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Thank you. Good afternoon, ladies and gentlemen, and welcome to the Skin Health Systems, Inc. Second Quarter 2026 Earnings Call. At this time, all lines are in listen-only mode. Following the presentation, we will conduct a question and answer session. If at any time during this call you require immediate assistance, please press star zero for the operator. This call is being recorded on Thursday, August 6, 2026. I would now like to turn the conference over to Dr. K.

and Vesta Relations. Please go ahead. Thank you, operator, and good afternoon, everyone. Thank you for joining us today to review Skin Health Systems' 2026 Second Quarter Results. We released our results earlier this afternoon, which can be found on our corporate website at skinhealthsystems.com. Joining me on the call today is Skin Health Systems Chief Executive Officer, Pedro Mala, along with their Chief Financial Officer, Mike Monahan. Before we begin, I want to remind everyone of the company's Safe Harbor language. Management may make forward-looking statements, including guidance and underlying assumptions.

Looking statements are based on current expectations and beliefs and involve risks and uncertainties that could cause actual results to differ materially. The centers are cautioned not to place undue reliance on any forward-looking statements. For further discussion of risks related to our business, please contact the Director These refer to the risk factors contained in the company's filings with the FCC. In addition, this call presents non-GAAP financial measures. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measure is available in the earnings crest release, which was furnished to the SEC and available on our website. Following management's prepared remarks, we will open the call for a question and answer session. With that, I would now like to turn the call over to our CEO, Pedro Mala.

Please go ahead, Pedro.

Good afternoon, everybody, and thank you for joining us to discuss our second quarter results. Let me start with a quarter at a high level. Overall, this was a mixed quarter. Revenue came in at approximately $72 million at a lower end of our guidance range. Equipment sales remain the biggest headwind as providers continue to take a cautious approach to capital investments. consumables proven a bit more resilient, supported by the continuous growth of our installed base, although treatment activity remained below expectations. This overall revenue pressure was evident across both our domestic and international businesses, with international markets remaining a bit more challenging. At the same time, profitability for the quarter was significantly stronger than we expected.

Adjusted EBITDA came in at $17 million, well above our guidance range and driven by strong gross margins and continued discipline in how we manage the business. In summary, we are not satisfied with our top-line performance, but the quarter reinforced an important point. Even in a more demanding commercial environment, we are building a stronger company with better margins, greater operating discipline, and a more resilient financial model. As importantly, nothing we saw this quarter change our strategic direction. If anything, it reinforced it. Let me spend a few minutes now on what we are seeing in the market, because it can provide an important context for both the quarter and the strategic choices we are making. The long-term demand for skin health remains healthy. What is changing is how that demand is being distributed.

Consumers have more treatment options than ever before, and providers are making more selective capital investment decisions as they evaluate a broader range of technologies. We believe that that environment rewards companies with trusted brands, meaningful innovation, strong clinical evidence, and deep provider relationships. And those are the areas where our company is best positioned to compete and where we continue to focus our investments. As we said last quarter, market conditions are only a part of this story. responsibility is to execute better. And that is exactly where our efforts are focused. We are strengthening our commercial capabilities, improving how we engage with customers, and becoming more effective at converting opportunities. Those are the things we can control, and that is where our team is focused every day.

We also continue to believe strongly in the long-term opportunity for this business. For more than 20 years, HydroFacial has built one of the most recognized and clinically validated brands in professional skin health. Today, we serve more than 36,000 providers worldwide, have a large and growing install base, and generate around 75 percent of our revenue from recurring consumables, which together build durable, competitive advantage that position us to create long-term value. Last quarter, we discussed several of the investments we're making across the business, including consumable boosters and the next generation of the hydrofacial device. Today I want to explain how this worked together to support our long-term strategy. Our strategy is built around three priorities. First, strengthening and growing the core hydrafacial franchise.

Second, increasing the value of every system already in the field. And third, leveraging our platform and provider relationships to expand into attractive adjacent categories. Together, these priorities are designed to accelerate sustainable growth by expanding our installed base, increasing treatment utilization, growing recurring revenue, and creating a more diversified business over time. Let me start with the first priority, strengthening and growing our core hydrafacial franchise. A key part of strengthening the franchise is making the platform accessible to a broader range of providers. As we discussed in prior quarters, capital constraints remain one of the most significant barriers of adoption. So to address that, early this month, we introduced in the U.S. a new device range. rental program designed to lower the upfront investment by providers and make hydrofacial accessible to more practices.

We believe this will expand our addressable market and support growth of our installed base. The financial accounting for the program is similar to our existing sales program with With the revenue for the sales being booked upfront upon shipment, also the program was built with a third-party financing partner who takes ownership of the devices and administers the program. Part of this strategy of strengthening and growing our core Hydrofacial franchise is also the investment we are making in the next generation of Hydrofacial platform, as well As we discussed last quarter, this remains a multi-year development program targeting a 2028 launch. Our objective here, with the next generation of the HydroFacial platform, is to deliver a meaningful step forward in clinical outcomes, treatment experience, and provider workflow, while also creating a compelling reason for existing customers to upgrade and for new customers to choose HydroFacial. Moving now into our second strategic priority. increasing the value of every system already in the field. Our installed base is one of our company's greatest competitive advantages. It gives us longstanding relationship with providers around the world and supports a highly recurring revenue model that few companies in our industry can match.

As we discussed last quarter, improving utilization remains one of the largest and most immediate growth opportunities that we have. So our objective here is very clear, is to help providers perform more treatment. deliver better clinical outcomes, and improve the value of every customer visit. And that is exactly what our investments in clinically validated boosters and treatment enhancements are designed to do. To support that strategy, our next clinically validated booster is expected to launch globally in the fourth quarter with additional launches planned throughout 2027. Finally, our third strategic priority, which is to use our platform and provider relationships that we've built over the past two decades and leverage those to expand into adjacent categories where providers and consumers are increasingly investing. This strategy is intended to diversify our portfolio, create additional growth engines, and to do so by building on capabilities we already have. The skin styling, skin stylus micro-needling device is a good example of that strategy in action.

It gives us participation in one of the fastest growing categories in aesthetics and continues to perform well. And recently we received the FDA clearance for the improvement in the appearance of periorbital wrinkles, and more importantly, it also demonstrates our ability to introduce clinically differentiated technology through the provider relationships we already established. Hydrosculpt is another example. The reposition and relaunch of CareViv extends our presence into the growing scalp and hair wellness category, while increasing the value of hydrafacial systems already in the field. Following its June relaunch, we are encouraged by how Hydroscope continues to gain traction. Also, as we discussed on our last call, we continue to make progress on our plans to introduce a new device to the U.S. market in 2027. This is not another hydrafacial device and reflects our broader strategy of building a platform of clinically differentiated skin health solutions that leverages the provider relationships and commercial infrastructure we spent more than two decades building. So before I turn the call over to Mike, let me leave you with two observations here.

First, we are not satisfied with our current performance. Despite our current business environment remaining challenging, improving execution is our responsibility and remains our highest priority. Secondly, we believe our company has exceptional access and a clear path to using them more effectively. The rental program and the continued advancement of our next generation platform demonstrates that the strategy is moving from planning to execution. We know that there is still plenty of work to do, but we are in the process of building a stronger and more diversified company with multiple opportunities for long-term growth. So with that, I'll turn the call over to Mike to review the financial results in more detail.

Thank you, Pedro. In the second quarter, total net sales were 72.1 million, down 7.8% versus the prior year. The delivery systems revenue was $18.3 million, down 18.4 percent, with 770 systems placed compared to 957 in the prior year. Consumables revenue was $53.9 million, down 3.5%, driven primarily by lower utilization and a tougher prior year comparison that included booster launches. Our active install base grew to 36,516 systems globally, up 3.8% year over year, and remains the foundation of our recurring revenue. Despite this continued top-line pressure, adjusted EBITDA came in above our projections. This was primarily driven by adjusted gross margin expansion, disciplined cost management, and timing of R&D investments and commercial initiatives. Sales performance by region is as follows.

America's net sales were 49.9 million, down 4.2 percent. Consumable sales were down 1.4 percent, while delivery systems reflected the broader capital equipment pressure. EMEA net sales were 14.9 million, down 19%, driven by softness in both equipment and consumables. We've been actively addressing headwinds in the EMEA market. We had personnel shortages in the region, along with a shift of timing in distributor orders, which we expect to improve in the second half of the year. APAC net sales were 7.3 million down 5.4 percent. During the second quarter we transitioned Australia and New Zealand back to a distributor model from a direct model.

We now have the entire APAC region being served by a distributor model. We believe this approach better serves the region going forward. The 2026 financial impact of the Australia-New Zealand transition to a distributor model is a reduction of revenue of approximately $1 million. Gap gross margin was 68.4%, up from 62.8%. adjusted gross margin was 71.8% compared to 65.9% in the prior year, representing a 590 basis point improvement. The year-over-year improvement was primarily driven by three factors. First, lower cost of goods on equipment due to sell-through of trade-in units that pressured margins a year ago. Second, lower inventory-related charges and continued efficiency in operations as we realize the benefits of tightened inventory purchasing and disciplined cost management.

And third, a favorable mixed shift towards consumables. Gap operating expenses were $45.8 million down from $51.8 million, reflecting lower personnel costs and improved efficiencies. With total operating expense, selling and marketing was $21 million, GNA was $23.3 million, and R&D was $1.4 million. We expect R&D to step up in the second half of the year as our innovation initiatives On a GAAP basis, we generated income from operations of $3.6 million compared to a loss of $2.7 million in the prior year. Net loss was 2.7 million compared to net income of 19.7 million a year ago. The prior year figure included an 18.1 million net gain related to the exchange and repurchases of our 2026 notes. Adjusted EBITDA was $17 million, up from $13.9 million in the prior year and above our guidance range of $11 to $13 million.

The year-over-year increase in adjusted EBITDA was largely driven by operating expense savings from lower selling and marketing expenses and lower professional service fees in GNA. We ended the quarter with approximately $206 million in cash, cash equivalents, and restricted cash. This is approximately 1.5 million above our first quarter ending cash position. Our October 2026 convertible maturity is approximately 103 million. Based on our current cash position and our expected second half cash needs, we remain confident in our ability to address this maturity. will continue to evaluate options based on our cash needs and market conditions. As of today, our current plan is to repay the October 2026 maturity with cash on hand at the end of the third quarter. We are lowering our revenue outlook to $280 to $290 million by reducing the top end of the previous guide, reflecting continued pressure on year-over-year device sales.

We are raising our adjusted EBITDA outlook to $39 to $46 million from $35 to $45 million previously, reflecting the margin strength and cost discipline we delivered in the first half of the year. Our second half guidance reflects increased investment of 4 million in R&D and commercial initiatives versus the first half of the year. result, we are projecting our second half adjusted EBITDA to decline relative to the first half. For the third quarter, we expect revenue of $65 to $70 million and adjusted EBITDA of $5 to $7 million. Finally, I'd like to briefly address our NASDAQ listing. As we disclosed, we received notice from NASDAQ that our stock had traded below the dollar minimum bid price requirement for 30 days. As outlined in our preliminary proxy statement filed last Friday, we will be asking stockholders to approve a reverse stock split at a special meeting scheduled for September 22nd to remain compliant. The proxy provides a range of potential split ratios, and if approved, our board will determine the specific ratio within that range it believes is appropriate based on market conditions and other relevant factors at the time of implementation.

For more information, please read the definitive proxy statement that we will file with the SEC.

With that, I'll turn the call back to Pedro. Thanks, Mike. Let me close with one final thought. This quarter did not change our view of the business. The market remains demanding, and we know that we need to continue improving on execution. But at the same time, we are making tangible progress against the strategic priorities that we laid out. The rental program is underway. Hydroscope has been relaunched. Skin stylist is taking good traction.

The development of our next boosters and next generation hydrophacial platform continues to advance, and we continue to make progress on our plans to introduce a new device. in the US in 2027. All of these are meaningful milestones, and they reinforce our conviction that we are building a stronger, more diversified company with multiple drivers of future growth. Operator, you can now open the line for questions. Thank you.

Ladies and gentlemen, we will now begin the question and answer session. Should you have a question, please press the star followed by the one on your touch tone phone. You will hear a prompt that your hand has been raised. Should you wish to decline from the polling process, please press the star followed by the two. If you are using a speakerphone, please lift the handset before pressing any keys. moment. Your first question comes from Oliver with TD Cohen. Please go ahead.

Hi, Pedro and Mike. Regarding what you're seeing with consumables being down relative to the active installed base, what's happening there with utilization and or the inventory on the installed base that you're noticing? And also, I think you had a tough compare there too. Second question on the convertible note due in October, what do you need for cash in terms of your base level of cash and also things we should know about working capital dynamics and needs there in terms of the cash flow? And finally, regarding the rental program, program. How do you manage for incrementality and not cannibalization? And what's the thinking that goes through? It sounds like it's going to increase your TAM and there's a reason for people to buy and a different reason for people to rent. Thank you.

Thanks, Oliver. So I'll address the consumable dynamics, and then I'll go just right into the rental program, and then I'll let Mark address the convertible note, the cash, and the working capital question. So in terms of what we're seeing in consumer dynamics, I don't think that the consumer itself has fundamentally changed. Meaning people, continue to invest in skin health, and they continue to believe in the long-term demand for non-invasive skin treatments. So that continues to be healthy. What has changed in our view is that consumers now have more choices than they ever did years ago. And they're basically spreading their static spending across a broader range of treatments. And also, on the same line of thinking, providers have to now work harder to keep these patients engaged. consumers engage and and these consumers coming back into their doors so that's why WE DON'T LOOK AT THIS AS SIMPLY AS A DEMAND ISSUE WHEN IT COMES TO CONSUMER BEHAVIOR, WHEN IT COMES TO OUR CONSUMABLES PERFORMANCE.

