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Establishment Labs Holdings Inc (ESTA) Q1 2020 Earnings Call Transcript

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ESTA earnings call for the period ending March 31, 2020.

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Establishment Labs Holdings Inc (NASDAQ: ESTA)
Q1 2020 Earnings Call
May 11, 2020, 9:00 a.m. ET


  • Prepared Remarks
  • Questions and Answers
  • Call Participants

Prepared Remarks:


Ladies and gentlemen, thank you for standing by, and welcome to Establishment Labs' First Quarter 2020 Earnings Conference Call. [Operator Instructions] Please be advised that today's conference is being recorded. [Operator Instructions]

I would now like to turn the call over to our speaker today, Juan Jose Chacon Quiros, Chief Executive Officer.

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Thank you, operator, and thank you, everyone, for joining us today.

Before we begin, I would like to introduce David Erickson, was recently joined Establishment Labs as Vice President of Investor Relations. Many of you already know David from his many years of experience in the medical device industry, and we are very pleased to have him on the team. David?

David K. Erickson -- Vice President of Investor Relations

Thank you, Juan Jose. Let me just quickly say how excited I am to be working with the management team here at Establishment Labs, and I look forward to engaging with our analysts and shareholders in the days and weeks ahead.

Moving on, our presenters on today's call are Juan Jose; and our Chief Financial Officer, Renee Gaeta. Following their prepared remarks, we'll take your questions.

Before we begin, I would like to remind you that comments made by management during this call will include forward-looking statements within the meaning of federal securities laws. These include statements on Establishment Labs' financial outlook and the Company's plans and timing for product development and sales. These forward-looking statements involve material risks and uncertainties, and the Company's actual results may differ materially. For a discussion of Risk Factors, I encourage you to review our quarterly report on Form 10-Q that we plan to file with the SEC tomorrow and will be available on our website at The content of this conference call contains time-sensitive information accurate only as of the date of this live broadcast, May 7, 2020. Except as required by law, Establishment Labs undertakes no obligation to revise or otherwise update any statement to reflect events or circumstances after the date of this call.

With that, it's my pleasure to turn the call over to our Chief Executive Officer, Juan Jose Chacon Quiros. Juan Jose?

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Thank you, David, and good afternoon, everyone. Thank you for joining us today. During these unprecedented times, our hearts go out to the families affected by this pandemic, and we applaud the healthcare workers and the other frontline responders for their selfless efforts to combat this crisis. As a women's health company, Establishment Labs is committed to helping our plastic surgeons and their patients around the world in whatever way we can.

I'd like to take a moment to thank each of our employees, who have donated their time and resources, to support local response efforts, while at the same time, working tirelessly to help keep our operations running as smoothly and efficiently as possible given the current circumstances. In particular, I would like to acknowledge our employees in Costa Rica, who have assembled and distributed several thousand protected face shields to the healthcare workers from the Ministry of Health and at local organizations, who care for the elderly patients recovering from major illnesses and other at-risk individuals.

I'd like to spend a few minutes discussing our first quarter performance, but I'm sure you're just as interested in how we expect COVID-19 to impact our outlook. So we'll provide you with as much information as we can to help frame the remainder of 2020. We are pleased to report that our first quarter sales were $24.5 million, at the higher end of the $23 million to $25 million range we guided toward during our last earnings call. This reflects 18% growth over the year-ago period as plastic surgeons and their patients continue to adopt Motiva Implants. Even though our March sales were measurably impacted by COVID-19, our first quarter still represented another record quarter for Establishment Labs and illustrates the strength and momentum of our product and brands in the market. Overall, sales in Q1 were strong. But as one would expect, during the month of March and at different speeds across various geographies, we began to see a steep decline in breast enhancement procedures as countries began to curtail non-essential activities, including elective medical procedures. While most countries were shut down in April, procedures did continue in some countries, albeit at a greatly reduced rate. We are now seeing a number of countries begin to come back online.

