Thank you very much for joining us today despite your busy schedules. I will now present SBC Medical Group's business overview and financial results for the first quarter of 2026. Let me begin by explaining how SBC actually operates, because our model is somewhat different from what many people initially expect. We are a Medical Services Organization or MSO. We provide clinics with everything they need to operate efficiently, including marketing, procurement, technology, hiring, and training. Everything is managed centrally, which makes the model highly scalable. As the clinics grow, our earnings grow alongside them. Our flagship brand is Shonan Beauty Clinic, the largest beauty medical group in Japan. We founded the business in 2000, listed on NASDAQ in 2024, and are now ready to expand this proven model globally. SBC is not a single brand business.
We have built a portfolio of brands covering a broad spectrum of beauty and medical services, ranging from quick, affordable treatments to high-end surgical procedures. In general healthcare, we also operate specialized brands in hair loss treatment, fertility, orthopedics, eye care, and dental services. The reason behind this strategy is straightforward. Different patients have different needs. By offering the right brand for each segment, we can serve a broader market more effectively. In addition, patients often move between our brands over time, allowing us to maintain long-term relationships within our network. Next, let me highlight our clinic business. We currently operate 284 clinics, primarily in Japan, and serve 6.7 million customers annually. This extensive network and strong customer base provide a powerful foundation for sustainable growth and reinforce our leadership position in the market.
Both the number of customers and average revenue per visit increased year-over-year, driving continued revenue growth, including solid growth at existing clinics. Going forward, we will continue enhancing our service levels through our multi-brand strategy, which enables us to address increasingly diverse customer needs with precision. Combined with the continual development of new services, we believe this will further strengthen our competitive advantage and support long-term growth. People often ask us, "If this model works so well, why has nobody else replicated it over the past 26 years?" The answer is the loop we have built. When patients receive great care, they trust us. When they trust us, they come back. When millions of patients come back, we accumulate an enormous amount of data. That data improves our training, strengthens our AI capabilities, and sharpens our marketing, which leads to even better care, and the cycle continues.
The key point is this. New competitors do not simply face a cost disadvantage. They face a 26-year data gap. You cannot buy your way out of that. That is a moat built over 26 years. Next, let me move to our consolidated income statement. Total revenue for the first quarter of 2026 was $43 million. While this represented a 9% year-over-year decline, the primary factor was a fee structure revision implemented in April of last year. This revision reduced franchising revenue by $6.2 million and management services revenue by $2.4 million, for a total negative impact of $8.7 million. In addition, procurement revenue and rental services revenue declined year-over-year. Meanwhile, growth in point revenue partially offset the decline in management services revenue.
Please also note that net income attributable to SBC Medical Group declined year-over-year, partly because the prior year quarter included a one-time life insurance surrender gain of $8.7 million. As mentioned earlier, the reported revenue decline was primarily attributable to the fee structure revisions. Excluding the $8.7 million impact from those revisions and further adjusting for the $1.3 million difference related to the AH consolidation period, underlying revenue grew 11% year-over-year. Similarly, excluding the $8.7 million impact from the fee structure revisions, underlying EBITDA increased 17% year-over-year. While the headline figures show declines in both revenue and profit, I would like to emphasize that excluding the impact of the prior year fee structure revisions, both revenue and EBITDA demonstrated solid underlying growth. Let me turn to where we are heading.
Everything we are building points toward one central idea, longevity, helping people stay healthier and feel younger for longer. We approach this opportunity from two sides, the appearance side through our aesthetic medical services and the physical health side through our general medical services. We are pursuing this vision through four key initiatives, I will walk through each of them. Last year, we launched SBC Wellness, a health and wellness benefits program for corporate clients. We are now preparing to take it to the next stage with SBC Wellness 2.0. This next phase is centered around one key concept, longevity. In the U.S., longevity medicine is already gaining significant momentum. Personalized health programs designed to help people perform at their best, not simply treat illness. In Japan, however, no clear leader has emerged yet. We intend to be first.