WE SEE IT ACTUALLY AS AN OPPORTUNITY TO INCREASE THE PRODUCTIVITY OF EVERY HYDROFACIAL SYSTEM THAT WE HAVE IN THE FIELD. WHY I DISCUSSED, YOU KNOW, DOING MY PREPARED REMARKS, THE SECOND PILLAR OF OUR STRATEGY, WHICH IS BASICALLY FOCUSED ON IMPROVING INCREASING THE UTILIZATION. WE HAVE THE BOOSTERS, HYDROSCOPES, ALL OF THAT ENHANCES THE UTILIZATION OF THE we also are working in in better provider education and And better protocols and all of those they they basically are they come with one single objective, which is for these providers to perform more treatments and to be able to personalize those treatments and be able to create a better economic return from every system that they own. So yes, consumables have been under pressure, and we think that they have been under pressure in the near term, but we see this as an execution opportunity for us. And that is exactly where we are investing. In terms of the rental program, you're talking now more about devices. As I explain, and if we look back, The rental program addresses one of our biggest barriers that we have seen in the last quarters, which is basically the upfront capital commitment from providers.

And with this new program that we launched in the U.S., we are giving qualified U.S. providers another way to access hydrofacial through a much more manageable payment structure and conditions. I'm not going to go through all the mechanics of the program right here, but the objective, and I'm sure it's pretty clear, the objective is simple. It's basically to remove a quite meaningful adoption barrier that we have been noticing in the past quarters, and when doing that, but the expectation is to expand the installed base. And we don't expect to cannibalize, WE EXPECT JUST TO BRING MORE PROVIDERS INTO THE FOLD GIVING THAT WE'RE GOING TO BE LIFTING THIS BARRIER. Mike, do you want to address the capital questions? Sure. Hi, Oliver.

The forecast, the midpoint of our forecast assumes that we'll end the year roughly with about $100 million in cash. That would exclude any kind of unforeseen items that we don't have in the model, but we feel pretty comfortable kind of with that level, and that gives us enough cushion in our view heading into 2027 to kind of manage that. the business and meet the working capital needs. Thank you. Best regards.

All right, thank you. Your next question comes from Susan with Canaccord. Please go ahead.

Hi, thanks for taking my questions. I guess maybe I was just kind of first looking for some color just around the consumer behavior you're seeing out there. The consumable is now down two quarters in a row. I guess, are you seeing consumers maybe extend the timeframe between treatments or maybe foregoing a treatment? more just that they're you know not trading up and adding consumables to their treatments that they're getting done. Thanks.

Sure. As I explained, yes, all of you, but there's definitely more choices for the consumables, for the consumers to come in, which is great, which means that the segment is healthy, continues to have innovation, and consumers continue to spend money in the category. And that is all the way through. WE NEED TO POSITION OURSELVES BETTER TO TAKE ADVANTAGE OF THAT WILLINGNESS TO SPEND IN AESTHETICS. SO, I THINK THAT'S THE ALL THE THINGS THAT I REFERRED, ALL THE INITIATIVES, ALL THE that we are putting basically into place specifically speak to that, right? The boosters, basically all the investment that we're doing in the boosters is there to increase the treatment frequency. RELOAD OF HYDROSCOPES IS THERE TO CREATE ADDITIONAL RECURRING REVENUE FROM THE SAME DEVICES ON THE SAME PRACTICES. the relaunch of the skin stylist. Basically, we put that there and we're putting a lot of focus because we want to leverage the relationship into a fast category that we currently have, which is microneedling. So all of that is actually targets to take advantage of that healthy spend that we have.

see happening. Okay, great. And then maybe if you could just talk a little bit about just the competitive landscape that you're seeing out there. I think last quarter you mentioned that it was intensifying, I guess. Are you still seeing a pretty intense competitive landscape from, you know, other competitors out there? Thanks.

Sure, Susan. No different from what I said last quarter. Basically, indeed, the market has become more competitive, and some competitors are using pricing and other commercial incentives more aggressively. We have seen this throughout the year. Nothing new here. But our focus is rather on showing these providers where we can differentiate hydrofacial, where we can differentiate skin stylus, and so forth. and where the economics of our treatment come in and where we can create value to their practice. So short answer, no change from last quarter in what we discussed, but these are kind of the undercurrent dynamics that we have been noticing in the market.

Okay, great. Thanks so much. Good luck the rest of the year. Thank you. Your next question comes from JP with Roth Capital Partners. Please go ahead.

Great. Hi, guys. I appreciate you taking my questions. If I could maybe just start, you know, hoping that you could give us an update on sort of new Cindeo equipment and where payback periods are. I know you opened up the rental program, but just kind of for those providers who are still making the full investment. kind of where do payback periods sit today, and how is that influencing your thoughts about, you know, the pricing for the eventual new equipment in 2028?.

So I can speak a little bit, I'll touch on the new Sindale. in terms of innovation roadmap. And Mike, you can share some of these numbers, just to round down the answer here. In terms of the next gen hydrafacial, AS WE'VE BEEN DISCUSSING IN THE PAST QUARTERS, THIS CONTINUES TO BE A PROGRAM THAT HAS A 2028 LAUNCH TARGET. AND THE OBJECTIVE AND WHERE THE TEAM HAS BEEN WORKING AND MOVING FORWARD IS TO BRING TO MARKET A MEANFUL STEP OF INVESTMENT innovation in terms of clinical outcomes, of the overall experience, in terms of provider workflow, and basically giving... the existing providers that have Hydrofacial now, a pretty compelling reason to upgrade, or obviously bring new providers into the fold with a strong reason to choose hydrafacial versus other procedures. It's a bit too early to discuss more details on specifically the features that we're working on or the economics behind it. And obviously, we'll provide all the details as the program progresses. But we feel very encouraged by the development.

and the gate cycle of the process that we are currently doing. Mike, do you want to? Sure. Hi, JP. Typically, we tell consumer and providers that the payback can be roughly around nine months. That obviously depends on... treatments and the volume that you do, the more treatments that a provider is able to do, the faster the payback is. But generally that's the,.

overall kind of number that we give. Okay. And then a follow up, Mike, maybe more for you. But, you know, on the last call, I think we sort of talked about Q1 gross margin, maybe kind of being the high for the year. Just curious, you broke down a little bit of where the strength in 2Q is coming from, but just if there's any more detail there and then about how you kind of expect gross margin to run through the back half of the year, it would be appreciated. And really the question then is sort of the implication for EBITDA on the back half. you've done obviously such a great job of managing costs that you've The question really is sort of why is that stepping down, and is that baking in a little bit of conservatism?.

Yes, thanks, JP. So overall, just to kind of speak to the midpoint of our guide. So, you know, the first half of the year adjusted gross margin was 72% is what we did. You know, the midpoint of our guide kind of assumes that there is a step down on adjusted gross margin into coverage. kind of the 68% range. And the real reason for that is a couple of things. we expect an increased mix of equipment revenue in the back half of the year. When you look at the percentage of the revenue mix, it leaned more heavily towards consumables in the first half of the year. And as we introduce the rental program and some of the other initiatives around the device sales, we expect that to, to shift a bit. So we're expecting adjusted gross margin to feel a little pressure there.

The second piece coming through there is actually within the equipment mix. So we modeled in an increased percentage of Sandeo machines. versus the first half of the year, and that's largely due to the rental program. To qualify for the rental program, it's only first in day-old devices we have and they tend to have a higher cost of goods than some of our other devices so overall those are kind of the two big drivers kind of pressuring more On the back half, again, just to speak to the midpoint, so the first half of the year, adjusted EBITDA was a little over 25 million. The midpoint of our guide would assume a little bit less than 17 million of adjusted EBITDA in the back half of the year. And that's going to be driven by three things primarily. The first is the lower adjusted gross margin that we just kind of walked through, the key drivers of that. Second is there's timing of RMD and commercial marketing expenses that are more backend weighted this year than they've been in the past.

And so we have those moving into the back. And then the last piece of it is we have some general operating expenses that we had, um, expenses than what I would call normal. A simple example is kind of our bad debt expense was running very, very low in the first half of the year, and we're projecting that to go back to more normalized levels in the back half of the year. you know, as you look at the overall kind of forecast towards the midpoint, it ends up being those two key factors, the higher operating expenses and lower adjusted gross margin.

Got it. Very helpful detail. Best of luck going forward, guys. Thank you. Your next question comes from Cindy with Jefferies. Please go ahead.

Hi, thanks for taking our question. So, when you think about the adjacent categories, how much of the opportunity comes from acquiring new customers versus increasing penetration within your existing provider base? And then, I guess just also wondering if there's any further detail that you can share on the new device that's coming out?.

as well thank you a city so in terms of where we think we're going to get the biggest share actually is going to come from both. We have an incredible large install base. It's actually one of our biggest and most valuable assets that we have. And so any product that we relaunch or launch, it's definitely going to be primarily target into that extensive install base because that's an automatic channel that we have and an automatic lift that we can that we can explore In terms of more details into the strategic partnership, so last quarter, basically we discussed our intention to expand into an adjacent category. And the most important update that we are ready to give is that we are indeed progressing in that area. And the goal is to bring a device to market next year. And the objective for us is to create as we've been working throughout this project is to basically broaden the set of solutions and the set of procedures that we can offer to this extensive provider network that I just mentioned. leverage the infrastructure that we have.

Right now, as we stand, we're not in the position to discuss the specifics of the technology But definitely we will share more as we get closer to concluding this project.

Any follow-up questions? All right, we're done. Your next question comes from Bruce with StoneX. Please go ahead.

Hi, thanks for taking my question. I wanted to ask a little bit more about the booster you plan to launch during the fourth quarter. Is it going to be targeted to any particular market segment? So, for example, the medical or the aesthetic segment? And will it be out in time for the holidays?.

Yes, Bruce. So the target date is Q4. It's going to be a clinically validated booster, which is going to be aligned with the new strategy that we're putting behind every single booster that we're going to put investment dollars behind from going forward. EVERYTHING IS GOING ACCORDING TO PLAN, IT'S TRACKING. PLAN, IT'S TRACKING. PLAN, IT'S TRACKING. THAT IS WHAT WE ARE COMFORTABLE THAT IS WHAT WE ARE COMFORTABLE THAT IS WHAT WE ARE COMFORTABLE TO SHARE RIGHT NOW. TO SHARE RIGHT NOW. We are expecting the same level of performance and commercial behavior as we had with Hydro-Lock as an example, which was again another booster that has good traction to it. This is just the beginning and we will be launching more clinically backed boosters next week as well, part of the booster development and innovation roadmap.

Okay, and then one follow-up. In 2027, what do you anticipate in terms of the launch cadence? So it's going to be like one every six months, one big one for the year. How are you thinking about that?.

IN THE CITY OF TORONTO. and I'll say good stewards of capital when it comes to boosters, we are going to only launch boosters that are clinically backed and can provide clinical outcomes.

Okay, that's it for me. Thank you. Thank you. Your next question comes from Olivia with Raymond James.

Go ahead. Good afternoon. This is Martin Metella on for Olivia. I just want to quickly touch on the rental program and sort of get an idea of what was the impetus of it. Was this sort of a request from potential existing providers? Is it something that other competitors are doing?.

What we have been doing is looking at challenges in terms of being able to expand our device footprint. We went through a strategic analysis of the market, and we identified pretty clearly that the ability to finance or the ability to qualify for finance, it continues to be one of the major barriers of a large number of providers in the U.S., So the team went to work and we built a rental program and model that will definitely ease that barrier of entry and allow these providers to have and to operate the hydrofacial machine in their practice. So basically, we saw the problem and we stood up a model that addresses, and in our view, will substantially fix that problem.

Great. Thank you very much. Thank you. Your next question comes from Naveen with BNP Parabas. Please go ahead.

Hi, thanks for taking my question. My first one is we have seen the neurotoxin market improving sequentially this quarter. So do you expect some improvement in the aesthetics capital equipment environment to follow with a lag?.

Or is that too early? So as I mentioned, that's a good question. As I mentioned in the beginning, we continue to see the market as a healthy category, aesthetics continues to grow. People continue to dedicate some discretionary spending into aesthetics, and a lot of these categories are actually growing. Toxins is is one of them. So we see this as an opportunity. What we are doing is catering and building strategies that can take advantage of that spend. And so all the strategies that I just discussed speak exactly to that objective.

Thank you. And maybe if you can discuss some early progress or examples on increasing the productivity of the hydropower and store base. Thank you. I'm sorry, can you just repeat your question? You just kind of broke up a little bit. If you could discuss some early progress or examples on increasing the productivity of the hydrafacial instill base.

Sure. So I can definitely start with commercial excellence. Again, this is an area that we keep investing in. That is one. The other is we are launching the boosters, speaking right into the utilization of the devices. another and and so again we are very focused on making more out of every single machine that that is out there in the field.

Yes I Nidhi I could add one one thing I would just add I think we can point to in terms of progress in q2 was around skin stylist so here was a product that we have that we began really focusing on the sales team refocus their efforts in order to sell into the existing base and while it's you know a small revenue stream for us it grew you know nearly 50 year over year in the second quarter when you know the sales and marketing team reshifted the focus So I just point that out, not that it has a material impact on the overall P&L in the second quarter, but it is an example of, you know, Salesforce execution and partnership and marketing where, you know, the team was really able to drive results.