Procedures are resuming at varying rates across countries, and it appears that those countries that faced COVID earliest and those who took aggressive steps to control its spread are coming back more quickly. It is also important to remember that the majority of breast enhancement procedures are not performed in hospitals, but in private clinics, often which are owned or controlled by plastic surgeons. For this reason, we would expect a more rapid return to normal procedure volumes than you might see with other hospital-based elective procedures that compete for operating room time.

As a reminder, our revenue base is geographically diverse with sales in over 80 countries. Except for Brazil, no single country represents more than 10% of our sales. While global diversity helps to spread risk, it also makes it extremely difficult to forecast 2020 sales accurately as each country has its own path on the return to normalcy. For this reason, we have decided to forgo providing full-year sales guidance at this time. We are hopeful that as the global outlook becomes clearer, we will be able to provide guidance later in the year.

Given the global impact of COVID-19, Q2 sales will be negatively impacted. However, we are seeing evidence of conditions beginning to improve in certain geographies. And for this reason, we do believe that we will sequentially see increases in Q3 and Q4 revenue. As we think about the balance of this year, it may be helpful to note that in Q2, we are seeing many procedures being rescheduled for the second half of this year rather than being canceled outright. This behavior seems consistent with the deep consideration, we believe, most women take when considering breast augmentation surgery. A research suggests that many women take several years to research breast augmentation exhaustively and, once they have made a decision to proceed, are very determined to follow through with their surgery. This has been true, both through previous recessions and also when our industry has undergone a period of significant negative headlines.

Our industry has been very resilient, and this is very much a testament of how important this procedure is to women, who choose to have it. In this unprecedented time, our commitment to women's health and the unique safety profile of Motiva is resonating strongly with patients, making a long-term decision to invest in themselves. We are seeing this determination play out once again. In Brazil, for example, our data shows that 76% of patients that chose Motiva Implants before the pandemic have decided to postpone, not cancel, their breast enhancement procedures. Even with the uncertainty around the speed of global recovery, we remain confident in the fundamentals of our business and the strength of our product portfolio, which, up until now, has resulted in robust year-to-year growth and market share gains. Our executive team has decades of experience in breast aesthetics and reconstruction, and we will navigate this turbulent time just as we have before.

COVID-19 does not appear to have had much impact on women, who are beginning their breast augmentation research, as evidenced by the relatively steady rate of web searches and social media activity we are seeing. There is a slower pickup in women scheduling new face-to-face consultations, and plastic surgeons are adapting by offering more online consultations and incorporating COVID-specific safety protocols for their patients and office staff. We have quickly converted our MotivaEdge in-person training programs and seminars to webinars online and have seen large increases in attendance. Some of these webinars have had over 1,000 registrants, and nearly all of our events routinely attract, at least several hundred participants. Plastic surgeons are taking this time to think about how they can improve their practices and learn about innovations in their field. And this is very much in line with Establishment Labs' message of innovation and presentations around the science of breast tissue management.

Despite our long-term bullishness about the breast implant business, we have taken early and decisive steps to prepare our Company to weather these uncertain times and position us for a strong recovery and further market share gains. Specifically, we have reduced our planned 2020 expenses by approximately 20% by eliminating unnecessary travel and non-essential discretionary spending, scaling back our manufacturing operations, lowering headcount and temporarily reducing management employee compensation. Renee will provide greater detail about these actions in a few moments.

While reducing certain expenses, we are also investing in strategic areas. For example, we are expanding our business excellence program from manufacturing to our entire global organization to enhance efficiencies and productivity, as well as reducing waste. Since 2017, this program has generated over $5 million in cost savings, including $1.7 million in 2019. With the new normal in 2020, we will be investing more resources in our digital footprint. Our digital marketing team is focused on initiatives to strengthen our social media presence and leverage other digital channels that provide valuable insight into patients seeking breast aesthetic procedures. We are also advancing with our plans to support plastic surgeons, who are restarting their practices, in select countries by linking them to patients interested in the improved safety and aesthetic outcomes of Motiva.

