Good afternoon. I'm Serge Belanger, one of the healthcare analysts at Needham & Company. Want to welcome you back to Needham's 25th Annual Healthcare Conference. For our next fireside chat session, we have the Evolus team with us, President and CEO, David Moatazedi, the company's CFO, Tatjana Mitchell, and Rui Avelar, who's the Chief Medical Officer and Head of R&D. Maybe to get us going here, I'll hand it over to you guys just for a quick overview of the company for those who aren't familiar with Evolus, and then we'll proceed to some Q&A.
Great. Serge, first off, thank you for having us on the line. It's exciting to be here. Evolus, for those of you that don't have a background, it's a company that was founded in 2012. We spent the first half dozen of our years in development stage getting our first drug approved, Jeuveau, and we've been commercial stage for just over six years. We're really proud of what we've accomplished as a company. We're the first company that's really gone head-to-head against market leaders in all of our clinical studies, whether it's Jeuveau or Evolysse, and we've created products that have the potential to be market leaders in the category through both the data as well as the way that we bring them to market, which is through a beauty lens.
We partner with clinics in a way that enables us to reinvest back into their growth in the form of things like co-branded media or a consumer loyalty program that now has over 1.4 million consumers in it. That collectively has enabled us to build a stronger presence in this category where our flagship product, Jeuveau, has achieved mid-teens market share. We've grown historically since launch at about a 40% CAGR, and we recently launched a new product, Evolysse, in the U.S., which has been a really strong product for us in expanding our portfolio with customers here in the U.S. as well as internationally expanded our footprint, where we now operate in nine markets outside the U.S.
Lastly, our guidance for this year reflects a shift for the company in our transition to profitability on the full year, and so we've guided to top-line double-digit growth and a transition to profitability on the bottom line.
All right. Great. Maybe we start with the kind of a broad view of the aesthetic market. There's been a bit of a slowdown, which was a headwind, but I think we're seeing signs of improvement. Maybe you can give just an overall perspective on what you've seen over the last year and what you've seen more recently that gives you, not hope, but some positive signs that things are improving.
Sure. Well, we've certainly seen that consumer confidence started to dip last year. It was very acutely felt in the front half of the year, which impacted procedural volumes across the category. And from that first half, we saw a step upward in terms of consumer sentiment and as a result, some of the procedural volume improved sequentially in the back half relative to the front half of the year. So that was a positive sign to close out the year. And despite that consumer pocketbook challenges that we saw in the category, our business continued to perform very well. On the year, we grew double digits in 2025, and we finished the year on a really strong note in the fourth quarter, notably growing 14% and achieving meaningful profitability. And importantly, that fourth quarter exit set the pace for what we believe is 2026 growth rates.
We've guided to another year of double-digit growth in 2026. That's on the low end of our guidance range. It could be above that on the upper end. Of course, as I talked about earlier, that puts us well on track to achieve profitability of what we said low to mid-single digit operating profit in the company.
What are current expectations for, I guess, the overall market on the neurotoxin side, and then we can talk about fillers, too?
Yeah. Tatjana, you want to take that?
Sure. As we exited Q4, we believe Q4 2025, the toxin market was about flat to slight single-digit growth. We believe that this will continue through 2026, and that's what's assumed in our guide as well. For the filler, it declined likely double digits in 2025, and we're expecting that to moderate in 2026 to see perhaps a low single-digit decline to flat in the filler market for 2026.
Okay. On the fillers, is it just you're starting to comp over some weaker numbers and it's improving, or there's been a change in trends in adoption for products?
Yeah.
Yeah, I just came back from a medical meeting this last week in AmSpa, and I can tell you that the sentiment overall from clinicians was far more positive than I've heard it over the past several meetings prior. I think what we're starting to see is some of that negative sentiment around filler is starting to turn as there's greater education around the safety of hyaluronic acid, the fact that it's not only naturally occurring in the body, but the fact that it's reversible, and also a shift in how these products are getting used. Consumers want a more natural look, and what that means is less volume per patient and using it a bit more carefully than they have historically. I do believe that the HA market is on a road to recovery.