Thank you. This is a helpful vote. Thank you. Ladies and gentlemen, at this time, there are no further questions, and this concludes today's conference call. Thank you for participating. You may now disconnect.

This live transcript is auto-generated without human intervention or review.

[Call has ended.]

Good afternoon, ladies and gentlemen, and welcome to the SkinHealth Systems 2026 First Quarter Earnings Call. [Operator Instructions] This call is being recorded on Thursday, May 7, 2026.

I would now like to turn the conference over to Norberto Aja, Investor Relations. Please go ahead.

Thank you, operator, and good afternoon, everyone. Thank you for joining us today to discuss SkinHealth Systems 2026 First Quarter Results. We released our results earlier this afternoon, which can be found on our corporate website at skinhealthystems.com. Joining me on the call today is SkinHealth Systems' Chief Executive Officer, Pedro Malha, along with our Chief Financial Officer, Mike Monahan.

Before we begin, I want to remind everyone of the company's safe harbor language. Management may make forward-looking statements, including guidance and underlying assumptions. Forward-looking statements are based on expectations and involve risks and uncertainties that could cause actual results to differ materially. Listeners are cautioned not to place undue reliance on any forward-looking statements. For further discussion of these risks related to our business, please see the company's filings with the SEC.

This call will present GAAP financial measures. A reconciliation of these GAAP nonfinancial measures to the most comparable GAAP measure is available in the earnings press release, which was furnished to the SEC and available on our website. Following management's prepared remarks, we will open the call for a question-and-answer session.

With that, I would now like to turn the call over to our CEO, Pedro Malha. Please go ahead, Pedro.

Thank you, Norberto. So as you know, 2 weeks ago, we rebranded SkinHealth to Skin Health Systems, and this was not simply a name change. It reflects a deliberate shift in how we operate as a company and that we are building a company with a clinical rigor, the commercial discipline and the operational mindset of a leading medical device company.

Hydrafacial remains at the center of that strategy as one of the most recognized specialty aesthetic treatments globally. And around it, we are building a broader platform that includes skin stylist, our microneedling and nano channeling technology and the up-and-coming relaunch of our Keravive for scalp Health. So the objective is straightforward. It's to build a clinically differentiated platform that improves provider economic, strengthens utilization and drives durable recurring revenue growth.

I also want to take the time to acknowledge the addition of 3 new independent directors to our Board: Kenneth Tripp; Dr. Sachin Shridharani; and Scott Beattie. Together, they bring deep experience across medtech, aesthetics and global consumer brands. And we believe we now have the right Board to support the company's next phase.

So now turning to the quarter. First quarter net sales were $64.9 million, so within our guidance range, while adjusted EBITDA was $8.5 million, up 17% year-over-year and well above the high end of our guidance range. So the quarter clearly demonstrated 2 things: first, that the top line growth has not yet returned; but second, that the operational foundation of the business continues to strengthen.

So let's go over first, our systems revenue. Here, device placements came below our expectations during the quarter. Several factors come into play here. On the macro side, the market has gone through rapid expansion, follow consolidation and some of the tailwinds that drove growth in prior years are not as strong today. So as a result, capital equipment demand continues to be constrained by tighter credit conditions and longer purchasing cycles. Also, competition has intensified and providers have more choices than they did 2 years ago. So all that I just mentioned are structural headwinds and not one quarter occurrences.

But the macro conditions are only part of the story. We see opportunities to improve our commercial execution, and we are taking the steps to strengthen our sales discipline to sharpen the focus across the organization and to improve how we convert the opportunity in front of us. So given the strength of the Hydrafacial brand and our current market position, we believe there is meaningful room to perform better, and this is where the focus is.

One relevant fact is that we continue to see the softness in device placements in Q2. So we are not expecting a near-term inflection of this trend because the commercial fixes that we are implementing, more structural sales processes, tighter pipeline management, better account prioritization and an improved commercial leadership, all will take time to fully translate into results.

Therefore, we are revising our full year revenue outlook to a range of $280 million to $295 million, which represents a reduction of approximately 2.5% or roughly $7.5 million at the midpoint. This revision reflects a more cautious near-term view on capital equipment demand as well as the time required for the commercial initiatives now underway to translate into improved trends.

Also, as part of our efforts, we recently made a key leadership change within the commercial organization, and I'm now taking on a more direct role in the global sales organization, particularly around how we sell and how we improve conversion across our pipeline. So as importantly, despite the revised revenue outlook, we are maintaining our adjusted EBITDA guidance range of $35 million to $45 million, which reflects the underlying margin strength, the operational discipline and the resilience of our business model.

Moving on now to our consumables business. Revenues for the quarter was $46.4 million, down 6.1% year-over-year, but approximately 2/3 of this drop was related to a transition of China to a distributor model last year, which continues to impact the year-over-year comparisons. So outside of China, consumables performance was impacted primarily by the timing-related variability across certain regions, which we expect that to normalize.

Moving into our installed base. Despite the placement softness, our active installed base grew this quarter to 36,400 devices, up 4% year-over-year. More encouragingly, device churn in Q1 declined 40% year-over-year, and that is meaningful, and a meaningful earnings signal that our provider retention and reactivation programs are working.

To close up our quarterly financial results, on profitability, the quarter demonstrated again the strength of our operating model. Adjusted EBITDA was $8.5 million, up 17% year-over-year and well above the high end of our guidance range, while adjusted gross margin expanded to 72.2%. Importantly, this performance was achieved while continuing to invest in R&D, in provider education, in commercial capabilities and in our innovation pipeline.

Now let's step back and look at the longer term. Innovation remains a central focus as we build the next phase of growth for the business. We are advancing our innovation pipeline across 3 key priorities: boosters; strategic partnerships; and the next-generation Hydrafacial platform.

First, on boosters. Here, we are restructuring our booster portfolio around clearly defined clinical use cases, differentiated outcomes and tier pricing designed to improve both provider economics and utilization. Later this quarter, we will relaunch Keravive, our scalp health treatment, with updated marketing, enhanced protocols and improved integration into the Hydrafacial platform. Given the growing consumer focus on scalp health, including GLP-1-related hair loss concerns, we believe timing is favorable for us. And in the fourth quarter, we also expect to introduce a new booster backed by strong clinical data.

Second, we are in the late stages of diligence, exploring strategic partnerships that will bring complementary technologies into the SkinHealth Systems portfolio. These solutions will expand treatment options for providers while at the same time, strengthens the broader Hydrafacial ecosystem.

And third, we continue to advance the development of our next-generation Hydrafacial device targeting a 2028 launch. Our objective here with the next generation of Hydrafacial is to deliver a meaningful advancement in clinical outcomes and treatment experience while creating a compelling upgrading opportunity for our installed base of more than 36,000 active systems. We are also making sure we are applying the lessons learned from prior launches, particularly around quality standards, partner selections and field readiness as we continue -- and we will continue to update you on the development progress.

With that, I will turn it over to Mike to walk you through the financials in more detail. Mike?

Thank you, Pedro. The first quarter demonstrated that the operational improvements of the past year are durable. Margins are holding, adjusted EBITDA is outperforming and the business is generating the financial flexibility to fund the investments required to drive future growth. For the first quarter, total net sales were $64.9 million, down 6.7% versus the prior year and in line with our guidance range of $63 million to $68 million. Consumables revenue was $46.4 million, down 6.1% versus the prior year.

By region, Americas was down 1.6%, primarily due to the outperformance of our Q4 promotions pulling demand forward. EMEA was down 5.6%, driven by distributor order timing and APAC was down 29.9%, as Pedro described, attributable to China's distributor transition. We believe the Americas and EMEA declines are timing related, and we expect them to normalize. Delivery Systems revenue was $18.5 million, down 8.3% versus the prior year, with 746 systems placed compared to 862 in Q1 2025.

Americas was down 8.5%. EMEA was down 13.6%, consistent with the broader capital equipment pressure we have discussed. APAC was up 6.8%, supported by increased device orders versus the prior year from our distributor partner, a different dynamic than consumables, where the transition impact was concentrated. Our active installed base grew to 36,400 systems globally, up 4% year-over-year. Adjusted gross margin was 72.2% versus 71.9% in the prior year, relatively flat despite lower revenue. GAAP gross margin was 68.5% compared to 69.8% in the prior year, with the decline primarily driven by higher amortization expense.

GAAP operating expenses totaled $46.2 million in Q1 2026 compared to $60.6 million in the prior year. Selling and marketing was $23.2 million versus $26 million, reflecting disciplined spending, while continuing to invest in provider education and training. R&D was $1.1 million, up slightly, reflecting early-stage investment in the next-generation device and booster pipeline. G&A was $21.9 million, down significantly from $33.6 million in Q1 2025, driven by lower headcount-related costs, reduced legal fees and lower depreciation and amortization.

Adjusted EBITDA was $8.5 million, representing a margin of 13.1% and an improvement of 17% versus the prior year, well above the top end of our guidance range of $3.5 million to $5.5 million. This was achieved while continuing to reinvest in R&D, sales force training and tools, provider education and marketing. Net loss for the quarter improved to $6.6 million compared to a net loss of $10.1 million in the prior year. We ended the quarter with $204.4 million in cash, cash equivalents and restricted cash. Our October 2026 debt maturity totals approximately $103 million.

Based on our current cash position, our Q2 and second half cash generation trajectory, we are confident we can address this maturity. We are revising our full year revenue outlook to $280 million to $295 million from our prior range of $285 million to $305 million. The primary drivers are continued softness in capital equipment demand and commercial execution improvements that will take time to be fully reflected in revenue. We are maintaining our adjusted EBITDA guidance of $35 million to $45 million as the operational discipline and margin strength of the business continues to offset top line pressure. For Q2, we expect revenue of $72 million to $77 million and adjusted EBITDA of $11 million to $13 million.

I will now turn the call back to Pedro.

Thanks, Mike. So to close, while top line performance remains below where we wanted it to be, the underlying foundation of our business remains strong. We have a growing installed base of more than 36,000 systems, a highly recurring consumables model, expanding margins and one of the leading brands in aesthetics.

So our focus now is execution, improving commercial conversion, increasing utilization across the installed base and continue to invest in the innovation pipeline that we believe will support sustainable, profitable, long-term growth. We understand where the opportunities are, and we are taking decisive actions. And so we remain confident in the long-term strength and potential of our platform.

With that, I will turn the call back to the operator for questions. Thank you.

[Operator Instructions] We will now take our first question, and this comes from Oliver Chen from TD Cowen.

Pedro, regarding your comments on the nature of competition and also the role you're taking more closely with the sales organization, what are you seeing there in terms of what's within your control? And also the outlook still could be pretty hazy with the interest rates as well as a pressured middle consumer. So just love your thoughts on innovation and where you think the company is with respect to what inning you're in on the devices side relative to consumables and the work you have ahead?

And then, Mike, as we think about that October maturity, what are the puts and takes on working capital and CapEx to give us more comfort in terms of achieving that obligation as well as generally when we're modeling free cash flow this year, what levers might you have in terms of protecting your free cash flow if there's lack of upside or downside risk to your guidance?

Thanks, Oliver. So I'll start addressing the competition question, and then I'll touch on the innovation agenda that we're driving. And then I'll just close out talking a little bit about the commercial organizational changes that we have done.

So in terms of the competition, it's true, the competition continues to increase. And this is very particularly around the lower end of the market. We are seeing some pressure from lower cost alternatives. Secondary market devices are coming in and a broader set of aesthetic treatments, right, because basically, we're all competing for the same treatment room time.

The secondary market is particularly relevant in this current environment because among the smaller providers that are now facing tighter financial conditions, these providers are looking for lower upfront capital commitments. So that's relevant there. Our overall strategy is not to compete purely on price because we know for a fact that providers ultimately optimize for their patients' outcomes and they optimize for the long-term return on their treatment rooms. So we believe that, that exactly plays to the strength of our company, to the strength of Hydrafacial platform and ultimately, will come up stronger as we see the market stabilizing.

In terms of innovation, definitely very, very over-indexed in our innovation agenda. Innovation needs to do 4 things for us. It needs to improve clinical outcomes. It needs to strengthen the economics of providers. It needs to obviously fit naturally into the treatment room where our devices of Hydrafacial and skin stylists already reside, and it needs to be accretive to margin. So if it does not meet those, we are not pursuing it.

And as I mentioned in my opening remarks, we are putting the right capital behind the development of the next-generation Hydrafacial, and we are putting the right capital and the teams behind our next generation of boosters, which I mean we are overhauling the whole strategy.

In terms of the commercial organization, I come from organizations where I had direct overview of the regions. And so with this change that we did, that gives me the possibility to have a direct hand and management of the U.S. and all international business and that will allow me, most importantly, to be directly involved with these regions, with the way we sell closer to metrics. And this is an environment that I'm very comfortable with and coming from all the experiences and positions that I had in the past. And that's the reason why the change was made. Mike, do you want to address the other questions?

Sure. Thanks, Oliver. The midpoint of our guidance assumes we have modest free cash flow generation in the last 3 quarters of the year. Overall CapEx, I'm expecting $8 million to $10 million for the year of CapEx. We spent $1.6 million, $1.7 million in the first quarter. So as you look at kind of overall, we expect free cash flow, as I said, to be positive after we service the debt for the last 3 quarters. Working capital, I expect to not be a significant drain. Actually, we're forecasting it to be relatively flat year-over-year. It was a use of cash in Q1, but that's largely due to the timing of payables. So my expectation is that, that normalizes by the time we get to the end of the year and specifically by the time we get to the maturity.

