023 was healthy, grew likely in this high single-digit rate, which is in line with historical trends that we've seen when you back out that COVID period. This is a category that has very low consumer penetration. There's a high affinity, especially as you go into this younger generation, of wanting to get treated that we believe creates potentially accelerating momentum as we look forward. And so when we exited the back half of last year, if you look at the market leader and what they reported, they reported really healthy growth.
When we looked at our business, you saw us accelerate and took a meaningful step up in the back half of the year where we grew over 40% in the third and fourth quarter combined, about 10 points below that in the front half. Some of that is market. Some of it is, I think, the team, to give them credit, did a really nice job continuing to execute on our strategy. And we believe that momentum carries into 2024. In our guide this year, we assume the market continues to grow at a healthy, high single-digit rate. It could very well grow in the low double digits. I think we'd prefer to be conservative on that assumption and watch it play out. I think I'm pretty confident the front half of the year will probably be in that low double digit.
It's a question of whether the back half, as you wrap around on last year, continues to grow at that rate or whether we see a slight step down in growth in the back half. I think there'll be a question around that until we get there.
Got it. Great. When you speak about this high single-digit to low double-digit market growth rate, clearly you're in a different league, a launch which has been going exceptionally well and seems to be taking off even further. Can you discuss the current market share for Jeuveau and your significantly faster-than-market growth rate, and what are the drivers that are getting you there?
Sure. What's interesting about this product, if you had asked me when we first launched, what sort of launch trajectory would you see, you would generally look at brands in this category and within 2-3 years, they settle out in market share. That's not the case with Jeuveau. We're celebrating five years on the market this May. And when we look at our market share, we've clipped up two share points now for two consecutive years. And last year, we exited with a 12% unit share, which we believe puts us on track. For those that do this market in dollars, it puts us on track for double-digit in dollars as well as a result of the 12% exit share. So it's been a very healthy growth story for us, but the momentum isn't slowing. You saw us exit, as I mentioned earlier, with accelerating growth.
We see a tremendous amount of potential. If you look at where we sit today, we're in 12,000 clinics around the United States. There's over 30,000 clinics that offer these procedures. We have a long way to go in terms of penetration. I think credit to the team. Again, they delivered 3,000 new accounts last year. We're on a healthy clip of adding new customers. But even at that clip, you can imagine it's a multi-year effort. This adding new accounts will continue beyond five years for us. We see a tremendous amount of momentum in the business. To go a layer deeper, it's not just new account growth. It's the health of the existing customers where our existing customer base, the 12,000 customers, they grew at a faster clip, a significantly faster clip than the market overall.
I think that reflects the continued penetration we see with Jeuveau once we get into these practices. We can talk more about the why. Obviously, it starts with the product that's differentiated, and then our cash-pay strategy is a second dimension on top of a very healthy market. Each of those parts contributes, certainly. Overall, I would say it results in a story of a very healthy company with really strong growth outlook in the coming future.
Great. As you continue to penetrate in these accounts, I do want to dig deeper into this, both the 12,000 accounts that you are in currently and, of course, continuing growth in accounts. What kind of metrics and targets have you set for yourselves over the next three years in terms of account penetration and what's working with these accounts?
Sure. So maybe it's worth just taking a step back in order to appreciate how we designed the company because it truly is unique. It's very different from the construct of other companies in the aesthetic channel with injectables. So we designed this company first with this focus around cash-pay aesthetics. Without a link to therapeutic, it gave us the ability to build what we call a performance beauty company. And I'll deconstruct performance beauty because it really has two dimensions to it. The performance side is the R&D and clinical development capabilities we have to develop differentiated products. And Rui, to my left here, led the development of Jeuveau in the U.S. and, of course, the approval of Nuceiva outside the U.S. and now a very differentiated line of fillers, which I'm sure we'll talk about, that we've recently licensed in and we expect to commercialize next year.
That's the performance side. It differentiates us from other companies in the retail beauty space because these are FDA-approved products, but they're regulated no differently. Then the beauty side of it is we shed this company of all the traditional pharma approaches to healthcare. And the idea there is that there's this younger generation of consumers that views this as a beauty treatment. They no longer view this as a traditional medical procedure. And so by designing the company as a cash-pay aesthetics company, we design every element of how the consumer engages with us. From our consumer loyalty program, which is a text-based program targeting this younger generation of millennials, to date, we have 750,000 consumers in that program in several years. So it's really been an incredible success for us.