We believe we are uniquely positioned to lead this market. We have accumulated 26 years of medical expertise, built a nationwide clinic network, and developed a large base of patient data. Together, these assets create a platform that is extremely difficult for others to replicate. By entering the market early with these advantages, we believe we can establish a dominant position before the market fully develops. We also believe the corporate channel is the most efficient way to scale this business. By offering Wellness 2.0 as an employee benefit sold directly to companies, we can reach large populations without relying heavily on traditional marketing spending. Companies want healthier and more productive employees, and we provide a compelling solution to support that goal. We believe the fit is very natural on both sides. Our second growth initiative is expanding the operational capabilities we developed in aesthetic medicine into broader healthcare categories.
There are three strengths we believe transfer effectively across medical fields. First, our marketing capabilities. We know how to attract patients and maintain long-term engagement. Second, our operational model. We have developed a standardized approach to clinic management that scales efficiently across multiple locations. Third, our ability to provide both cash pay and reimbursed care medical services within the same platform. We are already applying these capabilities in orthopedics, fertility treatment, and eye care, all of which are attractive and fast-growing healthcare markets that align naturally with our existing strengths. Turning to global expansion, our approach is disciplined and straightforward. Japan remains the strong foundation that supports everything else we do. We are not pursuing aggressive overseas expansion. Instead, we are expanding selectively, leveraging the operational model we have already proven in Japan.
In the United States, we are partnering with OrangeTwist, a premium medical spa group operating 24 locations. OrangeTwist has deep expertise in the United States market and delivers an excellent patient experience. SBC contributes strong operational capabilities and an efficient clinic model. Together, we are opening new locations and building a presence in the emerging longevity market. Over time, we also expect to bring the best elements of the United States operating model back to Japan and other Asian markets. The final component of our strategy is AI. This is fundamentally about transforming how we operate. Today, our business requires significant human labor to manage. As we continue to scale, that naturally becomes more expensive and more complex.
Our solution is to leverage 26 years of patient clinic and operational data to build tools that do the heavy lifting for us, including automated bookings, smarter marketing systems, AI support for clinic staff, and 24-hour patient communication services. We are using AI to improve both sides of the business simultaneously, enhancing the patient experience to drive revenue growth, while also increasing operational efficiency to reduce costs. This is not an either/or strategy. We are pursuing both growth and efficiency at the same time. The result is a business that can scale more rapidly without increasing headcount at the same pace. Other companies may attempt to build similar AI tools. However, they do not have access to the data we have accumulated over 26 years. That is our lasting advantage. Let me conclude by returning to the six key reasons we believe SBC represents a compelling long-term opportunity.
First, our track record. SBC is Japan's largest beauty medical group by number of clinics. We started with a single clinic in 2000. Today we operate 284 locations across more than 20 brands. We serve over 6.7 million patients annually. 72% of them return to us. That level of loyalty sustained over more than two decades is not accidental. Second, we have built a business model that is extremely difficult to replicate, supported by a 26-year operational and data advantage. Third, we generate strong profitability. Net income reached $51 million last year, up 9% year-over-year. Our EBITDA margin exceeds 40%. We reinvest that cash flow back into future growth. Fourth, we believe we are still early in the development of Japan's longevity market, where no clear market leader has emerged.
Fifth, we are now extending the operating model proven in Japan into international markets through partnerships and investments in Southeast Asia and the U.S., including our strategic stake in OrangeTwist. Sixth, we have a strong management team. Our inclusion in the Russell 3000 Index in 2025 reflects our position as a well-managed and increasingly recognized public company. We believe SBC is uniquely positioned to lead the next generation of healthcare and longevity services, both in Japan and globally. Thank you very much for your time today.
Thank you very much for that. That was very interesting, and it gave a good overview of the company and its operations. We can now open the floor up for additional presentations or questions and answers. Let me begin with one question about the types of clinics that you're operating. There was a mention in the presentation of different types of medical specialties, aesthetics and cosmetics being one of them. Do you have a certain division of the types of clinics or any kind of strategy to go into certain types of over-the-counter or medical specialties or general medical care?
Yeah. Thank you very much. First of all, we think the aesthetic medical area will continue to be our core businesses. As we mentioned at the presentations, our new theme is longevity. In order to achieve longevity needs.
We would like to expand the non-aesthetic medical area as well, including AGA, orthopedics, eye care treatments, dentistry. Yeah. Going forward, I think that our medical department will be expanded.