And the next question comes from Allen Gong from JPMorgan.

Just a quick one on the guide and the cadence that you expect to see throughout the balance of the year. I think previously, we have been hoping that there would be a return to modest growth in the back half of the year off of some easing comps and also some continued stabilization. But is the right expectation now that we probably won't be getting to positive growth in the back half of the year? Or do you think that's something that you can still achieve, say, like in fourth quarter?

So Allen, let me just refresh the numbers and the change on the guide that we just communicated. So definitely, the Q2, it's not coming as expected. As I just spoke about, we revised our top line guidance to reflect the current market conditions and the execution that is underway across our business. So we are basically guiding the revenue to a range of $280 million to $295 million. But also very strongly, we are maintaining the adjusted EBITDA guidance, right, that we had before.

The way we are looking at the quarter -- the current quarter, at the midpoint of the guide, the quarter is sitting at $74.5 million, which basically translates this into having a quarter that will decrease 4.7% year-over-year. And that is largely driven by, again, the lower device sales trends that we're seeing across the board, while consumables in the U.S. and the rest of the world, excluding the APAC, are expecting to be flat.

In terms of how do we play it out for the remaining of the year, the expectation is that we are still seeing 2026, and that has not changed, as an execution year and as a stabilization year. And the key drivers of our performance and the way we're going to be showing up the year is by improving the device conversion and as I spoke in the beginning, by improving utilization across the installed base and also improving the booster attachment rates. So the way we are seeing the year is that in the first half of this year, we expect to see the pressure in the device placements and utilization trends to continue.

But as we move through the second half, we are expecting a gradual and a sequential improvement as our commercial initiatives provide more results and start taking traction. So it's important that -- to say that if we execute well against all these initiatives, against all these priorities, we believe that the model will begin to compound, utilization will begin to improve and the recurring revenue base naturally will become more productive. That is why we believe the business is positioned to return to more consistent growth in 2027 and beyond.

But based on the current trends we are seeing and the expected timing of the initiatives that are underway, although we think that growth will come in 2027, the cadence of that recovery within the year will absolutely depend on how quickly the device business stabilizes and on the timing of any impact of some of the catalysts that I just mentioned, which are the new booster launches and the strategic partnerships take into effect.

And the next question comes from Olivia Tong from Raymond James.

Pedro, what gets you to the upper end versus the lower end of your ranges on sales and EBITDA? And in your view, is the shortfall more in just devices or consumables? It sounds like it's devices, but just kind of curious how you think about sort of consumables and the demand there? And then how much of this is a function of your execution versus the volatility in terms of the external environment?

Sure. So focusing on consumers. Consumables obviously remain very core to our model. And if you exclude the impact of China and the shipment timing that we went through, the business remains actually relatively stable. The larger opportunity that we know for a fact exists is around utilization, which we still believe remains below its potential. The market -- we feel that the market is still there. The consumer remains engaged, although we have seen in the past years the spending behavior being much more selective. But we -- across the category, we're still seeing strong demand for treatments and -- but only for treatments that actually deliver visible results and a very accessible price point, which we play directly into that position.

But as I mentioned in the beginning, the market continued to be impacted by tighter credit conditions, longer capital purchasing cycles, which have been indeed putting continued pressure in the device placement. And that is across the industry over the last couple of years. So the way we see it is the market is gradually maturing, which means that utilization and the productivity per treatment room has become incredibly important to drive our acceleration. And that is what we are pivoting our strategy to increase that utilization with our booster strategy, with better training of our sales force, with better value selling with our reps, because the market indeed has changed and has become somewhat more challenging.

The next question comes from Susan Anderson from Canaccord Genuity.

I was wondering if maybe you could give some more color on the partnerships that you mentioned that you're looking at for the Hydrafacial brand? I guess, what will these look like? Are they partnerships for additional boosters or other types of partnerships?

Thanks, Susan. So there's obvious -- for obvious reasons, there's so much I can say because we are still in the phase of diligence and I would say, late exploration. But as very core to our strategy, we believe that Hydrafacial and SkinHealth Systems is indeed a platform and should be a platform of -- as an ecosystem of different solutions. So we have the team working around not only identifying feasible partners that will play well in that ecosystem. As I mentioned, we are in very late stages of that diligence.

I personally, at this stage, feel encouraged by what I see. And this will become, again, together with skin stylists, another part of our portfolio that the reps can use in selling the overall solution. Again, that's so much I can say, but I feel encouraged by what I see and the time lines of the strategic partnerships that we are pursuing right now.

I can just add, Susan, they're both on the device side and the consumable side on the partnerships.

Okay. That's helpful. And then maybe just -- I wanted to ask about, I think you mentioned some timing-related variability in certain regions related to the consumables decline, I think like maybe the Americas. Maybe if you could just expand on what that was and when you expect it to normalize?

The Americas was down, Susan, the 1.6%, which was a smaller portion of the difference. It was largely due to we do a fourth quarter promotion that outperformed in the fourth quarter of 2025. So some of it was a smaller kind of pull forward. The other timing piece of it was we had a large distributor order at the end of Q4 2025. A portion of that order was consumables that came in, that pulled forward some of the revenue as well. The largest portion of the $3 million year-over-year difference on the global consumables was the move from the China -- to a China distributor. In Q1 and a large portion of Q2 last year, we still were direct in China. And so as we move through the year, that comp is going to pressure the first half of the year and should subside a bit as we move throughout 2026.

The next question comes from John Block from Stifel.

Joe Federico on for John Block. Maybe just focusing on EMEA following up on the last question. Obviously, growth was a little bit softer this quarter after kind of having been the bright spot in performance for the last handful of quarters. So with the ongoing conflict in the Middle East and subsequent rise in energy costs over there, are you seeing anything specific in the consumer in those regions? I think some of the consumables commentary you just gave speaks to it improving. But do you expect the softer performance to continue on the capital side in the near term? Just any trends would be helpful.

Yes. So I'll -- I can take that and then Mike can chime in. So in terms of the conflict is, the way we are seeing is, is not going to have a material impact. Obviously, we are monitoring the situation very actively. But so far, we're not expecting or forecasting any impact on our business.

In terms of the EMEA, the split, between devices and consumables and the way they show up in the quarter, EMEA is very -- what's happening to EMEA, it's very much in line with what we have seen and are seeing much more broadly going over globally in terms of devices. We have seen still a softness in device sales, and that is true for the U.S. and for EMEA. In terms of consumables, it's a mix -- a little bit of a mixed bag. There's some timing issues there. But again, we expect those to normalize over time.

Okay. Great. Really helpful. And then maybe just as a quick follow-up. When you originally gave the 1Q guide, it was mid-March, and so I would think a good line of sight into how the quarter would shake out. And obviously, you came in within range on sales, but the EBITDA was well above. So was there anything that really deviated in the final weeks of the quarter operationally that led to that outperformance? And then maybe just one step further, with reiterating the full year guide for EBITDA, did some of those operations not continue into 2Q? Or is it just simply a function of the now lower sales outlook?

A large portion of the EBITDA beat was driven by outperformance on gross margin and then management of the overall OpEx. So OpEx, specifically in March came in lower than we had forecasted. On the gross margin side, there were 2 drivers -- 2 of the largest drivers. The first was in the Americas, average selling price on devices was higher than we projected. And so that favored even though we had pressure on the overall number of units and came in lower than we were forecasting. The ASP offset a portion of that, which drove higher overall kind of profits on a lower number of units.

The second thing is on the operational side, we project each quarter expected scrap and write-offs, and it was much, much lower than normal in Q1. So as we look going forward, we're projecting overall gross margin to come down from Q1 a bit, still stay in the high upper 60s. And it's really, the overall projection is we expect -- as we're projecting device unit sales to come back a little bit, we expect the overall ASP to come down and normalize a little bit below where it did, specifically in the Americas on Q1, and we expect overall scrap to return to normal levels.

And the next question comes from Sidney Wagner from Jefferies.

So you mentioned restructuring the booster portfolio around clearly defined clinical use cases. Can you just walk us through how does that differ from how boosters were positioned previously? And what specifically was maybe not coming through clearly around the efficacy or attended use before?

So we have done in the past quarter, 1.5 quarters, a lot of not only strategic work around our booster strategy where boosters play a very important role in consumables, overall sales, but also in driving a higher utilization, a higher interest from overall consumers getting to the door and most importantly, how it drives a higher return on investment for all providers. So boosters, we continue to see as the main driver of that to drive utilization. What we have seen is that historically, the company has had a lot of different boosters, a lot of SKUs. What we're going now is rather for simplicity and impact.

So we are redoing the whole selection of boosters. But most importantly, we are selecting the boosters that bring clinical outcomes that actually will give what consumers are looking for. And that requires a different view of what boosters can do and what type of boosters we are going to be offering. Just to tell you that we have 2 planned launches this year. The first is actually next quarter when we're going to be launching the HydraScalp booster, and we're going to be using that for -- to reactivate basically an asset, which is Keravive, that never got to deserve attention or focus.

And in the second, we're going to -- in -- the second booster is going to be launched in Q4 of this year, and that is definitely going to be much more clinically backed booster that is going to be supported by real clinical data. So the team is very enthusiastic about that booster. And we know for a fact, and we have those proxies in our business that we will -- when we launch a booster that delivers the outcomes that they're supposed to deliver, that drives sales. That drives provider engagement, that drives consumers into the doors, and that is a huge part of our business. So we plan to over-index on that strategy.

Okay. That's helpful. And then just one more on competition. So when you think about Hydrafacial's competitive positioning, is it more about differentiation versus similar facial devices or systems? Or are you increasingly competing for consumer spend against adjacent treatments like lasers, for instance?

I think it's both. It's not only the low end of the market that we are competing, is becoming more crowded. But we also are competing for time space of those treatment rooms as more treatments, more technologies coming in, trying to get that time from the consumer and dollar. So it's both. It's both. But we feel that we are very well positioned, actually very well resilient throughout all these challenges and throughout all these past years. Hydrafacial continues to be the gateway for other treatments. We plan to over-index in that. It's a staple in the majority of all the med spas and is a technology and is a procedure that delivers results.

So although we are seeing an increased competitive pressure, we feel that is a natural pressure because the segment is still very appealing. And we plan to combat that. We plan to have the right strategy, the right sales force execution, the right messaging, the right segmentation and a well-prepared and well-trained sales force that is able to win in a little bit of a more challenging market that we're facing right now.

And the next question comes from Bruce Jackson from The Benchmark Company.

A couple of macro questions. So with the rise in oil prices, are you seeing any effect on your inputs, for example, with plastic resins or freight costs? And if we do get above inflation, how do you feel about your ability to protect the EBITDA margins?

No, we're not seeing anything specific, Bruce, on overall increases in our prices. On the capital equipment side, we have a decent amount of raw materials already in-house. We've been working through our existing inventory. So we shouldn't see an impact of that in the near term. So overall, I'm not concerned about inflation materially impacting the adjusted EBITDA guide.

Okay. And then a follow-up, if I may. With the booster that you're launching in the fourth quarter, are you providing any additional details about that at this time?

Not at this time. It's in late stages of development, and we will provide you the updates in the coming quarters as we get closer to the launch time.

Thank you. And there are no further questions that came through. This concludes our conference call for today. Thank you all for participating. You may now disconnect.

Good day, and welcome to The Beauty Health Company 2025 Fourth Quarter Earnings Conference Call. [Operator Instructions] After today's presentation, there will be an opportunity to ask questions. [Operator Instructions] Please note this event is being recorded. I would now like to turn the conference over to Mr. Norberto Aja, Investor Relations. Please go ahead.

Thank you, operator, and good afternoon, everyone. Thank you for joining The Beauty Health Company's Fourth Quarter 2025 Conference Call. We released our results earlier this afternoon via an earnings press release, which can be found on our corporate website at beautyhealth.com. Joining me on the call today is Beauty Health's Executive Officer, Pedro Malha, along with our Chief Financial Officer, Mike Monahan.

Before we begin, I would like to remind everyone of the company's safe harbor language. Management may make forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 as amended and Section 21E of the Securities Exchange Act of 1934 and as amended, including guidance and underlying assumptions. Forward-looking statements are based on current expectations and beliefs and involve risks and uncertainties that could cause actual results to differ materially. Listeners are cautioned not to place undue reliance on forward-looking statements.

For a further discussion of risks related to our business, please refer to the risk factors contained in the company's filings with the SEC. This call will present non-GAAP financial measures. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measures is in the earnings press release furnished to the SEC and available on our website. Following management's prepared remarks, we will open the call for a question-and-answer session.

With that, I would now like to turn the call over to our CEO, Pedro Malha. Please go ahead, Pedro.

Good afternoon, everybody, and thank you for joining us today. The Beauty Health has built 1 of the most recognized platforms in professional skin health. And my first 5 months with the company have reinforced my conviction in the long-term opportunity ahead of us. But before we review the quarter, I'd like to share a few observations here. My background is in global med tech business built around differentiated technology and disciplined commercial execution to drive growth. And what attracted me to The Beauty Health was the opportunity to bring the same model to the company. The foundation is already in place.

We have a global recognized brand. We have a large installed base of systems placed with providers around the world and we operate a consumables model that when executed well, generates meaningful operating leverage. So our task now is straightforward to unlock the full economic potential of these assets. And that means strengthened the commercial engine behind the platform with greater discipline and operating rigor consistent with established med tech companies. And it all begins with activating the installed base, improving utilization, reinforcing the economies of our providers and continue to invest in clinically meaningful innovation. But before discussing the progress we are making, I think it will be useful to step back a little and look at the broader market.