Just in the fourth quarter alone, there were 170,000 consumers that got treated with Jeuveau and earned their $40 in savings associated with that. So the scale of the business around the consumer loyalty is very evident. The second is we've created a pricing program that rather than just rewarding based on volume, which is what's commonly done in the industry, with savings on the vial, what we've also done is we reward back in advertising. And what we've created is something called co-branded media. And to date, as a result, we advertise for thousands of practices around the United States, and we're advertising our brand, Jeuveau, with their practice. And it's all happening within a radius of that office. And so it's driving two things. One is it's driving consumers into those clinics that use Jeuveau. Keep in mind, we're in 12,000 of the 30,000.
So mass advertising is not the most efficient vehicle for us given our penetration. The second is it's driving awareness to our brand. And that awareness has resulted in multiple surveys that show us as one of the top five brands in aesthetics in terms of name recognition. So it's driving the recognition. And then importantly, it's forging a partnership with these practices. So when you look at our consumer loyalty, the way we advertise with them, and then our brand, what it stands for, the precision targeting millennials, I think that entire ecosystem is what's driving what we have, which is a long-term outlook of this business growing to $700 million, to answer your original question. And we see that happening by 2028. And that happens really with the neurotoxin.
We had originally got it to $500 million in 2028 when we signed the filler deal with Symatese last year. We increased that number to $700 million. Most of that incremental $200 million is, of course, the filler, but there is some amount of incremental revenue we expect the filler to bring to the toxin as well. So we feel that that's a very achievable number. And let me go one step further on that point, and then I'll turn it back over to you. That $700 million, as we provided that guidance last year, as you know, we signed the rights in the fourth quarter to the European filler. We didn't update our $700 million guidance around that change. And of course, we beat and raised multiple times in the back half of the year. We didn't raise our outlook with that assumption. We continue to be a management team that prefers to be on the conservative side of our guidance, but really have high confidence in our ability to deliver that long-term outlook.
Fantastic, David. I think there are quite a few things that I want to probe in there, but I'll pause it here. And I want to get Rui's take around the whole Evolus range of fillers from Evolysse and what led you to them and what is differentiation for these fillers versus existing ones like Juvederm or RHA lines, which is the latest entrant in the filler category a couple of years ago, right?
Sure. I'll take a step back. If we think about fillers, there are these gels that have these amazing properties. They're cohesive, yet they come in and they can lift tissue. They can create these features in the face without migrating to different places when you're asleep. How do they do that? Well, the fundamental building block of these gels is hyaluronic acid. Mother Nature invents a hyaluronic acid. It's this long, complex molecule. Now, if you were to inject hyaluronic acid into itself, into the skin or into tissue, it wouldn't last very long. So industry figured out how to cross-link them. We use these little cross-linkers called BDDE. Basically, they've got two little rings, and they react and bring things together.
So this is where the differentiation is, was really the objective that Cimetase set out to do is, can you actually preserve that natural structure? Because when you cross-link them, you have to do two things. You have to increase the pH. And when you increase the pH, that hyaluronic acid molecule becomes really fragile. And you also use some form of heat. Some are at room temperature, about 24 degrees Celsius. Some go as high as 35 degrees Celsius, 40 degrees Celsius. But high pH and then any form of heat will start to fragment down those building blocks. So what Cimetase did was they solved for that fundamental problem. They figured out how to do this reaction at near-freezing temperatures between 0-5 degrees Celsius. So what they were able to do was do a very good job preserving that natural HA block.
And then from there, they built a spectrum of products ranging from something that's very soft that can go into lips to something that's a little bit harder and has different properties that can go into the most common area treated that needs the nasolabial folds to something that's very robust and can almost simulate kind of cheeks and create more structural things. So it's a full spectrum of it. So that's why we were fundamentally very interested in it. We appreciated the technology. We had benchtop data to actually support that this could potentially last longer and withstand shear and abuse. And then we just presented clinical data that actually showed this stuff works really well. And then the time horizon for approval worked really well for us. So if we think about it, we have basically all of these fillers in Europe, except for eyes.
We expect that to be approved by the end of this year. Then in the United States, they're well on their path. We just finished the last patient in the two nasolabial fold products called Smooth and Lift. We expect to file the PMA this year. We expect to present top-line data this summer. Those two should be approved in the middle of next year, 2025. That's an important one because nasolabial folds are your highest volume. Following that will be the mid-face product, and that's the product called Sculpt. That's halfway through clinical trials, and that should be approved in 2026. Then lips, that's a priority for us. It's usually one of interest for our millennial population. That falls on 2027 and then eyes in 2027.