Establishment Labs remains an entrepreneurial and agile organization that can adapt quickly to dynamic and complex environments. I believe that the combination of these actions will result in an even stronger Company that is well positioned for continued growth and success even as we navigate the uncertainty that has resulted from the COVID pandemic.

Establishment Labs has the most comprehensive portfolio of advanced smooth implants worldwide, and we are continuing to invest in our future by developing new products and entering new markets. Clinical trials of medical devices currently being studied in US hospitals have understandably been impacted by COVID-19 as centers focus their energies on more critical needs. Although we continue to activate trial sites and secure IRB approvals, the pandemic has delayed enrollment in the reconstruction cohort of our Motiva pivotal trial, which could add at least six months to our timeline. As you already know, enrollment in our aesthetic cohorts was completed last year, and we are presently in the follow-up phase. We are modifying our patient monitoring and follow-up plans according to the FDA's COVID-19 guidance, and several of our sites in the US are already conducting virtual consultations with patients as part of their follow-up protocol. As a reminder, roughly 80% of the US breast implant market is comprised of aesthetic procedures.

We continue to work toward our goal of receiving FDA approval for a Flora tissue expander. We still expect to receive a CE Mark for Flora and begin market development activities in Europe this year. We believe the proprietary features of Flora offer compelling advantages to currently available product and will be an important part of our product portfolio.

Turning now to Motiva MIA, our minimally invasive breast augmentation initiative, we began proof-of-concept cases in Asia last December, and we are very pleased with the results, although COVID-19 has slowed the pace of additional surgeries. Surgeon and patient feedback has been positive, and we are working to expand our initial patient series in additional countries. We continue to believe that the introduction of a minimally invasive breast augmentation procedure has the potential to grow the total addressable market for breast aesthetics and contribute to our long-term growth strategy. Later this year, we are expecting the publication in a highly respected scientific journal of a groundbreaking study on the biocompatibility of our proprietary SmoothSilk surface. This paper will add to the growing body of evidence in peer-reviewed publications on the unique safety profile of Motiva Implants. Publications like this, combined with surgeon experience and positive patient feedback, are key reasons for our success to date and should help drive continued market adoption and market share gains.

Turning to other developments. During the quarter, we announced the issuance of a US patent that protects the proprietary surface technology of our Motiva Implants. We believe this innovative technology is one of the key aspects of the exceptional safety profile of Motiva and provides our Company with a strong competitive advantage. We will continue to dedicate resources to developing innovations that improve patient outcomes and protect those innovations with a robust IP portfolio.

Finally, we are pleased to welcome Rosalyn d'Incelli to our leadership team, who will lead our clinical and medical affairs effort. Rosalyn, who has more than 20 years of experience in the breast implant industry, will initially focus her energies on our US IDE for Motiva Implants. At approximately 50% of the global breast enhancement market, the US represents a large growth opportunity for our Company, and we look forward to bringing our innovative Motiva Round and Ergonomix implants to women who seek outstanding aesthetic results.

With that, I'd like to turn the call over to Renee to discuss the financials in detail. Renee?

Renee Gaeta -- Chief Financial Officer

Thank you, Juan Jose. As stated earlier, our first quarter reflected both strong sales growth and expense control, and we are very pleased with the results. The expense reductions we have implemented in response to COVID-19 will provide sustained expense control during Q2 and Q3 of this year and gives us a solid financial footing as business conditions recover. You can find additional details about our first quarter financials in our earnings press release and Form 10-Q, which we plan to file tomorrow.

For the first quarter, total revenue was $24.5 million, an 18% growth rate over the $20.8 million reported in the year ago period. This strong growth rate was despite the steep decline in breast enhancement procedures seen toward the end of March.

Breast implant sales, which accounts for over 90% of total sales, grew 23%. Distributor sales were responsible for most of our growth this quarter, led by the Latin America and Asia Pacific regions, and represented approximately 60% of total sales. Growth in direct markets was down year-over-year, due almost entirely to softness in Brazil, resulting from a strong year-over-year comparison and exchange rate pressures. In the year ago period, we recorded higher-than-expected sales while a major competitor was temporarily off the market. From a regional perspective, sales in Europe comprised of 40%, Asia Pacific and Middle East was 30%, and Latin America was 30%. Brazil accounted for 10% of sales this quarter as compared to 17.7% in the year ago period.