We saw some bit of improvement in terms of the growth rate relative to before, but we expect on the full year that the HA market will continue to be down. We're optimistic that we might see a quarter where it turns to positive growth. As a matter of fact, in Europe, which is a close analog to the U.S., we do believe that the market for HAs has started to turn back to positive. All really good signs as we continue to see this market improve. Of course, as you know, we're a new entrant in this category, and so Evolysse's first quarter was our fourth quarter since launch with the product. We still have a lot of opportunity to continue to go wider with the product into new clinics.
As they're getting more experience with the product in the existing clinics, we're becoming a bigger part of their overall filler use. Just four quarters in, we're really pleased with the uptake we're seeing. Lastly, our flagship product is a product called Evolysse Sculpt, and that's specifically indicated for the mid-face. That is currently under FDA review, and we expect that product to get approved by year-end. Serge, as you know, in this category, all the leading manufacturers have one flagship product that's commonly used. In our case, we believe that Sculpt product to be that brand.
Okay, just going back a little bit to the market, when you did see the slowdown, was it kind of a broad slowdown or in specific pockets of the market? I know you guys kind of over-index towards the younger patients. Were they more impacted than others, than the broad market?
Yeah. It's a question we got from a lot of investors. Interestingly, we went into our database, as we talked about, we have 1.4 million consumers in that database, and we looked at the different segments, by age demographic, income demographic, and we pretty much saw something consistent, which is, it doesn't vary by age. It really is this middle-class consumer that felt the effect. Across the board, that consumer base is stretching those intervals between treatments. It has nothing to do with anything other than the pocketbook. Of course, the more wealthier consumer continued to use these products as they were before because those consumers, they benefit from real estate prices rising, stock values appreciating, and so those consumers were very active in the category and continuing to spend. In the aesthetic space overall, however, it continues to be fueled by that middle-class consumer.
It's not just a luxury good type of product. It's a mass-market product, and that's not unique to our brands, it's to the whole category. We continue to see that be an area that holds the market back from faster growth than it has today.
Did the injectors start adjusting prices due to lower demand for the neurotoxins? I guess same thing with the fillers, I think they're subject to tariffs, so did that impact the pricing for procedures?
Yeah. We didn't see any change in pricing related to tariffs at all, and nor did any of the manufacturers that we're aware of pass along any form of price increase associated with those tariffs, which are specific to devices as you know, up through last year. What we did see was with the slowing in the market, of course, it became more competitive in different cities, and so clinics would offer different promotional ideas and ways of trying to bring consumers back faster into their clinic that may have been stretching those intervals or try to attract new consumers to their clinics over maybe a clinic down the street. Those tended to be more in the form of promotional type of activities rather than just a shift in their overall pricing strategy.
Yeah. Going back to the Evolysse launch, maybe I'll ask Rui to just provide a description of the technology behind Evolysse and how it differentiates the product from what's available on the market.
Sure. Just to make the obvious statement, hyaluronic acid gels are made of hyaluronic acid, and where the differentiation really takes place is one of the critical steps in the manufacturing, the cross-linking. If you have strands of HA and they're not cross-linked, you don't have the properties, and they disappear. You have to cross-link them to give those gels those properties, that lift, that bounce, all those textures. That cross-linking process is really harsh and causes fragmentation in the hyaluronic acid. Our partner, Symatese, they just figured out a way of manufacturing and doing that cross-linking step in a way that just better preserved the HA structure. The way they did it was by conducting that cross-linking step at near freezing temperatures. In other words, they took all the thermal energy out of the system.
If you think about it, if you have that long, complex HA chain still intact or better intact, you may get the benefits. Those gels may be more efficient, kind of like David was saying. Less gel just goes a longer way. You may get better performance, and you may get longer longevity. On the benchtop, we certainly saw that. The thing that was really nice was, when we started looking at the data clinical trials, that's exactly what we saw. With less material, we were getting more correction, and we were certainly seeing longer duration. From a natural perspective, that's actually the feedback that we've gotten. That fundamental approach of just trying to do a better job preserving the HA and hoping that would translate into a better product is what we seem to be seeing.