Great. Thank you for recapping those timelines, Rui. And as you think about getting these or introducing these into the U.S. market and Europe too, how would the market positioning be for these vis-à-vis existing market leaders, and what kind of strategy would you employ? Would we see something similar to a Jeuveau, which is focusing on the younger generation? And in terms of pricing, how do you think about it?
Yeah. I think we're working through that now. In fairness, we're launching next year, and we're preparing our go-to-market strategy. This is a premium line, as Rui talked about. We looked at over 100 fillers over the last several years around the world. Believe it or not, there's more than that even that we didn't get a chance to see. In the end, there are very few differentiated next-generation of hyaluronic acids. This product line certainly fits that bill. It's in the clinic now, as Rui talked about. I think the data will speak for itself. You saw the head-to-head data we released around our earnings call that validates the science that Rui outlined. We feel really confident that we have a product that's very competitive in this space.
In the end, this market is more analogous to the toxin market in the sense that when we enter, there's really three families of fillers today in the United States, and this will be the fourth. When we entered the U.S., there were three neurotoxins, and we were the fourth. I think the dynamics are more similar than different. We do believe we have a differentiated line that can occupy a meaningful position in this market. As you look at our longer-term outlook, as I talked about with the $700 million, we've been very conservative with what we believe the filler will do. That ramp of the filler, adding just under roughly $200 million by 2028, it assumes our shares are a fraction of what we've accomplished in the U.S. with Jeuveau.
So I think we continue to be conservative in our outlook, but we remain very optimistic based on the data we're seeing. The feedback we're getting now from key opinion leaders that are involved in the studies and understanding how we could position this is giving us a lot more optimism. But we sort of will be guarded about that until we get closer to launch.
Got it. When I consider that your target segment, which has really always been the younger generation and the millennials, and the product which is most critical for them, which is lips, and that's only coming through in 2027, so your $200 million does not include contribution from this product.
Right. Well, it's 2028 at that number, so it has a little bit from the lips. But you're right. I think it's fair to say that the Lift and Smooth and the Sculpt products, in all fairness, in 2020 will probably represent, we've said, 70%-80% of that revenue potential. So it is largely driven by that. And the reality of this younger generation is, keep in mind, millennials are in their early 40s now in the upper end of the range. So they are of the age now for fillers. But I do think, in fairness, the demographic skews slightly older with fillers than it does with neurotoxins. And so our new Chief Marketing Officer, she recently joined us. She comes from the beauty category. She is working through how do we position this brand.
In the end, look, great companies know how to position products and brands against the right consumer demographic. The overlap of injectors is nearly identical. When you think about our 12,000 customers, nearly all of them offer facial fillers that currently sell our Jeuveau. The customer overlaps the same. The use of consumer loyalty programs, the opportunity to layer in co-branded media, all of those elements are the same. You should expect that when we launch Evolysse. Our customers certainly want to be a part of things like that. But as far as the consumer positioning, there will be nuances in terms of how this brand is positioned relative to Jeuveau.
I want to go back to the account dynamics again. Have we had instances or a significant portion of instances where accounts have said that, "Guys, you don't have a filler. Come back to me when you have a broader bundle with Jeuveau"? Or what I'm trying to really get at is to see if there's going to be an accelerated uptake of accounts once you launch the fillers in this category.
Yeah. It's interesting. When we first launched, there was a lot of that. And we always believed that our story was very different. And I outlined that for you. And I think you saw in the fourth quarter, we had over 800 new customers. So I think we have a sales force that believes there isn't an account in the United States that we couldn't build a business around. It's just a question of being able to spend the time. And what we've built is something a little different. When we open a new account under Rui's team, we go and train them on how to optimize the precision of Jeuveau. This product is different. And these injectors all use these toxins differently.
And so understanding how they use toxins, how they dose toxins, and helping them bridge that learning gap to Jeuveau has resulted in greater confidence and faster uptake. And then we go in and we show them our loyalty program. And then we introduce co-branded media, and we create ad units for them. This whole process takes about 12 months. And we see accounts from the time we start until they become meaningfully productive is about a 12-month window. So as you asked about acceleration of new accounts, frankly, we don't have a goal for our sales force on how many new accounts we want them to add each quarter. What you're seeing in terms of the acceleration in new account adds is purely just organic demand and the interest in partnering with Evolus rising.