Gross profit for the first quarter was $15.5 million, or 63.2% of revenues, which is a significant improvement over gross profit of $11.3 million, or 54.2% of revenues in the year ago period. The increase in gross margin percentage was driven primarily by the reduction in the amortization related to the fair value of inventory recorded from our distributor asset acquisitions in Q4 of 2018, and cost savings from increased manufacturing efficiencies. Margin was negatively impacted by 1.1% in Q1 of this year in comparison to 7% in Q1 of last year due to this amortization related to the fair value of inventory. Excluding this impact, our gross margins improved by 3.1 percentage points year-over-year.

Total operating expenses for the first quarter were $23.2 million, an increase of 18%, compared to $19.6 million in the same period a year ago.

SG&A expenses this quarter increased $2.9 million, or 18.2% to $19 million, compared to $16.1 million in the first quarter of 2019. The increase in SG&A is primarily due to the increase in compensation costs as a result of hiring additional sales, marketing and administrative personnel.

When we last spoke to you in mid-March, we were just beginning to make COVID-related expense reductions. And during Q1, those reductions amounted to approximately $1 million, mainly coming from travel, commercial events and consulting costs.

Our R&D expenses increased $600,000, or 17.2% to $4.2 million in the first quarter. This compares to $3.6 million in the same quarter a year ago. We intend to continue to invest in research and development to strengthen our product portfolio and drive future growth.

Net loss from operations for the first quarter was $7.7 million as compared to net loss from operations of $8.4 million in the year ago period. For the first quarter of this year, our total net loss was $17.8 million, which includes several non-cash items related to the change in fair value of our debt derivatives and unrealized foreign exchange losses as a result of the current economic environment. These non-cash items totaled $7.7 million.

From a balance sheet standpoint, our cash position remains strong. With the net proceeds from our January follow-on public offering, our cash balance at March 31 was $93.6 million, compared to $37.7 million at December 31.

During the quarter, we used $6.8 million to fund operations, compared to $4 million for the fourth quarter of 2018 and $8 million for the first quarter of 2019. The quarter-over-quarter increase was due to inventory purchases in line with our original production forecast and employee incentive program payouts. We communicated in March that we are focused on reducing our cash burn in 2020, and we remain on track for improvements from 2018 levels. However, we expect to see fluctuations quarter-to-quarter depending on the impact of the COVID-19 on our sales levels. Overall, and especially with the global response to COVID-19, we remain very focused on controlling operating expenses as we manage our way to breakeven and cash flow positive.

Before I conclude, I would like to provide some additional details on the actions we have taken to reduce 2020 spending in light of COVID-19. We acted early and decisively with a comprehensive review of our 2020 budget, and these actions will result in a reduction of planned expenses by approximately 20%. The majority will be realized in the second and third quarters of this year. And as we monitor the COVID-19 impact, we remain flexible to make further adjustments if necessary. Some of the steps taken include an approximate 15% reduction in employee headcount and a temporary adjustment of approximately 25% of base salary across the Company for all employees and 50% for the CEO. Through these changes, we have retained the vast majority of our sales force and customer-facing employees, who remain in close contact with plastic surgeons by offering web-based training programs and online tools to stay connected with their patients.

In April, we took our manufacturing sites off-line and successfully completed our routine annual maintenance programs that are typically conducted midyear. This provides greater manufacturing flexibility for us as we move forward and enabled us to provide the opportunity for many of our employees to self-quarantine. We are now back online but are being careful to match product supply with projected demand. We have the ability to adjust production further in either direction in order to quickly respond to changes in the market. We estimate that we presently have more than six months of product inventory on hand. Overall, we continue to monitor the COVID situation very closely, and we have a number of additional strategies to employ if the pandemic continues to disrupt our business for an extended period of time.