Okay. I think David mentioned earlier that there's, especially with fillers, a movement towards less product, more natural look. When we're talking about less product, are we talking about 30% less, 20%? I'm sure maybe it varies, but is there a kind of a range?
Yeah. I don't know that we've explored that completely. Certainly, for instance, when we looked at our U.S. FDA approval study for a product, one of them, Smooth, for instance, it was split-face, so the treating physician would treat one side, treat the other side, look at how much material was required. In general, in the Smooth study, there was 20% less material used. Despite that, when you looked at the primary endpoint, we hit both non-inferiority and statistical superiority. When you looked at over the year, we always had more improvement. In the case of Form, we always had more improvement, and when you looked at every data point over the course of the year compared to the active control, we actually hit statistical significance at every single time point.
Okay. If I recall, when the product was approved, there was some language around GLP-1s. Has that been something you've been able to leverage? Does that differentiate the product?
Turn over to David for that.
Yeah. Well, what makes it unique, as you pointed out, is Rui was successful in getting the mention of weight loss into our patient label information, and that gives us the unique opportunity to advertise that to consumers, and we're the only hyaluronic acid that has this mention in the market. We are using that mention of weight loss in our co-branded media. Matter of fact, we put out billboards across the U.S. with mentions of weight loss. We have digital advertising as well with it. It starts with first establishing the science and the technology, getting the clinician interested in the product and starting to utilize it to build up their confidence. Once they build up their confidence and they're starting to use the product, then the co-branded media becomes effective.
We are now in the early stages of building out our commercial presence from an advertising standpoint with Evolysse, just like we did with Jeuveau, which has been incredible, the awareness of that brand in the five short years we've been there through the co-branded media capability. It allows us to take any one clinic that's adopted our product and start to advertise our product in partnership with them in a radius of their office. We're starting to do that now with Evolysse, and as the product scales, we'll do a lot more of it all across the country.
Okay. You mentioned the training. Is that just getting the product in their hands, and they trial it on staff and significant others, and that's how they gain experience with it?
Yeah, it's been interesting. That's exactly right. The initial take when we give them samples and they trial it, they'll generally, with all these products, they'll start with people that they trust. And then from there, their adoption will broaden to their own patient base. And with Evolysse , one thing we've learned is because of the unique properties that Rui talked about, these clinicians will play with it a bit, gain some comfort, and then we'll bring in a second training because that'll be the one where they can address some of the other questions around the broader utility of the product and how to maximize those unique properties. And so that second training is where we start to see a meaningful lift in the overall usage of the product in those offices.
We've been active on doing both the initial trainings as well as bringing accounts once they're at a certain level of proficiency in for a second training.
Do you have an idea of what product you're displacing, or it's kind of like Jeuveau, where you kind of displace the products that have the most market share, and that's kind of how it works?
Yeah. It's a little too early to say, right? Jeuveau went in a market where the share was heavily concentrated in the market-leading product. That's not the case in the category of hyaluronic acid. At this point, it's too early to say, but it is a representative mix, we believe, not overly concentrated against one particular product.
Okay. The next product, Sculpt, is going to be launching this year. Is that still on track for late 2026?
Rui?
Yeah. That's what we've been guiding.
Yeah.
Is for approval in Q4. We just kind of made that assumption take about a year, a little bit over a year, last longer than the Form and Smooth. It's a two-year study instead of one year, and the duration profile of that product's longer. We continue to guide to a Q4 approval.
Yeah.
Okay.
I would add, Serge, that there's no revenue assumed in our 2026 guide.
Right.
Before approval. Yeah.
That was my next question. But Sculpt is going to be the workhorse of the Evolysse franchise, right? This is your mid-face product?
That's right. It's a premium flagship product in that franchise. We already know from the investigators that have used the product in Europe, where we put it in the hands of some of the top users, Sculpt continues to be a standout product in that market. That area, in particular, is especially challenging to formulate a hyaluronic acid gel that's effective in the mid-face. Sculpt was really the key starting point as Rui and I looked at various assets early on, and Symatese stood out because of this brand. We're very excited. I know the clinical investigators are equally excited. In the field, the noise level around that product is the highest we've seen of any product that we've worked around.