So to that point, I think Evolus likely increases the interest in partnering with us because now we do have a broader portfolio. And we've heard that from some accounts. But we'll sort of gauge that in terms of how we continue to build our organization. But we see just a tremendous amount of synergy here with the filler and an opportunity to be a more holistic part of the practice with the two products.
Great. I do want to hit upon the competitive dynamics also a bit, especially with the Letybo getting approved recently. I think they've had a successful strategy on the pricing front. How do you see this market evolving with an entry of a lower-priced competitor? Would you see this maybe setting the bar lower for other companies like yourselves?
Sure. Look, it's a fair question. I think having been in this category for 20 years and working on a brand like BOTOX when there was no competition, this has been a consistent theme. We're going to have our sixth entrance now with Hugel's approval. The reality of it is a brand like BOTOX is bigger today than it was when they were a standalone product with no competitors. That's because the market opportunity here is so significant, and it's significantly underpenetrated. There's new med spas opening frequently. The practices that we support are growing at a rapid rate, whether they're adding additional facilities, adding new injectors, or just filling their demand book. There's just so much opportunity for growth. From our standpoint, I mean, just take a look at the latest entrant that came in. They've captured some portion of the market.
Despite that, you saw our growth accelerate in the back half of the year. These are consumer brands. We're building a brand that consumers ask for by name. I don't believe that a new entrant changes anything that we do. As a matter of fact, if you look at this year, our guidance of $255 million-$265 million, which is about 30% growth on the upper end of the range, reflects the entrance of Hugel in the back half of this year. I think we feel good about the fact that new entrants increase the noise level in the market, create an opportunity potentially for them to capture some share. For us, nothing changes. Our strategy is very clear that we're building a performance beauty company, and we're building it around this younger demographic. The way that we're partnering with these practices, it's all about growth.
I think for a new entrant, whether that be Hugel or the prior entrant, I think they have to establish their own unique value proposition in order to grab a clear stronghold in the market. There's plenty of opportunity there.
Got it. Great. Dave, for us today, we had a skincare clinic visit. And I think one of the key learnings that I had was practitioners speaking about how the industry itself has been destigmatized significantly. And I think a lot of it would also be on the back of your launch and your product positioning, which has helped drive this trend. I do want to hit upon something else which resonated a lot with investors, which is your profitability outlook. And I mean, you recently revised your guidance there. So just take us through how the operating margin outlook looks and then your cash flow profitability that you're inspecting.
Sure. Well, when we look at our business overall, I think one thing that we've done really well over the last several years is we've had an eye on expenses while we also drive top line. So what you've seen is a 2-to-1 leverage on expenses. So our top line's growing at 2 times the rate as our expense base. And naturally, you do that for multiple years, and you get closer to profitability. And we were in a position in this latest earnings call to bring forward our profitability outlook. And so we expect to be profitable in the fourth quarter of this year and expect to be profitable for the full year of 2025. And to be fair, we would have been profitable before that if you back out the cost of the filler.
So that includes covering the cost to launch this filler, which, of course, there are incremental costs that we're incurring today as we speak to prepare for this launch. So I couldn't be more proud, I think, of the team because balancing the two sides of driving top line growth, which is multiples above what we expect the industry to grow this year, but then also delivering on the profitability outlook, I think that's the sort of discipline we want to have in the company. And I think the filler is just the perfect fit for us. As you know, this was a very cost-efficient transaction for the company. It created a tremendous amount of shareholder value.
If you just look at that outlook relative to the cost of doing that licensing deal, which, by the way, just to put a fine point on that, that licensing deal effectively mirrors our toxin in the sense that it's a 20-year transaction with automatic renewals, not just in the U.S., but internationally. What was important to us is that we build this brand. We want to own the brand for the long term. I think that's a really important part of our investment into this. Cimetase thought the same way. I think it improves our margins, by the way, the fillers, as we look out over time. We've got it sort of 68%-71% on the high end is sort of our margin range that we've provided.
We see very healthy pricing in the market environment going forward, not just with toxins, but with fillers. That also reflects that margin outlook, reflects the international business being a pretty meaningful contributor by 2028. We've said 10%-15% of the revenue. Of course, the international business, it is on a lower margin. Price points are different there. Despite all that, we have very healthy margins overall as a company.
Got it. Great, David. Still multiple questions to follow, but we are out of time. We'll leave it there. Thank you again for joining us, Rui and David and Sandra. I wish you guys a very productive conference.
Thank you.
Thank you.
Thank you for having us.