As you heard from Juan Jose, the fundamentals of our business are strong. And together with an engaged workforce that is committed to helping our Company succeed, we believe we are very well positioned to weather this storm and emerge stronger than many of our competitors.

I will now turn the call back over to Juan Jose for some concluding remarks.

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Thanks, Renee. Before we open it up for questions, I'd like to say once more how proud I am of the employees of Establishment Labs and their commitment to women's health by transforming this industry through science and innovation. Although the world is facing some uncertain times right now, our Company has successfully weathered challenges in the past. And I am convinced that Establishment Labs will come out of this as a leaner and stronger Company that is well positioned for continued growth and success. We have a tremendous opportunity to drive near-term growth in the more than 80 countries we presently serve. And the major untapped markets of the United States and China represent a significant growth potential in the years to come.

With that, I will turn the call over to the operator for the Q&A.

Questions and Answers:


Thank you, sir. [Operator Instructions] And our first question comes from Josh Jennings with Cowen. Your line is open.

Joshua Jennings -- Cowen and Company -- Analyst

Hi. Good afternoon. Thank you. Juan Jose and Renee, and it's great to hear David's voice on an earnings call again. I was hoping to just start off about 1Q results, the solid numbers -- clearly, strong numbers in the setting of this COVID storm in the back piece of the quarter. I was wondering if you could help us get a sense of the momentum in the business pre-COVID. I mean, could the quarter have looked like a 30% growth quarter or 40% growth quarter if the COVID storm hadn't hit in March?

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Yeah. Thank you, Josh, for that. Yeah. We come off of significant momentum in Q4 of 2019, and we started the year very strongly. And like -- just like the rest of the world, we got hit with this pandemic most strongly in March. So, yeah, definitely, we think that the quarter could have been bigger and stronger without the effects of the pandemic, especially in the month of March.

Joshua Jennings -- Cowen and Company -- Analyst

Got you. And just thinking about the recovery period, I know you said in your prepared remarks, and you've talked with us historically about the potential for maybe a speedy recovery within aesthetics, but particularly in -- with breast implant procedure volumes, as most of these aesthetic cases are done in private clinics by plastic surgeons, and I totally understand that. But as you discussed with your surgeon customers their plans in the recovery period, I mean, how are they thinking about ramping back up and increasing their daily volumes? Are they talking about accelerating back through their historic daily breast implant surgery numbers for a period of time to clear out their backlog? Are they expecting to get back to their historic run rate? Any help you can give us just in terms of your discussions there? And I just have one last question.

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Yeah. That is a complex subject because we sell our products in more than 80 countries. And what we are seeing is that, a number of these countries are putting plans in place to come back slowly. But those things are going to happen at different dates and definitely at different rates of speed. We are seeing an improvement from April though. And I've been talking to plastic surgeons in Europe, Latin America and Asia over the last few weeks, and I think they are seeing some promising signs of them going back to work. In some countries, we are seeing surgeons already beginning reoperations and follow-ups with certain patients that need a quicker access to surgery, and some are expecting to have like primary augmentations and things like that coming on board later. But as I said before, it's a very complex subject because of the speed at which this is going to happen, it's going to vary like literally, not only country-to-country, but almost region-to-region.

I will tell you, though, that, for instance, I spoke to a surgeon in Madrid, which is one of the cities that has been hit the hardest worldwide with this pandemic. And he performed his first primary breast augmentation this week, and they have been putting in place very sophisticated protocols to ensure the safety of their patients. So, we're going to be watching this very closely, and we're going to be communicating with you as we get more information that is meaningful as it aggregates.

Joshua Jennings -- Cowen and Company -- Analyst

Excellent. Thanks for that color. And then just lastly, just on the FDA trial. The aesthetics cohort is fully enrolled, and we're coming up, I believe, in August on one-year follow-up data. Any update or further discussion with the FDA about whether that data will potentially be able to be released publicly? Or is that -- is it still too early to disclose that? Thanks a lot.