Okay. So we should expect Sculpt to be a nice growth driver for 2027, just given the importance it represents for the franchise?
That's right.
I think you started your bundling program with Evolysse and Jeuveau, I believe it was in the fourth quarter. Any update there on how well it's gone?
Yeah. As you know, Serge, we're a single-product company for almost six years before we introduced Evolysse. We're all proud of the fact that with a single product, given our value proposition in the market, we were able to capture double-digit market share. Now with Evolysse, we finally have a portfolio to start talking about more than one product. That enabled us in the fourth quarter to pilot our first rebate that was tied directly with purchasing of our portfolio of products. We purposely piloted the program to understand what the interest level would be, engagement with clinicians, and it exceeded our expectations that we had set internally. As a result, we turned around in January and we rolled it out to our entire sales organization, and now it's being broadly introduced around the country.
It's a six-month program that gives a benefit to clinicians who grow with Evolus. To grow, of course, that means committing more of your partnership to us across both toxins as well as with Evolysse, our new HA. That six-month period ends at the end of June. We know a number of accounts are building up their volume with us in order to participate in that portfolio benefit, which is a financial incentive for those accounts. It's an opportunity cost for them to switch away from something else to us, but it's also our first opportunity to compete with a bundle after seven years of being on the market in total.
Okay. I think prior to the start of bundling, you're already in 50% or so of U.S. accounts, 15,000, 16,000. Did the process involve going back to these existing accounts and offering the bundling program, or? Just curious how it was rolled out and how it will continue being rolled out for 2026.
Yeah. As you know, a lot of our growth in our first six years came from a combination of adding new customers to get to, as you said, half of the clinics in the U.S., in addition to continuing to build our presence within existing customers. With Evolysse, it's more skewed towards going back into those existing customers and establishing Evolysse and building the portfolio benefit while we spend a bit lesser time on adding new customers. Over time, we'll go back to spending more of our time adding more clinics, because, as you pointed out, there's still roughly half of the clinics that we're not in today. It's a combination of both to some degree, with a heavier emphasis on going deeper.
Okay. You view this as a growth driver for Jeuveau, not just Evolysse?
That's right. Yeah. We see the portfolio bundle as an opportunity to take our brand, which we believe is mid-teen share overall, but in the clinics that we're in, tracks at roughly a 25%-30% market share, and an opportunity to go deeper within those clinics that bring on Evolysse and make us the partner of choice.
Yeah. Okay. On Jeuveau, the product's been out on the market now for seven years or around that time, right?
That's right.
Obviously not growing at the 40%-50% annual growth rate that we used to see, but you're still outperforming the market. Maybe just highlight what you're expecting from that product in 2026, with the bundling program and just potential market recovery.
Sure. Tatjana, you want to take it?
Yeah, I'll take this one, and David can chime in. For 2026 and beyond, we do expect Jeuveau to continue to outpace the market. The portfolio rebate, as David mentioned, is part of that really drive. When you think about 2026, we also have two new entrants into the market in the toxin in the U.S. When we did our guide, we really were considering that as a potential impact, even if temporary, to Jeuveau.
Okay. Those two entrants, you're referring to Letybo and the short-acting product from AbbVie?
Yeah. The two entrants are the short-acting product from AbbVie, TrenibotE.
Yeah.
We could talk more about this, but with the short-acting, what AbbVie is really looking to do is expand the market for toxin. Bring those consumers, so this is a heavily under-penetrated market, and bring the consumers who are on the sidelines, maybe nervous about getting treated, bring them into the market, which we see as a positive for the entire market. The other one is Relfydess, and that is a liquid toxin by Galderma.
Okay. With these new entrants, obviously the short-acting one I feel is a little different, addressing a different segment, but do you expect any impacts on pricing for the neurotoxin market?
We do not at this time. What we've done, given that it's a pretty sluggish market, it's been in 2025 and going into 2026, right? We have not increased prices, and broadly, our competitors haven't either. From a pricing perspective, we're looking to stay stable.