First, the fundamentals of the aesthetic category remains strong. Research shows that consumers continue to invest in their scheme even when they pull back in other areas. Skin Health is increasingly becoming a lifestyle category 1 that is built around prevention, routing care and clinical proven outcomes. And we have seen this evolution before in areas like oral health or wellness where treatments that once happen occasionally became part of everyday consumers' behavior. We believe skin health is following the similar trajectory, which can make the long-term opportunity for this category significant. The market itself has expanded dramatically.

According to industry data, the U.S. med spa market has grown from roughly 1,600 locations in 2010 to more than 13,000 today. And at the same time, the consumer has evolved. We are seeing broader demographics entering the category, manned, Gen Z and younger consumers are engaging with treatment earlier and today's consumers are seeking outcomes that look healthy, natural and authentic. Also, consumers are more informed than ever before. They understand ingredients, treatment mechanisms and outcomes. So they're not simply purchasing a brand they're looking for results. Providers also have evolved as well. They are more focused on return on investment and are increasingly building treatment protocols that combine multiple modalities to deliver better clinical outcomes.

So taken together, we believe that all of these trends are well aligned with our core product strength. Hydrophacial treatments are noninvasive, clinically credible and repeatable and they also serve as an accessible entry price point for consumers into the aesthetic category, which helps to bring new patients into the providers' practices and in creating opportunities for additional procedures. Hydrofacial is also uniquely versatile. The treatment works across genders, ages and skin types, a combination that very few technologies in the medical aesthetics space can match. Because our treatment is repeatable and easy to integrate, it also fits naturally into prevented skin health routines and combination protocols, which is exactly where the market is moving.

So The Beauty Health is uniquely positioned at the intersection of clinical skin health and consumer aesthetics. However, our commercial model was built for an early phase of the market. One where the category was newer, competition was lighter and placing devices with the primary growth driver. That plate worked well for a long time, but markets mature, and we need to evolve our model ahead of that curve and shifted from a model of device placement to a model of device utilization which is where we believe the long-term growth of the business is. Over the past year, the company strengthened its balance sheet. It improved its cost structure, and restored financial discipline across the organization.

Our fourth quarter results reflect that progress. But at the same time, we hold the view that these results do not yet reflect the full potential of BeautyHealth. What they do demonstrate is that the foundation of the business has stabilized. So for the fourth quarter, total revenue was $82.4 million, representing a decrease of 1.3% compared to the prior year's quarter. A meaningful improvement from the double-digit decline we experienced in Q3. Consumables revenue increased to $57.7 million from $56.7 million in the prior year, representing a growth of 1.7% year-over-year and reinforcing the resilience of our recurring revenue model. Device revenue was $24.7 million, still down 7.9% year-over-year, but performance improved meaningfully here related to the third quarter. And this number still reflects some pressure in the capital equipment segment, which is consistent with the broader macroeconomic environment.

That said, the trend is moving in the right direction. And the improvement we saw from the prior quarter is an encouraged sign that the capital equipment business is stabilizing. Adjusted gross margin expanded to 67.4%, while GAAP gross margin expanded to 64.4%, driven primarily by a favorable mix shift towards consumables revenue. Additionally, profitability improved significantly. Adjusted EBITDA was $5 million in the fourth quarter compared to $9 million of last year's quarter, representing approximately 700 basis points of margin expansion.

For the full year, adjusted EBITDA increased to $45.1 million compared to $12.3 million in the prior year, again, a significant improvement. So the results for this quarter highlight 2 important characteristics of our model. First, this business has meaningful operating leverage. Second, that leverage responds directly to disciplined execution. Operationally, we placed more than 1,000 devices in the quarter, and they ended up the year with over 36,000 systems in our global installed base. That installed base is the strategic core of this company, and it represents a recurring revenue infrastructure that is already in place. While this base has already been built, we think it remains underutilized. We believe that even modest improvements in utilization can drive significant consumables revenue and margin expansion. So is to unlock the full productivity of that installed base.

Now looking ahead, the message here is that we remain optimistic about the category in which we operate. Demand for non or minimally invasive science-based treatments continues to grow globally. The market is shifting away from procedures driven primarily by short-term trends towards treatments outcome-driven protocols. The market is also shifting from individual treatments towards combination therapies and from soft marketing claims towards more clinically validated results. These trends favor companies with scale, clinical credibility, stronger provider education and durable recurring economics, which is exactly where BeautyHealth is positioned. At the center of our strategy is a powerful commercial model. Our brand credibility drives consumer demand, consumer demand drives patient traffic into the providers' practices, Patient traffic drives higher treatment utilization per device and utilization drives consumables revenue, which is our margin engine.

For providers, this generates additional revenue and motivates them to expand, upgrade and deepen their relationship with us. But utilization is at the center of gravity. And we believe that when utilization improves, it creates a positive momentum across the model. So to accelerate this flywheel, we are focused on 3 priorities: first, sales force excellence; second, marketing discipline; and third, focused innovation. Starting with sales force excellence. Historically, much of our commercial success was relationship-driven, that work well in the early stages of the company, but the next phase of growth requires a much more structured, disciplined commercial approach. So we are now transitioning to a value-based selling model, 1 where our teams clearly demonstrate how hydroficial drives revenue, patient demand and attractive returns for provided practices. That means also sharpening our clinical and economic differentiation, improving how we segment and prioritize accounts, and we are implementing more structured sales plans.

These plans focus not only on acquiring new practices, but also on expanding utilization across our installed base and reactivating low utilization accounts. We are also deploying stronger commercial tools and analytics, so we can track activation, utilization and retention across the installed base in real time. And this gives us better visibility into performance and allows us to manage the business with greater precision. Second, marketing discipline. Our marketing strategy needs to be more focused on demand generation that directly supports provider growth. So we are working to refine the position of hydrophacial as a clinical-grade skin health platform, 1 that is supported by science outcomes and stronger provider education.

At the same time, we are activating an underleveraged asset in our portfolio, skim styles. It's a strong technology in the growing microneedling category that historically has never received the commercial focus it deserves, and we see a meaningful opportunity to expand its role with the providers' practices. We are also expanding consumer demand generation programs designed to bring new patients into the provider's office and strengthens the economic value proposition of these providers. Additionally, we recently brought a new brand and clinical strategy office with deep med tech experience to lead our brand and marketing strategy and strengthen the clinic position of our technology. Third, focus innovation. So innovation will remain disciplined and targeted at opportunities that only strengthen our platform. This includes the development of a next-generation hydro facial system, which will be designed to drive upgrades across the installed base and expand our market share. We are also investing in a much more selective portfolio of clinically backed boosters designed to increase booster attachment rates, improve provider economics and expand treatment protocols.

If we look back, hydrofacial has historically been viewed primarily as a single treatment, but we see it differently. We see hydrophacial as the foundation of a broader skin health platform, 1 that integrates devices, boosters, protocols and complementary technology into a comprehensive ecosystem for providers and customers. So we are also exploring selective commercial and technology external partnerships aimed to broaden our product ecosystem and enlarge our relationship and offer to providers. So all in all, we believe that taken together, these initiatives will strengthen the installed base, expand Hydro facials role in providers practices and accelerate the compounding economics of our model. But this means that we will shift from a single product company to a skin health platform. And for that reason, 2026 will be an execution year, focus on stabilization and investment into the next phase of growth. This means that with the operational changes that we are implementing, we expect to return to growth in 2027 and accelerate beyond that as innovation and product launches scale.

BeautyHealth has 1 of the largest installed bases in the aesthetics industry, 1 of the most recognized brands in skin health and a proven device plus consumables model. a global and a global commercial infrastructure across North America, Europe and Asia Pacific. These are proven and durable advantages. Our task now is to match those advantages with the commercial discipline and the operating rigor of the best-in-class med tech company. So before I turn over to Mike, let me quickly frame our expectations for the year. The first half of 2026 is likely to come in modestly below the prior year. But as our initiatives take hold, we expect momentum to build through the second half, position the company to exit 2026 on a stronger trajectory setting up the stage for returning to growth in 2027.

And so with that, I'll turn over the call to Mike to walk you through the financials and our 2026 guidance in more detail. Mike?

Good afternoon, everyone. Key financial metrics for 2025 reflected meaningful improvement. Our global footprint surpassed 36,000 systems. We increased our adjusted gross margins from 62% to over 68%, and GAAP gross margins increased from 54.5% to 65.3%. We grew adjusted EBITDA from $12.3 million to $45.1 million or 268%. We generated over $37 million in operating cash flows and we strengthened our balance sheet by proactively restructuring our debt. Because of this, we exited 2025 a stronger company than we were a year earlier. These improvements did not happen overnight and are the result of the hard work of our dedicated teams.

As we continue to stabilize the company and prepare to return to growth, we believe we are positioned to drive improved profitability and increase margins in the future. For the full 2025 fiscal year, net sales were $300.8 million compared to $334.3 million in 2024. We Consumables revenue totaled $212.7 million, while device revenue was $88.1 million. We ended the year with an installed base of over 36,000 systems globally, which remains the foundation of our recurring consumables revenue model. We delivered adjusted EBITDA of $45.1 million, representing a significant improvement from $12.3 million in the year prior. The year-over-year change was driven by our continued focus on expense discipline and sustained margin improvement, demonstrating the operating leverage of our business model.

On the balance sheet, we ended the year with approximately $232.7 million in cash, cash equivalents and restricted cash compared to approximately $370.1 million at the end of 2024 and representing a 37% decrease. The year-over-year change was primarily driven by the repurchase of convertible senior notes during the first half of 2025, which, along with the refinancing of our notes significantly strengthened our capital structure and extended our debt maturity profile. For the fourth quarter, net sales were $82.4 million, a slight decrease of approximately 1.3% compared to the previous year. The year-over-year decline primarily reflects lower delivery system sales. We placed 1,032 delivery systems during the quarter compared to 1,087 units in the prior year period. GAAP gross margin was 64.4% in the fourth quarter compared to 62.7% in Q4 of last year.

The improvement in gross margin was primarily driven by lower inventory related charges and a favorable mix shift towards consumables, partially offset by lower average selling prices on equipment. As planned, we successfully sold through the majority of our Elite FRC devices during the quarter, which are sold at a lower ASP than our new Ceneo devices. Adjusted gross margin was 67.4% in the fourth quarter versus 67.1% in the prior year. We continue to manage costs tightly throughout the quarter with GAAP total operating expenses coming in at $52.9 million in Q4, down from $59.5 million in the prior year.

Selling and marketing expenses declined to $23.5 million, reflecting lower head count and disciplined spend management. Research and development expense was $1.7 million, up modestly year-over-year, reflecting professional services related to early-stage product investments. General and administrative expense declined to $27.7 million, driven primarily by cost control, lower bad debt expense and reduced expenses resulting from our shift from direct to distributor distribution in China. As a result, adjusted EBITDA for the quarter came in much stronger than the prior year at $15 million compared to $9 million in Q4 of last year. Net loss for the quarter improved to $8.1 million compared to a net loss of $10.3 million in the prior year. Moving to guidance. 2026 projections reflect the execution priorities Pedro outlined earlier.

For the full year, we expect revenue in the range of $285 million to $305 million with positive adjusted EBITDA of $35 million to $45 million. At the midpoint, this implies revenue broadly consistent with 2025 when normalizing for our go-to-market change and softness in China with a more back half-weighted cadence as execution initiatives take hold. We believe this is the appropriate framing for 2026, given the work underway to strengthen the commercial foundation of the business, including sales execution, installed base activation and targeted investments in marketing, education and innovation. From a cadence perspective, we currently expect the first half of 2026 to be modestly below the prior year. This expectation reflects continued macro pressure in capital equipment, increased competitive activity that has lengthened the device sales cycle the transition work underway within our sales organization and ongoing investments in certain international markets, ongoing adjustments in certain international markets, including China. It's also worth noting that fourth quarter results typically benefit from year-end ordering patterns, which do not repeat in the fourth quarter.

As these actions take hold, we expect improving momentum in the second half with the business exiting 2026 on a stronger underlying trajectory than where we began. We believe these actions will strengthen the underlying productivity of our installed base and reinforce the durability of our recurring consumables model, positioning the company for a return to growth in 2027. For the first quarter of 2026, we expect revenue of $63 million to $68 million and positive adjusted EBITDA of $3.5 million to $5.5 million. As a reminder, the first quarter is historically our lowest revenue quarter due to seasonal dynamics, including increased sales and marketing activity early in the year and typical ordering patterns among providers. Overall, our outlook reflects a disciplined approach, prioritizing operational execution while investing in long-term growth. With that, I'll turn the call back to Pedro.

Thanks, Mike. So to close our fourth quarter reflects meaningful structural progress in margins, profitability, balance sheet strength and in the operating foundations of the business. key characteristics that make Beauty Health a compelling long-term platform remain unchanged. The scale, the brand equity, a recurring revenue model with an operating leverage and a global distribution. What is changing is a discipline and operational focus we are bringing to those assets. We believe that as utilization improves, and innovation strengthens the platform, the compounding economics of this business will become increasingly visible.

We expect 2026 to be the year we demonstrate that operationally, and 2027 is when we expect that progress to translate into sustainable revenue growth. and we look forward to updating you on our progress in the next quarter.

So I will turn now the call back to the operator for questions. Thank you.

[Operator Instructions]

And the first question will come from Alan Gong with JPMorgan.