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Yeah. Thank you, Josh. Well, one of the good things is that, we have been able to work with the FDA's COVID-19 guidance. And we have resumed patient follow-up compliance and on-site monitoring visits virtually, and that's a really good news for us as we are following our patients of that aesthetic cohorts.

Now, when it comes to the PMA submission and also other things regarding the one-year data sets being released, I will remind everyone that our trial endpoint for data readout is at 24 months, and that is in the second half of next year. So, we have still not been able to get to the point with the FDA where we can actually respond to that, but we will get there.

Joshua Jennings -- Cowen and Company -- Analyst

Thanks again.


Thank you. And our next question comes from Raj Denhoy with Jefferies. Your line is open.

Rajbir Denhoy -- Jefferies LLC -- Analyst

Hi, good evening. I hope everyone's safe and healthy. Just wanted to follow-up on something you mentioned, Juan Jose. I think you said 76% of cases in Brazil in April were postponed. One, I want to confirm if that was correct? And I'm curious how that compares to what you saw in some of your other markets. Also Latin America, Europe, Asia, do you see similar levels of procedure deferrals in April?

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Yeah. I think, as I said before, April was shut down pretty much all over the world. And one of the interesting things about this industry is that, patients take a good amount of time to do their research. And once they've made the decision to go ahead with surgery, they're very committed to it. So, one of the promising things that we see is, like those numbers from Brazil, where 76% of patients are just saying, well, I'm going to have it later when things like social distancing and the ability to have elective surgery is, again, a possibility. Now, we are seeing some of those same signs in other countries in Europe, so we do think that it's going to help the recovery to have these groups of patients that did not have their surgery in the previous months have it as these markets start coming back online. So definitely, it is one of those promising signs.

Rajbir Denhoy -- Jefferies LLC -- Analyst

Understood. Another follow-up on Brazil as well. I think you also noted -- maybe it was actually Renee, about how, as a percentage of your revenue, it actually fell from 17% down to 10%, right, which implies about $1 million of lower revenue in Brazil this quarter versus a year ago. Appreciate that things were different there with the recalls and the like, but I'm curious what that says about your ability to hold that share. When clinicians moved away from the withdrawn implants to your implants, have they switched back now? Or what happened with that lost revenue?

Renee Gaeta -- Chief Financial Officer

Yeah. Thanks, Raj. It definitely was sort of two factors in Q1 of 2019. We definitely benefited from sort of an uptick in competitor -- the competitor being temporarily off. And some of those have gone back or have now a mix in their practice, but we were also detrimented by some of the fluctuation in the Brazilian real for the quarter. So, our commercial team is definitely focused on maintaining new customer acquisition and very focused to it. I think it's just one of those market dynamics that is hitting us this time, but we remain resilient, and that those doctors and patients understand the benefits of our implants, and especially when right now patients would definitely be looking for these safe alternatives. We're shining that message, and it's resonating.

Rajbir Denhoy -- Jefferies LLC -- Analyst

Understood. And maybe just one more for you, Renee, as well. I think you also noted in your commentary the plan to reduce operating expenses by 20%. I'm curious how we should think about that. So, if operating expenses in the quarter were about $23 million, should we assume about a 20% reduction off of that in the second quarter, and then kind of continuing until revenue picks up again? Or how to think about that cost reduction initiative?

Renee Gaeta -- Chief Financial Officer

Yeah. So when we took a look at it, we took a detailed look at our full 2020 budget for the year and, of course, focused the efforts for cost-cutting to Q2 and Q3, given what we expect initially for the impact and knew we were going to have in April and potentially in May. And so, it is a 20% for the full-year, but it is, I would say, loaded into Q2 and Q3. But we've also really taken a hard look at our business excellence programs and manufacturing volume adjustments just to make sure that we really are sort of leaner and stronger going forward and find efficiencies throughout. So, it's been a really collaborative process with our organization, and I'm really proud to say that we're making the correct adjustments now, but also to be able to be -- maintain our ability to quickly adjust if things do come back online quicker than we expect.