We think we're well-positioned in the market. Our value proposition is unique and different, as you know, between the value of the product, Jeuveau, with the head-to-head data and then the portfolio benefits that they're now earning on top of the co-branded media and the consumer loyalty. We'll continue to lean into our value proposition, just as we did as the last two entrants entered. You did not see us looking at price as a lever to do that, but to focus on what we're building, and we'll leave it up to the competition to establish their positioning. Fortunately, Jeuveau's weathered through a slowdown. It's weathered through multiple competition and continues to outpace the market.
I think the story behind that is we just have an excellent product here with an increasing amount of evidence that supports that it's differentiated within this category and deserves to be here, if not deserves to have a bigger presence than it currently does in the space.
Yeah. Remind me again where you exited 2025 in terms of market share.
At 14%.
Okay, 14%. Since you expect it to overperform the market, we could see that move upwards in the future?
Yeah, we're guiding for 2028 to step up incrementally and still be in the mid-teens market share for Jeuveau in the U.S.
Got it. I wanted to spend a little time on the ex-U.S. efforts. I think that's becoming a more important part of the top line. Just an overview of in which countries you are now and which additional ones you expect to be.
Yeah. We operate now in nine countries outside of the U.S. We have a presence now in the Big Five, so to speak, in Europe, which are really important because not only do we have a presence, but we're direct in all of those, with the exception of France, where we have our partner, Symatese
Mm-hmm.
Importantly, we're launching the new HA products, the Estyme line, all four products in the second quarter of this year. We're really excited to build on their portfolio. Now, all of those markets are in different stages of maturity. U.K. was the first market we entered, followed by Spain, and then followed by France, Italy, and Germany that we took a direct presence in more recently. Beyond that, we have a presence in Canada and Australia. Australia is a direct presence and a partner in Canada with some smaller markets like Austria, and Ireland as well that we have a presence in starting last year.
In these ex-U.S. markets, I guess the main part right now is Europe, since you're in the Big Five. Have you noticed any slowdowns or some macro pressures that have led to some of the issues that we've encountered here in the U.S. markets?
Yeah. Europe's been a strong economy through last year. Of course, we're watching it closely because we're aware of their reliance on energy and the impact that the war could have on Europe. Thus far, we haven't seen anything that significantly shifts that view. Keep in mind, we're in very early innings in Europe when you think about some of these markets. We just hit one year in those markets, so our market shares are lower. Although we're pleased in the U.K., where we're three years in, and we're nearly at a double-digit market share there.
We're seeing the markets outside the U.S. mirror the ramp of what we accomplished here in the U.S., but it's a lot more about gaining our presence in the market and getting into clinics than it is about the absolute growth of the category at this stage in our maturity for those markets.
How do you see the opportunity for the four HA products you'll be launching in Europe, just given that the differences in the market makeup versus the U.S. one?
Yeah. That's a competitive market in Europe, as you point out, with hyaluronic acids. There's more competitors there than there are in the U.S. That being said, we're one of a handful of companies that has both an injectable neurotoxin as well as an injectable HA and a differentiated one as well with Nuceiva. I think we're really well-positioned. The team is incredibly excited. We did engage clinicians from all of those key markets in an early experience program that started last year. We do have a large base of clinicians that have experience with Estyme products, but we're particularly excited for the launch in Q2 because this will be the first market where all four products are available simultaneously and the Sculpt product too. We know there's a lot of excitement about the Sculpt product in that experience program.
Some of those clinicians have started to adopt our brand, and we of course look forward to the launch, being what will more broadly engage some of the bigger Nuceiva accounts and others to participate. Look, it'll be a welcomed addition to the portfolio, but it puts us in a unique place with just a handful of companies that will have that.
Okay. Tatjana, you spoke a little bit earlier about guidance. The company kind of updated their long-term outlook last year. If you can go over that and kind of the moving parts that get you to your long-term target for 2028.
Yeah, we did. What's important to note about that is that we started from 2025, which was a lower base. We just talked about, right, the trends both in the toxin.
Yeah.