So I guess like my first is going to be on the guide. I think following -- you've been taking in the last couple of years to really stabilize the underlying Syndeo business, and I understand that you're doing a pretty substantive overhaul of the underlying sales organization. But when I look at your outlook for next year, despite the fact that you have another year of sales declines on tap, it looks like you're still expecting to generate pretty good adjusted EBITDA.

So just help me to right set expectations for these investments into the sales force and this overall with being able to drive continued leverage I'll just...

Thanks for the questions. So I'll just summarize back on what we're guiding here. So -- on revenue, at the midpoint, we are expecting to be flat year-on-year. Once you normalize actually mostly for the China transition, and that's pre intentional, the guide. Because in the end, we view this 2026 as an execution year. On adjusted EBITDA, that number means that at the midpoint of the guidance, this will be slightly below 2025, largely because of the reinvestment that we're doing into the business with an increase in R&D for basically future innovation. So the expectation, and Mike alluded to this is that with all in the first half of the year, we expect to be down mid-single digits. And in the second half, we expect to be flat.

Without the EPC, which is majority a China impact here, the first half is expected to be down low single digits in the second half to be positive low single digits in terms of growth. And the main drivers are actually both consumers and devices here. As we ramp up towards the second back half of the year. Mike, I don't know if you will...

Sure, Alan. I can add. If you also wanted to know where the middle of the P&L, how we were thinking about the guide on the gross margin side, I would expect we modeled in gross margin for the full year to be relatively consistent with where we have been in 2025. The team has made a lot of improvements on the cost side of the business to get leverage within overall gross margin. We expect that to continue for the full year of 2025. And then on the OpEx side of the business, as you mentioned, we still are driving savings and cost efficiencies through the G&A line of the business, but we're reinvesting that back into the R&D line of the business into innovation for new products into the future.

Got it. And then I guess just on the underlying environment. I know you called out continued challenges on the capital side, but you clearly had a very, very strong systems placement performance to close out the year. So when we think about the underlying assumptions for the market environment, especially given all the volatility from a broader macro perspective, can you just help us with your underlying assumptions for trends throughout the year and in the first quarter?

Sure. So in terms of the overall, I'll say, end consumer signals that we are basing ourselves into our data shows that the consumer is still spending, but it's being more selective in choosing treatments that deliver clinical proven results at an accessible, we can call it an accessible price point. But actually, that is exactly the space that hydro facial occupies. The aesthetics category has been pressure and has been pressured for the last couple of years. And this is mainly due to the tightness of credit and the capital spending decisions taking longer because of that. But if these conditions improve, then we can see procedure volume pick up, and after that, we typically see device placements pick up as well.

But actually, if you look at it, our ability to return to growth is not relying on the change of these market trends. Rather, it hinges on our ability to execute on our strategy. If you want to go down and dip a little bit to a lower level in terms of the provider trends that are shaping this market -- in the Medical segment, which, by the way, is 70% in the U.S. of our business, which medical pass occupy the large, large percentage of that segment continues to be the engine of this market. And we believe that this engine will continue to grow, because they are indeed using hydrofhacial as a way to bring patients in and upselling them into higher ticket treatments.

Plastics surgeons seem to be losing some traction and dermatologies are more stable. But this is driven more by the specific patient treatments needed rather than just pure discretionary spending. At the high end, more -- the way we summarize it is the more the invasive side of aesthetics seems to be softening, while the noninvasive skin quality treatments like ours are holding up. If you look at the nonmedical segment, which is 30% of our business, which includes the DaaS and the single room staticions, we see that playing out more stable throughout the year.

The next question will come from Oliver Chen with TD Towers.

This is Jonna on for Oliver. Would love to get additional color just around the trend that you saw in the quarter and what's baked in, in terms of the trend rate in your guide? And how do you anticipate tackling the churn rate throughout the year? And another question is you mentioned men and Gen Z or the newer customer set how are you repositioning your marketing messaging, if at all, to target those new customer set? We appreciate the color there. .

Mike will take the first part of that question, and I'll take the second.

Sure. Thanks for the question. Churn was a little bit higher than usual for the full year 2025, but it improved in Q4, both year-over-year and sequentially from what we saw in -- so in the fourth quarter, it was about 1.1%. When you look versus the year prior, as I said, it was a little bit higher than that. In Q3, it averaged around 1.8%. So we're moving in the right direction. The driver of the churn is mostly our smaller accounts that don't have a business development manager assigned to them.

So we began over the last few months restructuring our inside sales and customer service teams to better meet the needs of these accounts. So our focus in 2026 is we expect to potentially improve on that area. The guide, however, assumes that we'll hold churn on a year-over-year basis, flat. So our hope is that there's upside to the guide that we gave in that particular line item.

In terms of the segments that are moving in our way, as I mentioned in my initial remarks, the strategy is based on 3 assets. We have a great brand, a very large installed base and it raised a razor blade model. That basically means that for every device we place, it can become an annuity from a high-margin consumables that potentially can last many years. So our job here is the different customers getting to the fold and different segments of customers getting to the fold is to basically unlock the full potential of these assets. And to support this strategy, we have a market, again, that is moving in various ways our way.

As I mentioned, the Mets past continue to grow. There is this set of new demographics entering the category, which we are building and addressing their needs, their specific concerns in terms of skin health. We are seeing more and more tumors getting into treatments earlier in age, and they wanted to treat Ken very, very much like a lifestyle routine which is definitely well positioning well hydrophacial and beauty health to take advantage of this shift, because we are indeed moving towards much more of an outcome driven protocol combination therapies and clinically validated results, which is exactly, yes. So all in all, as more consumers, more demographics seems to be expanding into the category, we are very well positioned to be at the forefront and to offer the exact solution that they're looking for.

The next question will come from Susan Anderson with Canaccord Genuity.

Alec Legg on for Susan. You hinted that you have a potential new system in the works or focus of your innovation. I guess, is there a time line that you're targeting for that launch, if you're able to talk about it? And then what type of additional services would that system potentially offer?

Sure. So let me bring you back into our innovation strategy and the initiatives that we have to support that same strategy. So we are improving -- let me start by saying that we are improving the discipline around new product launches, Period. And basically, we're not going to go and chase trends instead what we are going is to invest and launch products and technologies and solutions that materially add value to our providers. And not only that, and that they are different versus our competitors, and they provide outcomes that consumers want. And in the end, they are created financially to our business in terms of margins.

So that's kind of kind of the framework that we are taking and using for innovation. Now when it comes to the next-gen hydro facial, the goal here is to build 1 that will give our existing more than 36,000 providers a compelling reason for upgrade. A new provider is a compelling reason to get into the hydrophacial universe. I don't want to go too much into the specific pictures of the next gen hydrophycial device at this moment. But what I can tell you and what I can commit is that we will launch a device that will materially advance the value proposition and the return on investment of hydrofacial to our providers.

And in terms of time line, we are right now at the early stages of development, but the plans are to launch the next gen of hydrophacial in 2028. And for sure, we're going to keep you updated as we get closer to those time lines.

That's pretty exciting. And then just thinking longer term about sales between consumables and new device placements right now, it's around 70% consumables, 30% new devices. Is that I guess, the rate that we should think about it? Is there a different target that you're thinking about longer term? We're not in a position to give a target right now, obviously, but our hope is -- or our expectation is that as we move through not just this year and into next year that we return to device growth. And so we haven't been able to give kind of specifics outside of being able to focus on growing both of those categories kind of into the future.

So later in the year, into next year, we'll continue to provide updates on where we think that can be.

Next question will come from Jon Block with Stifel.

Joe Federico on for Jon Block. Maybe just to dig a little bit deeper into the consumables performance in the quarter. EMEA has been pretty strong in terms of consumable sales over the past or so quarters and in the back half of the year off of more difficult comps as well. So I mean, can you just give us some color on what's driving that? Is it just a healthier end market? Or -- is there any sales execution drivers that can be replicated in some of the other regions? Any thoughts would be helpful.

Sure, Joe. So overall, at the highest level, in terms of the full quarter performance, so on consumables, we grew low single digits compared to actually negative subsequential growth in Q3. For the full year, we grew as well, low single digits. An but the booster sales grew much more, and that's an important point, high single digits. So if you want to break out that by region, the U.S. and looking at the larger provider groups and dermatology practice, both of these guys are growing. While small independent providers we see that they are still under pressure.

Now you touch a good point, which was EMEA. And within EMEA, specifically Germany is performing exceptionally well. The only pressure that we saw in the quarter when it comes to consumer performance was actually coming from China and is a direct result of the China transition. Now -- if you add this to what is the underlying trends driving this consumer demand, what I can tell you is the core demand is still there. Consumers seem to continue to to prioritize our treatments as part of their skin health time and also because of our price position versus other aesthetic treatments. Actually, the average spend per treatment in the U.S. in consumables is up 10% year-over-year, and that is driven by our premium boosters and the strategy of the booster. Mike?

If I could just add 1 thing, additionally to that. EMEA was a little bit different than the other regions last year because they launched 5 new boosters throughout the year. And these were some of the -- some of them got regulatory approval later. So these were boosters that were launched earlier in the Americas. And so the booster growth that we saw there really kind of demonstrates the power of innovation kind of in this business and when you can launch new innovative products that can actually drive demand.

And within EMEA, we saw that not just in the direct markets, but also in the distributor channel, where we saw really good consumable and specifically booster growth.

Okay. That's really helpful color. And then maybe just a follow-up on guidance. The 1Q '26 revenue guidance at the midpoint implies kind of a more outsized sequential decline than we've seen over the past handful of years. And so the past couple of quarters, actual performance has come in pretty solidly ahead of guidance and expectations. Should we assume any more conservatism to the guidance philosophy going forward? Or is there like a specific reason to point to for more pronounced decline in 1Q quarter-over-quarter?

The Q1 midpoint does assume a decline in the mid-single digits. It's primarily due to softness in the APAC region and the equipment softness in the Americas. That's reason number one. The second point is on the consumables revenue for Q1. We're projecting that to be lower year-over-year on a consolidated basis. for a couple of reasons. First, distributor orders that came in, in Q4. There's some timing a lot of times it happens with the distributor channel. They came in strong at the end of the quarter. So we're factoring in a bit of a decline in Q1 just due to timing.

And also, overall, as Pedro mentioned, we're seeing lower signature treatments due to kind of macro pressures even though consumers who are coming in to get treatments there they're electing more boosters than they have in the past, which is driving up the overall treatment. But we factored in that lower consumable revenue and treatments into the first quarter. So I would suggest the way we guide is to -- towards kind of the midpoint. So we don't really factor in deliberately conservatism. That's kind of where what we're seeing in the business. we're obviously always striving to do as best we can. And if we can outperform, we will certainly do so.

Next question will come from Bruce Jackson with the Benchmark Company.

Looking at the strength in consumables this quarter, was there anything going on in terms of average selling price increases or additional upselling. Can you provide any color on that? And then given the importance of the boosters, what is the anticipated launch cadence for 2026? So Bruce, so in terms of the boosters themselves, roughly, they're about 1/5 of the treatments. 15 of the treatments use a booster and what we are seeing is that, that ratio keeps improving.

For Q4, the booster revenue was up 7% year-on-year. And this happened and it was driven by the clinical proven hydrophilic and hydro lock boosters launch in the medical channel because the providers and the consumers actually saw the results and that was a major engine of growth from the boosters. In terms of -- and this speaks exactly to the strategy that we are putting forward, which is we are going to be over-indexing in launching clinical differentiated boosters with a very disciplined cadence. And also, we're going to be equipment providers with impactful marketing, good, strong marketing tools and keep investing in education. And also, we're going to amp the post sales onboarding and making sure that every provider knows how to maximize their return on investment.

And finally, we're going to invest our marketing into driving customer mind share and investing in the brand. So that's kind of the backdrop of the Q4 performance is mainly heavy on the way the boosters are taking share out of the main treatments. But in terms of 2026, yes, we just spoke that Q1 will be pressure a little bit modestly, with a modest decline versus prior year. But as Mike just said, that is largely driven by the APAC region with -- and majority with a change in China. But as the year progresses in terms of consumables, we expect to see modest growth in the Americas to happen.

The next question will come from JP Hallam with ROTH Capital Partners.

Right. I appreciate. If we could maybe start on the consumables side. So I think 4Q would have been kind of the first promo or busy season for consumables following the price increase. So just curious if you can talk about reception to the pricing increase and kind of what that means for whether price might be a lever going forward? And just as a follow-up there, like -- when you think about consumable utilization between your best partners and your worst, what's separating them? What does that difference look like? .

I can speak to a couple of those questions. The first on the price increase, we did the price increase on consumables actually at the beginning of -- so the third quarter was the first quarter where you saw the impact. I think the follow-up to that question was we really didn't see -- we did a 5% increase, and we really didn't have a lot of complaints or pushback on that. so far, we -- that's been very successful for us.

Going forward, the sales and marketing team continue to evaluate the overall pricing strategy. So we don't have any plans at this point to make any changes, but we'll keep you posted if anything changes there.

In terms of -- I'll just chime in, in terms of what we see being the reasons why boosters get higher attachment rates in certain specific segments of customers versus others. And what we have seen and what actually our data shows is that a provider who understands how to prescribe a booster uses roughly 3x more as many as boosters as the 1 that doesn't. And that is exactly why we are investing in marketing and investing in education to these providers. .