Okay, great. In terms of locations, there was a quick slide that showed Japan, the U.S., and Asia. Did I hear correctly that Japan was going to be the majority of the growth going forward? Are you partnering with OrangeTwist to expand into the U.S. and expecting that to be one of the sources of growth?
Again, I think the Japanese market will continue to be our core market. At this moment, more than 95% is operations is conducted in Japan. On top of that, we would like to expand our businesses internationally, including United States and Southeast Asia. Stephen, can you touch on that, add some comments?
Yeah. Thanks, Robert, thanks for letting us be here. Yeah, like Hikaru said, the core business is based in Japan. We've been there for 26 years. It's such a dominant player there and such a widely recognized brand in Japan. I think if you ask anyone there, they would immediately know the company and what we do and what we stand for and our reputation. We can leverage our scale really well in Japan. We've built something really amazing there to continue to grow and acquisitions. We're predominantly in the aesthetic market, looking to, as Hikaru mentioned earlier, expand into medical areas as well. We feel our platform really supports those types of businesses, not just cosmetic surgery or aesthetic dermatology, but it can support infertility clinics, ophthalmology, orthopedics. There's a lot of areas for us to grow into.
We also have a really cool kind of telehealth business, too. You can get your finasteride, minoxidil through our sites or through our clinics. There's a lot of different areas that we're continuing to develop and build. We're also looking into parts of Japan that we haven't reached out to yet. We're predominantly focused in the metropolitan areas, but there's a lot of geographic regions within Japan that we haven't reached. Within Japan itself, I'd say there's a lot of opportunity that's still on the table, and that's where the near-term growth is going to continue to be. As we think longer term, too, we're starting to plant seeds globally. We did an acquisition in Singapore. We have about 20, 24 clinics in Singapore. We have our partnership with OrangeTwist in the U.S. with 24 clinics here.
The strategy that we're thinking is, how do we continue to plant seeds that give us a lot of long-term upside potential, while still focusing on our core business in Japan? We don't want to disrupt that as we continue to expand. You'll continue to see new, exciting things happening in the U.S., which we're excited to continue to share as we develop. You'll still see a lot of strong and cool things happening in Japan as well.
Okay, great. Now we have a few questions from the online audience. The first one is, what is your long-term same clinic revenue growth target, and how much is currently driven by pricing versus customer volume?
Yeah. Thank you very much. First of all, we don't have a concrete same clinic revenue target at this moment. For the first quarter 2026, we are successfully increase the 6% growth in same clinic revenue. Of course, we are now keeping the growth trend in terms of the number of customers and also maintain the average revenue per visit level as well. I hope we will keep the current trend going forward as well.
Yeah, I don't think it was in this slide, but you'll notice that there's been an increase and kind of a return to our average sales price over the last quarter or two to [inaudible ]. That's 11% up. We've also seen increase in volume as well. We're at about 6.76 million unique visitors across all of our clinics. It's going to be probably a combination of both as we go forward. Yeah.
Okay, the next question is on that topic. This viewer asks: Average revenue per visit has recovered. Is that being driven by mix shift toward higher value procedures, improved pricing, or reduced discounting?
Yeah. Thank you very much. Yeah. In 2024 and early 2025, Japanese market, aesthetic market, was very competitive, because for many doctors, aesthetic medical market looks very profitable. Number of new joiner was increased. After that, we hire a new CSO and a new CMO, and they are trying to optimize these situations. We brush up our pricing model and our treatment mix as well. Basically, due to the several initiative, this average revenue per visit has been improved. In terms of the treatment mix, in the past, our majority of our treatment is aesthetic surgery. Definitely, the average revenue per visit for aesthetic surgery is higher. These days, the number of aesthetic dermatology has been increased. The feature of the aesthetic dermatology treatment is they are very recurring businesses.
Even the average revenue for aesthetic dermatology is not expensive. I think the businesses will turn to more continuous one. That's the current situation.
Okay. One of the things mentioned in the presentation was a fee structure revision. What was revised and what was the change before and after, and the reasons behind them?