Filler markets for that year. Starting from that base, we applied what I would say is a modest market CAGR, mid-single digits for toxin, and even a bit lower than that for filler. Maintaining our shares, so really thinking about much like in the last guide, in the filler in the U.S., achieving high single-digit market share and the toxin getting into the mid-teens and really advancing that from the 14% where we're at today. Within that also, international is contributing, so international nearly doubled in 2025, even though with rounding, went from 5% of global revenue to 8% of global revenue. We're looking for that to be in the mid-teens percent of global revenue by 2028. When you take these pieces together, that is what from a revenue perspective, and it's growth across the portfolio.
Jeuveau in the U.S., Evolysse in the U.S., right, i nternational, Nuceiva, and Estyme gets us to that $450 million-$500 million.
Got it
Importantly, if we are looking at margins being relatively stable over that timeframe, really looking at our operating expenses and really showing this operating leverage. You already see that in our 2026 guide. We have $210 million-$216 million range for OpEx, and that is really 0%-3% growth year-over-year. That's because in 2025, we really set this expense base to support the portfolio, both domestically and in international. We took out $25 million, in fact, of the planned spend in 2025. With this base, we can support the portfolio through 2028 without really needing meaningful step-ups in operating expense. That's what drives the leverage. When you look at our adjusted EBITDA guidance, we're guiding to low to mid-single-digit percent adjusted EBITDA in 2026, and for that to get to 13%-15% by 2028.
Okay. As you know, once companies cross the profitability threshold, questions about what to do with their growing cash balances become more common. How interested are you in BD, and what kind of assets would you be interested in?
Yeah. I will start, and then I'll hand it over to Rui. We are actively looking at assets to add to the portfolio, and two categories in particular that we are looking at that would be similar to how we executed with Evolysse are biostimulators and their products in that category that are showing really healthy growth in the United States. The other is skin quality. Both of these are devices. Both of these are injectables. They would both be very capital efficient in terms of developing them and bringing them to market, and we would be looking at that being 2028-2030 revenue, right, given the timeline on a lot of these products, which would be really well lined up because we have Sculpt and Lips, right, and then these new assets coming up.
Rui, maybe you could touch on these two categories in particular.
No, I think that was perfect. As you know, fillers is a broader category. We have the HA component. The biostimulator's a really nice add-on, and it fits in with our channel. Skin quality, again, same thing. It's a really nice complement to the portfolios that we have in our channel. The only other BD opportunity that I would add to Tatjana's is we also are very interested in hair. It's an interesting opportunity. It's underserved, so we continue to explore opportunities there.
Okay, maybe just to wrap up here since we're coming up on time. David, the stock has obviously felt the impact of some of the macro pressures and re-rated lower over the last 12 months. Anything you want to highlight about the story that you feel is still underappreciated or misunderstood by us analysts or the investors?
Yeah. I would just say the story's the same as it was when we first commercialized in the U.S., and that's now coming up on seven years, which is we're building not just a medical aesthetics company, but a performance beauty company. We think that the consumer mindset's shifted more to seeing this as part of their routine beauty treatment, and Evolus is incredibly well-positioned to capitalize on that shift that's occurring. Over the past seven years, you've seen Jeuveau capture mid-teens market share in the U.S. We've grown historically at a 40% CAGR as proof of our ability to get there. Last year, despite the market dislocation, we still grew double digits and exited with faster growth than we did on the full year. Of course, we rebased our expenses now in our maturity to focus on profitability, and we're deeply committed to it.
You saw that in the back half of the year, the profit that we were able to generate on our new expense base, and that expense base enables us to maintain roughly a flattish expense base on the full year this year, which is meaningful profitability that drops to the bottom line on our journey to get to 2028. We're really excited about putting our heads down, executing on the business we have today, gaining approval of Sculpt, executing internationally, and looking at pipeline deals that enable us to continue to build on our platform of assets that drop right into the bag and bring more value to clinicians that are looking to build their business with Evolus around our beauty positioning.
All right. Well, we want to thank you all for joining us this afternoon and giving us an overview of Evolus and how the company is growing. Thanks for your time. We appreciate it.
Thank you.
Thank you, Serge.