Understood. And maybe, Mike, for you as a follow-up. As we think about kind of OpEx and you've done such a great job kind of managing expenses there, understanding the need to invest from here. But just curious, as you think about kind of some offsets to the investment, where are you in terms of maybe kind of centralizing some international double costs, whether that's accounting, finance, anything of that nature? Like are there still offsets that you see in terms of the OpEx line for the upcoming investments? .

Yes. In terms of shared service centers, we are creating them. That's been a process that's been ongoing over the last year and will continue -- so we're continuing to see really 2 things. We're making investments in the back-end system infrastructure that enables us to manage the global business effectively through shared service centers, which is helping us with cost. We expect that to all be finalized more so by the end of this year. We made a lot of progress in some of the global entities the past year, and we have a few more to do this year and we'll continue to do that. Our guide this year assumes that there is G&A as a whole is stable to slightly up.

And then there's the additional reinvestment back into R&D. I think over the long term, there is opportunity to continue to gain efficiencies in this business. But most importantly, I think when you look at the overall OpEx there's a huge opportunity as we return to growth to get leverage out of that fixed cost infrastructure going forward. And that's really, as we continue to get more focused on system innovation processes. We've done a lot of work there. We're really positioning the company in our view, to start to have a lot more of that gross profit drop down to adjusted EBITDA when we return to growth.

And this will conclude our question-and-answer session as well as our conference call for today. Thank you for attending today's presentation. You may now disconnect. Goodbye.

Good day, and welcome to The Beauty Health Company 2025 Third Quarter Earnings Conference Call. [Operator Instructions] Please note this event is being recorded.

I would now like to turn over to Norberto Aja, Investor Relations. Please go ahead.

Thank you, operator, and good afternoon, everyone. Thank you for joining The Beauty Health Company's conference call to review our third quarter 2025 results. We released our results earlier this afternoon, which can be found on our corporate website at beautyhealth.com.

Joining me on the call today is BeautyHealth's Chief Executive Officer, Pedro Malha, along with our Chief Financial Officer, Mike Monahan.

Before we begin, I would like to remind everyone of the company's safe harbor language. Management may make forward-looking statements, including guidance and underlying assumptions. Forward-looking statements are based on expectations and involve risks and uncertainties that could cause actual results to differ materially. Listeners are cautioned not to place undue reliance on any forward-looking statements. For further discussion of these risks related to our business, please see the company's filings with the SEC.

This call will present non-GAAP financial measures. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measure is available in the earnings press release, which was furnished to the SEC and available on our website.

Following management's prepared remarks, we will open the call for a question-and-answer session.

With that, I would now like to turn the call over to our CEO, Pedro Malha. Please go ahead, Pedro.

Thank you, Norberto. So good afternoon, everybody, and thank you for joining us today. Before I get into our quarterly results, let me by start thanking Marla Beck for her leadership during an important transition period. BeautyHealth team did a fantastic job stabilizing the business and positioning it for the next phase of growth.

This next phase is actually one of the reasons why I chose to lead BeautyHealth. We have an incredible opportunity to leverage our Hydrafacial, device platform and expand it into a category-leading ecosystem of skin health technology solutions. This is a unique company with a proven and resilient razor and blade business model, which is anchored in recurring high-margin consumables and supported by a global network of providers who believe in our technology and in the outcomes of our treatments that are delivered every day to thousands of people around the world.

BeautyHealth is also well positioned to lead the skin health category as we continue to see the market shifting towards a less invasive, increasingly personalized and more science-backed procedures and treatments. I say well positioned because if we look across the landscape, every -- very few companies are capturing the recurring economics behind procedure volumes.

And this is where BeautyHealth stands apart because we participate on both sides of the equation, the capital equipment and the consumables, which creates a self-reinforcing flywheel of predictable and profitable revenue.

So since I joined BeautyHealth a month ago, I've been very impressed by the passion and the commitment of our teams around the world and by the loyalty of our customers and providers. But as we all know, passion alone does not create shareholder value. So we need to make sure that this passion is harnessing with a clear strategy and operational excellence and a consistent top line growth and financial performance.

So we are going to go and over-index our capital and attention in 4 different areas. First, our priority will be protecting and growing our Hydrafacial installed base of over 35,000 devices worldwide, because we know that for every device we place that will drive years of high-margin consumable growth.

Second, we will focus on driving consumable utilization. This is the engine behind our profitability. Consumer -- consumables generate strong gross margins, so increasing device to consumable efficiency and usage across the installed base needs to absolutely be a key focus area for us.

Thirdly, we must keep innovating across both devices and consumable platforms, and we will do that by bringing to market superior clinically backed products that meet our providers' needs and deliver the desired results for our customers.

And fourth, we will continue to strengthen our operational discipline around commercial execution, cost control, margin expansion, supply chain and quality. And this is an area where we already have done very good work, and we will continue to focus on.

So now turning to our third quarter results. For Q3, total net sales were $70.7 million, down 10.3% year-over-year, slightly ahead of the high end of our forecast for the quarter. In our device segment, Q3 revenues were $20.8 million, a decrease of 24.6% year-over-year, primarily reflecting continued pressure on equipment sales globally and the impact of the China transition to a distributor partner.

Looking at our consumables segment. Q3 revenues were $49.8 million, a decrease of 2.6% year-over-year, primarily reflecting the change in the China business model. If we net out the China impact, consumables sales will have actually increased modestly versus last year. So as a result, our consumable mix moved from 65% of net sales in Q3 of last year to 71% this quarter.

Now looking from a portfolio perspective. We continue to deliver on our new product launches. Hydralock HA and HydraFillic with Pep9 Boosters together contributed to 14% growth in the booster sales category this quarter.

We also achieved significant milestone in operations. We are holding inventory below $60 million, which is the lowest in 3 years. And this is the result of the work the team has done to improve demand planning, forecasting and production quality.

In terms of Q3 adjusted gross margins, we landed at 68%, a decline of approximately 150 bps from Q3 of last year. And this was driven primarily by lower average selling prices as our distributor markets held a larger unit share of the overall equipment revenue year-over-year.

Looking at adjusted EBITDA, that was $8.9 million, up 11% from Q3 of last year and reflects a tight control of cost and a solid operational execution.

Now looking ahead, we are confident in our outlook of raising adjusted EBITDA guidance for the remainder of the year as well as the midpoint of our full year revenue guidance. And that is because we are encouraged by the momentum we are building as we enter 2026.

So with that, I'll turn the call over to Mike to walk you through our third quarter results in more detail.

Thank you, Pedro, and good afternoon, everyone. I'm pleased to share another quarter of steady execution and disciplined financial performance in which we once again exceeded our initial expectations. Our team across all functions continues to work tremendously hard to support our providers and drive shareholder value.

As expected, revenue declined year-over-year, primarily due to device sale pressure. However, we delivered strong margins and profitability, reflecting the continued benefits of operational discipline and cost management.

For the third quarter, net sales were $70.7 million compared to $78.8 million in the prior year, primarily reflecting lower device sales, which declined 24.6% to $20.8 million, consistent with the macroenvironment. Overall, consumable sales declined 2.6% to $49.8 million as international gains were offset by softer U.S. trends. The decline includes lower consumable sales due to our transition from a direct seller to a distributor model in China. Excluding China, consumable sales would have increased modestly year-over-year. Price increases were partially offset by lower volume.

From a regional perspective, revenue in the Americas declined by 7% to $48.3 million. APAC revenue decreased 41.5% to $6.3 million, while revenue across EMEA was relatively flat at $16.1 million. The decline in APAC reflects our planned go-to-market transition in China, where we have shifted from a direct to a distributor model. As part of this change, we prepositioned sufficient capital equipment inventory in China to meet anticipated demand through year-end, minimizing tariff exposure on devices.

Our global footprint continues to expand, which adds to the recurring consumables revenue stream. In the third quarter, we sold 875 total units worldwide at an average selling price of approximately $23,794. As of September 30, 2025, total active machines in the field increased to 35,409 units versus 34,162 units at the end of Q3 2024.

GAAP gross profit increased 12.3% to $45.6 million, resulting in a GAAP gross margin of 64.6%. Adjusted gross margin came in at 68%. The GAAP margin improvement was driven primarily by lower inventory write-offs and a mix shift towards high-margin consumables revenue. Q3 2024 includes charges from our China manufacturing exit and our retail-specific Perk write-offs.

We have maintained tight control over expenses this quarter as sales and marketing spending was below our plan, reflecting lower headcount and disciplined spend management. Total operating expenses for the third quarter decreased by 16.5% to $51.9 million as we continue to manage our expenses.

Selling and marketing expenses were $20.9 million compared to $27.6 million last year, a decrease of $6.7 million or 24.2% year-over-year. The decline was primarily due to lower headcount and targeted spending.

R&D expenses were $1.7 million compared to $1.1 million last year, an increase of $0.6 million or 53.2% year-over-year. The increase was primarily driven by higher other professional service expenses related to early-stage future product investments.

G&A expense was $29.3 million, down from $33.4 million in the prior year, a reduction of $4.2 million or 12.5% year-over-year, driven by lower headcount and bad debt recovery, partially offset by higher legal and incentive-related costs. These results led to an operating loss of $6.2 million in Q3 2025, a significant improvement versus a loss of $21.5 million in the comparable prior year.

Adjusted EBITDA was $8.9 million, up from $8.1 million in Q3 last year, with adjusted EBITDA margin improving approximately 240 basis points to 12.6%. The increase reflects continued cost control even in the face of lower top line volume.

Moving to the balance sheet. We ended the quarter with $219.4 million in cash and equivalents compared to $370.1 million at year-end 2024. The change primarily reflects the completion of our convertible note exchange under which we repurchased approximately $20 million of principal and exchanged $413 million of our 2026 notes for a mix of cash and $250 million of new 7.95% secured notes due 2028.

This transaction significantly extended our debt maturity profile and enhanced our long-term financial flexibility. Cash used for refinancing activities was partially offset by cash flows from operations, reflecting a strong improvement over the breakeven position in the prior year.

Inventory declined to $56.1 million, down from $69.1 million at year-end, reflecting stronger demand planning and improved supply chain efficiency. We also continue to make progress selling through our Elite fair market value devices with 131 units remaining, which we expect to sell by year-end.

As previously noted, our U.S.-based manufacturing footprint is fully operational and remains a strategic advantage, enhancing product quality, increasing agility and mitigating domestic tariff exposure.

Given our performance through the first 9 months and our visibility into year-end, we are raising the low end of our full year 2025 revenue guidance to between $293 million and $300 million and increasing our adjusted EBITDA guidance to between $37 million and $39 million.

For Q4, we expect net sales between $74.5 million and $81.5 million and adjusted EBITDA between $6.9 million and $8.9 million. The midpoint of this guidance reflects reduced year-over-year revenue declines and continued cost management discipline.

Now I'll turn the call back over to Pedro for final comments.

Thanks, Mike. So to close, it's important to highlight that we are operating in a tough and still unpredictable environment where inflation remains an issue, access to financing continues to be challenging for capital equipment purchases and consumer confidence continues to be uneven, especially in the discretionary categories where BeautyHealth operates.

But despite the macroeconomic backdrop, we will continue to prioritize and lean towards the levers within our control that will drive device footprint expansion and repeat consumer treatments, all with the objective to keep building the Hydrafacial global brand, accelerating our revenue growth and profitability and position BeautyHealth firmly as the leader in the global medical aesthetics market.

So with that, I'll turn the call over for questions.

[Operator Instructions] The first question comes from Oliver Chen with TD Cowen.

Encouraging on the guidance. I would love your thoughts on what's happening in Americas and also the more cautious trends you cited in Americas, and how you weigh that against the guidance you gave? Also to help us compare and contrast a little bit about Americas relative to EMEA being flat.

Sure, Oliver. So if you look at the regional dynamics of our business, it's kind of a mixed picture, but I believe we're trending in the right direction here. So just to look at the Americas, which, by the way, it's our largest business, 65% of our total revenue comes from that.

Overall, yes, the Americas was down 7%. Out of that, devices was down 16.3% and that's the explanation for that. And the driver for that was the lower device placements and because of the macro pressures that are currently affecting the country. But despite being a decrease, Q3 was less than the previous 2 quarters. So you saw an average of 20% decrease in the prior 2 quarters of the year. We believe that we are seeing some stabilization here in terms of devices for the Americas.

Consumables, a little bit of a different mix. We were down about 2.7%, and that was driven by a combination of, again, consumer spending, some headwinds there, coupled with lower device placements that we had in the first half of the year. But if we look our booster sales have increased. So that's kind of the picture of the Americas.

If you want to contrast that with what's happening in EMEA, EMEA, it's a little bit of the same narrative. 25% of the total sales comes from that region. But overall, we were flat, and we were flat because of the mix of different performance. We have strong momentum in Germany, strong momentum in the medical channel. But again, devices were down in EMEA about 21%. And again, very similar challenges as the U.S. with the consumer confidence being generally lower than a year ago. And with the added factor that in EMEA, we have a little bit more of a crowded space there. So the local teams are very focused on training and education, on the benefits of Hydrafacial versus other treatments. And that's -- but that's taking an effect.

If you look at the consumables on EMEA, we continue actually to perform well. This is a bright spot. It has been a bright spot for us. It's definitely a bright spot for the quarter. We grew there double-digits, about 10%. And that was driven by very strong performance in Germany and then again, from the medical channel. Then we have a small portion of APAC, which is about 10% of our total sales, and which has been down substantially due to the China transition to a distributor market with both devices and consumables being down.