Yeah. Thank you very much. Yeah. It passed almost one year. Again, almost one years ago, Japanese market was very competitive. That's why, especially for the small size clinic and the newly open clinic, was struggling to make money. That's why we revised the fee structure, fee level, based on the size of the clinic. And we consider this change a support to for suppose the medical corporation to expand their network more. Again, I think the clinic situation is getting better, and the average revenue per visit has been turned around to positive. Latest figure is +11%, and the total revenue has been increased, including same clinic revenue. That's a background, and the situation is getting better, much better.
Yeah, so-
Yeah, it's-
Go ahead, Steve.
Yeah. I was just going to maybe emphasize, too. It was more of a flat structure across the board. The reason why we did it was to just ensure longer term sustainability and growth within the business. Like Hikaru mentioned, you don't want to just throw flat heavy fees on a new growing clinic. We've made it a little bit more variable. Kind of we wanted the structure to scale with the clinic itself. I think there was that short-term impact. Now we're seeing the recovery this year. From next quarter too, you'll start to see more of an apples to apples kind of year-on-year comparison. We feel like this has been a really positive change overall for the business and the overall health of our clinics.
We feel like we're in really good shape at this point.
Yes. The numbers in the slide that you have up show that.
Yeah.
Okay. The next question is, you operate through a large franchise management services model across aesthetic medicine and other healthcare categories. What are the key competitive advantages of that model?
Yeah.
I think you-
I think-
you kind of mentioned some of the standardizations and best practices that you apply across the entire network.
Yes, exactly. Exactly.
And-
Yeah, I think in Japan, our brand power is very strong based on the 26 history. We consider getting the very good satisfaction from customer, more than paying cost, is very important. I think the number of our fans, our customer, is very huge. We consider the educations and the training to the doctors or nurses and concierges is very important. We utilize the huge data into this education training. That's why this enable us, our treatment level or service level is quite high. I think this is one of the very big advantage compared with other competitor.
Oh, absolutely.
Our scale too. One of the things that really we can leverage is just the amount of scale and volume that we can leverage and I think we're one of the largest Botox users in the world. We do a lot of Botox in Japan. Also too, our brand, we have 20 different brands that target different demographic groups. You can have in the same area in Tokyo or even the same building, multiple different branded SBC clinics that can operate and be successful, even if they're so geographically close to each other, just because they're targeting different specific demographic segments. There's a lot of flexibility built into the business that allows us to continue to grow and operate and to reach different groups within Japan.
I would also expect that the administrative services that you can provide at scale would be more efficient and take some of the tasks away from the individual clinics and standardize them, centralize them, and provide them at lower cost as well.
Exactly. Yeah. It's incredible, the price difference even between the U.S. and Japan. If you go in for Botox here, if you want to get, let's say, your forehead done, maybe you're spending $ 200 to get your Botox. Whereas in Japan, you're probably looking at $ 60. Pretty significant price difference what you would pay in Japan, just because we're able to leverage a lot of scale and other things to keep costs down.
Okay, great. Next question is that you report a 72% repeat rate. How has that trended over the past several years, and what's the lifetime value of a typical customer?
Thank you very much. I think that we keep the current level from the past. I think that our repeat rate is quite high compared with other competitors. On the left bottom shows the number of customers and unique customers as well. Total number of customers is 6.7 million annually. On the other hand, unique customer means 2.1 million. It means that in average, every customer visit our clinic three times a year. Again, we have a very variety of brands in the aesthetic dermatology area, surgical area, and the non-aesthetic healthcare area as well. I think that our customers' LTV is quite high as they are circulating among these, our brands.
Yes. I would expect that there's probably a fair opportunity for cross-selling between the brands.
Yes, exactly.
As you mentioned, one building can have several brands so that a customer is familiar with the location and can visit several in one day or several visits.
Yeah, exactly. Thank you very much.
Okay, great. All right. Just in the interest of time, we're about out of time. Are there any closing statements that you would like to make in terms of any milestones going forward or financial metrics that you think people should pay attention to?
Yeah. Thank you very much for your time today. I think that our clinic situation in 2026 is very nice. Again, we set a new theme of longevity going forward. We would like to expand our businesses, our more diversified businesses going forward. Yeah. I'm very looking forward to see you next time. Thank you very much.
Great. Hikaru, Steve, thank you very much for presenting for us today. Look forward to speaking again and following these milestones.
Yeah. Thank you very much.
Thank you.