And then one broader question. As you mentioned, the 4 focus areas, which ones were going to be more near term in terms of what you're seeing in your hypothesis and which ones may be longer term? And as you mentioned, the skin health technology ecosystem, how do you envision that? Or how would you frame that in terms of device platforms, digital diagnostics or partnerships as you think more broadly?

Yes, sure. So the way we're kind of looking at the business, there's a broader plan or strategy that is overarching for the whole company. And then we will definitely have a more surgical strategy for our device business and consumable business. And definitely, over time, I'll share much more in how we're shaping the future strategic roadmap as we go along.

But my initial observation is that, our competitive advantage really relies on our core value proposition. We need to keep driving utilization. We need to keep driving device placement. And this is because we all know that for every device that we place that drives multiyear consumable revenues after that on the tail. So then our job after that is just to make sure that we are capturing the long tail of recurring customers, the consumables.

We need to focus on innovation, and that's going to be a play across both devices and consumable platforms. And so the intent is to continue to launch superior, and most importantly, clinically backed products that meets our provider needs.

Execution has been a very bright spot in the prior quarters. We will continue definitely tying up the execution performance, continue to drive commercial excellence around our business with better targeting and lead conversion. And as with every business, we'll keep a close eye on capital efficiency, making sure that every dollar is invested or driving profitable revenue or in margin improvements.

And then if you look more specific into what we're planning to do for devices, again, I will definitely share more about my thinking here. But we have to attack this problem from a multitude of angles here.

First, we have to address the providers' financing challenges. That has to be -- has been definitely a gating item for us in the prior quarters. And we have to do that with smarter and more targeted pricing strategies. And secondly, as you guys remember, we rolled out the good, better, best program, which basically gives customers more flexibility in terms of price points across our portfolio of Syndeo, of Elite and Allegro. And that is definitely helping now the consumers navigate the macro better. And also on devices, we have to be reinforcing constantly the commercial discipline around targeting segmentation and conversion. And the team is doing a great job there.

Different -- a little bit of a different strategy that we're going to be exploring is going to go on the consumable side, because that's where we're going to really lean in on the innovation. And that's kind of -- that's the formula that has been working for us. And we're going to do that by launching differentiated boosters with clinical -- real clinical proof there. And we're going to continue to equip our providers with marketing tools that are relevant, that are impactful, and we're going to continue to invest in education because that's kind of -- that's the gating item that will move the needle.

Post sales onboarding, very important. We have to continue to over-index on those, making sure that every provider knows and how to maximize the return on investment of every machine that they commit to. And consumer mind share. This is in the end, boosters, serums, they need the inbound traffic to happen. So we'll definitely have to be invested in driving that consumer mind share. So overall, still very high level, but this is kind of the key areas I personally and the team are very focused on.

[Operator Instructions] The next question comes from JP Wollam with ROTH Capital Partners.

Pedro, maybe if we could start with you. As you kind of get your hands wrapped around the business a little bit more and get a better understanding, is there anything else you can share about the sort of international strategy and sort of where you feel makes the most sense to have direct versus distributor models?

Definitely. Thanks, John. Thanks for the question. We are a global company. So if you want to grow, which is the intent, we have to address international markets as part of that formula. And so we have to obviously focus on that and have, in my view, very targeted commercial programs designed to fit the different regions' economics that -- in where our products are present.

We have been historically leading into an extensive distributor network that is part of our DNA, and we will continue to do that in order to drive penetration and reach. That's part of our -- the way we go to marketing has been quite of a successful formula there. So we will definitely continue to do that. But at the same time, we need to make sure that we invest in education and training as we scale and help out the distributors increase their penetration in their respective markets.

So that's kind of [ additional ] strategy. Not a big change over overall. It's still a small portion of our business. We intend to explore the opportunities of growth in different markets, being those through direct channel or distributor channel. But definitely, just to respond to your question, John, definitely international has to be part of that equation for us.

And then just a quick follow-up. I believe you took the pricing on the consumables side in July. Can you just talk about how the reception has been to that price increase and what it says about potential pricing power in the future on the consumables side?

No, no problem, John. So the team has been very pleased how the market not only digested, but actually took that price increase, which was triggered around the summertime of this year. So ASP for -- you look at consumers ASP is up, and that is the reason -- because of the price -- the 5% price increase that we drove. And another thing that we are seeing is that the boosters are driving that ASP also up for us. So overall, for our consumable category, ASP overall on average is up, which is a good thing.

The next question comes from Susan Anderson with Canaccord.

I'd love to hear maybe just kind of your thoughts on stabilizing the systems. I mean, it looks like they're already stabilizing, but what initiatives do you think you need to put in place to get those to grow again?

Sure, Susan. So let me just anchor on our quarter performance. I think that's probably best as we start discussing how we're doing with devices. So for the quarter, devices were down. Devices represent about 30% of our total revenue. And by the way, Syndeo represents 70% of total new device placements. So a big chunk there on our new platform.

They are declining indeed, and we feel that this is a direct -- indirect correlation to the economic environment that we live in which translates into a tighter lending environment as well. But at the same time, we look at how we are expanding the footprint of our devices globally, and actually we look at Q3, and we sold an extra 875 units. So we continue to expand that footprint. We continue to broaden our reach, and that is definitely good news for us.

Now we understand that the devices keep coming down and have been coming down for some quarters. But what we are encouraged to see is that those numbers are stabilizing. We are coming up -- coming off rather out of easier comps more and more. Our lead pipeline is improving. Our field teams are getting more disciplined about lead conversion. So if I look at -- in the future, I definitely expect this trend to continue as the financing access improves and the sales teams executing better.

So I look at devices and specifically the performance of our ability to sell devices into the market to get better and better as the quarters progress and the comps get easier, and we do a better job in commercial execution.

And then I guess to add one follow-up on the consumables front. I guess, just curious your thoughts around -- I guess, I think Marla was creating some products not just necessarily for treatment such as boosters, but also for use maybe during treatment or for purchase in private spa. I guess just curious on your thoughts around the consumables area and kind of where you're going to be focused at.

Yes, absolutely. So we have decided to actually pause the skin care initiative. And that decision was a deliberate strategic decision. My opinion is that our competitive advantage lies rather on the clinical differentiation, on recurring consumables, on stronger provider partnerships. And that's where we generate long-term value.

So after reviewing the business case, we basically concluded that skin care will pull us away, will pull us away from our core business model and -- which, by the way, is the business model that provides us with a very strong competitive advantage. So we have decided to instead focus our capital rather on things that are core to our business instead of -- into ventures where we have no expertise or actually no right to win.

As we make that decision, we also look at the potential impacts on the revenue. And so actually, the project was pre revenue. So we will -- and on top of that, we will have -- it will have to require heavily investment before we could scale up. So by not pursuing the skin care initiative, we actually preserve capital, which indeed will absolutely help us in our near-term profitability profile.

The next question comes from Olivia Tong with Raymond James.

This is Lillian on for Olivia. I'm wondering if you could talk through the trends you're seeing in different channels? And then also any color on what you're seeing from an end consumer standpoint and whether you've noticed any incremental weakness as macros remain pretty choppy?

Yes. So Olivia (sic) [ Lillian ], as you know, we divide our consumable business between the medical and the non-medical segments. So medical, just for reference, that includes your med spas, your dermatologists, your plastic surgeons. And that segment itself represents about 70% of our providers in the U.S. -- this is just the U.S., with the largest segment being about 2/3 being med spas, which, by the way, is the channel that keeps the market growing overall. Well, the plastic surgeons, from what we understand, are experiencing some slowdown because basically consumers now are prioritizing less invasive care.

And then you have on the other side, the non-medical segment, and that includes the day spas and the single room institutions. And here, we are seeing a stable progression there as well. But basically, the U.S. and EMEA has the largest portion of the medical side and medical spas. But with all the challenges that they are facing in the macroeconomic realm, that is impacting their business. The bright spot here is Germany, as I think, I mentioned before and on the consumable medical channel.

But overall, we still believe there is growth opportunity in both of these segments or channels, both the medical and the non-medical. And our job from now on is to make sure that we design products and have the right pricing strategy and positioning to capture the opportunity in both of these segments. Mike, do you want to chime in?

I just wanted to add about the end consumer piece. One of the things we saw during the quarter where booster attachment rates were very high. They've been a real bright spot in the business. And that can really highlight the impact of the innovation that we've been investing in over the last year. So you look at a year ago, the company launched Hydralock. And then in the second quarter, we launched HydraFillic, and they've had a real positive impact on the overall business.

Utilization rates on our installed base, we've seen a little pressure, highlighting that the end consumer who's coming in for just a normal Hydrafacial without electing kind of boosters has been under a bit of pressure. And so we really focused on the sales and training aspect of the business to make sure there's outreach there. We're leaning into education to make sure our providers are equipped with the tools they need to communicate the benefits most effectively around the Hydrafacial treatment.

The next question comes from Allen Gong with JPMorgan.

I guess starting just with a broader strategy question. This has been a reset year for BeautyHealth. You are hopefully stabilizing. This will be a nice baseline for you to grow off going forwards. So when I think about the outlook for 2026, how should I think about how you're going to prioritize top line growth versus profitability and diving deeper into existing accounts and focusing more on consumables versus trying to drive a reacceleration in delivery systems?

We're actually going to be focusing on all of those lines. You have to bring top line revenue growth to this business. We can definitely flex our spend, and we -- the team has been doing that for some time very successfully, increasing our gross margins as well and which translates in an expanded profitability and EBITDA. But if the top line is not there, we're always going to find ourselves behind the 8 ball. So our total focus will be to drive that top line. We have a very strong business model that keeps delivering recurring revenue. The team has to be focusing on that for sure.

In terms of next year in the way we are looking at -- and I'm not going to provide any guidance because I think it's a little bit premature to start talking about specifics about 2026. We'll actually share more detail commentary on our next call. But we feel good. We feel good about the setup. We're coming from 2 consecutive quarters of good progress, which basically gives us a strong base heading into next year.

But again, and I think it transpires throughout the call this momentum that we feel strong about will depend on several factors kicking in. And first and foremost, the market that we are participating is still under some pressure versus prior years. And I think that we're going to be definitely continue to see some lumpiness in the near term.

Overall, consumer spending, again, is still rating -- limiting factor for us. And so we're going to keep an eye on that as well. But looking at next year, if the macro conditions improve even slightly and if our device momentum improves, which will be the focus of the team, then we can expect operating leverage and further expansion on our bottom EBITDA. So where we stand, yes, I think we have the elements that we need going into next year with a good momentum.

We move to the next question. It's from the line of Jon Block with Steifel.

It's Joe Federico on for Jon. So maybe to start, and Mike, this might be more for you, but just to flush through some of the updated guidance dynamics. Revenue expectations, I think, came up by $4 million at the midpoint and EBITDA came up by $7 million, so a decent clip more. Can you just maybe walk us through some of the moving parts more specifically as to why there's so much more of a drop-through on the incremental sales? I know gross margin outperformed in the quarter. So is that just sustainable in coming quarters? Any additional color would be helpful.

Sure. A big portion of the fall-through happened in Q3, Joe, as well. So we obviously exceeded kind of the midpoint of our expectations on Q3. I think the midpoint of our original guide was around $3 million, and we obviously came in well above that. So that's the piece.

But when you look to your point around adjusted gross margins, as I think about kind of Q4, seasonally, gross margins tend to be a little bit lower quarter-over-quarter because we run the consumables promotion in the fourth quarter, the Black Friday, Cyber Monday promotions. So I would think about gross margins in the fourth quarter coming in more similar to the second quarter versus the third. And then OpEx, it tends -- I would expect it to go up quarter-over-quarter, about $2 million to $3 million versus Q3, and that's primarily due to higher commission dollars because of sales growing and marketing spending associated with that.

So the key themes -- those are the financials. The key themes Pedro touched on are, we're seeing -- while devices still continue to be under pressure, it's a lot less as we've moved throughout the year and really executed on the sales initiatives that we've had and introduced kind of the good, better, best, and we've also put together different pricing portfolio bundles for Syndeo that we've started to see some success with. So our expectation behind the guidance is that you'll continue to see those trends improve through the fourth quarter.

Okay. Got it. That's really helpful. And then maybe just a quick follow-up. We're calculating that churn in the quarter was just under 2%, which is a modest improvement compared with last quarter, but it's still pretty elevated compared to the last 7 or 8 quarters, call it. I know you had planned actions to moderate that in the back half of this year. Maybe just how are some of those progressing? Are you starting to see them moderate more in 4Q to date? Just your latest thoughts there.

Yes. So I'll take that, Joe. Definitely, churn is definitely higher than usual, about 1.8% versus, I think, about 0.9% of last year. And look, we're looking at this very seriously. We believe the causes could be actually multifactorial. And then our data points and the team is still running a lot of analysis here. But our data points to financial pressure being the primary factor. And driven -- and this is driven by the economic challenges on the low-volume small providers that -- or are closing down, simply, they're closing their doors or they have a higher staff turnover and that comes with less consistent device utilization. And so I believe or we believe rather than these factors are the main culprits behind the increased churn that we just saw this past quarter.

Now what are we doing about it? Actually, there's ways you can see this. You can see this as a loss or you can see this as an opportunity, and we rather are looking at this as a reactivation opportunity, and we're taking a very proactive stand in reengaging this -- particularly these low-volume providers. And we're going to go -- we are going in and offering more support and improving our training to them. And so the goal that the team has is to bring these churn numbers back to what we think are the historical levels over -- and we'll do that over the next few quarters.

That was the last question. This concludes our question-and-answer session. The conference has now concluded. Thank you for attending today's presentation. You may now disconnect. Thank you.