Rajbir Denhoy -- Jefferies LLC -- Analyst

Great. Just to put a finer point on it. So it's -- we should think about, if you spent $85.8 million and roughly $86 million in operating expenses last year, we should assume a 20% reduction for the full-year of 2020, so almost $17-ish million, $18-ish million of savings this year versus last? And again, I appreciate the load in the middle part of the year.

Renee Gaeta -- Chief Financial Officer

Yeah, that is correct. It's around that range. And we picked up a little bit that we mentioned about $1 million in Q1, but certainly the rest of it is going to primarily be in Q2 and Q3 and a slight tail of it still in Q4. And then as we mentioned, if we need to make further adjustments, we're in a position where we could do that. But for right now, that's how we're playing it out.

Rajbir Denhoy -- Jefferies LLC -- Analyst

Understood. And maybe I could just squeeze one more in for Juan Jose. On the MIA implants, the minimally invasive series you did in Japan, you noted you got -- you had very good outcomes or very positive results, and you're looking to expand it. Anything more you can provide in terms of how many implants were actually done and what the plan is to do additional implants in Japan?

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Yeah. Thank you. And, of course, we are super excited with MIA, especially because the results of the proof-of-concept cases that we did have been phenomenal, and we've had very good surgeon and patient feedback. But I have to tell you, at this point, we cannot give you the number of surgeries. Remember, these are case series, and they're done by the surgeons in Japan themselves at their own responsibility. Now, we are looking to expand our initial patient series in additional countries, especially in Asia, and we are very strong believers in the potential market development opportunity with MIA.

Rajbir Denhoy -- Jefferies LLC -- Analyst

Okay. Thank you.


Thank you. And our next question comes from Marie Thibault with BTIG. Your line is open.

Marie Thibault -- BTIG, LLC -- Analyst

Hi. Thank you for taking the questions and great quarter. I did want to dig into a little bit more. You've kind of framed up the customer pretty well that they take several months or maybe years to do their research and are very determined to get the breast augmentations. But I'm curious about what your customers are hearing, the clinics themselves are hearing from patients in terms of hesitancy and, I guess, going back out for elective procedures. And also any concerns around discretionary purchasing? Is this patient group a little bit more immune to some of the concerns that we know are hitting kind of around the world like unemployment?

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Yeah. Thank you, Marie. And I think that's one of the most interesting things about this industry. And as I said before, and you noted, women in breast aesthetics do take quite some time to do the research and make that final decision. Usually, by the time they've made that decision, they've looked at their different opportunities for their discretionary spending, and they've realized that this is something that they've put at the top of their list.

With everything going around with the pandemic, we've been asking surgeons, how do they see things moving forward? And I think they see it very similarly to what they have seen in previous economic crises. Remember that we sell in over 80 countries. Some of these countries have had very severe financial problems over the last decade and more. I'll give you the case of Greece. Probably compared to what they've went through a few years ago, this pandemic is not hitting them as hard economically. So, it really varies country-to-country. But what I can tell you is that, the patient in aesthetics and what past recessions have shown us is that, these patients are very resilient and will put at the top of their list when making their choices some of these procedures. So, we remain confident in the strength of this market.

Marie Thibault -- BTIG, LLC -- Analyst

Okay. That's really helpful, and great to hear. One thing you've said in the commentary kind of sparked my interest. I hadn't heard it before. You are helping surgeons restart their -- who are restarting their practices, you're actually linking them with patients that are interested. Can you tell us a little bit more about that program? It sounds like a pretty efficient maybe digital feeder program. So I'd love to hear more on that.

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Yeah, of course. And I have to start by saying that Motiva has a commanding presence in social media. And we've done this over the years. We've built a compelling story around improved safety and aesthetic outcomes. And that really resonates well with patients who are doing research and talking to influencers and other groups of women, who have gone through these procedures. So definitely, that is something that we are building on with additional efforts that come through our digital platform. So just to give you an example, in April, we conducted several Motiva health and beauty sessions on Instagram that reached more than 280,000 women in different markets. We've been having around 20,000 unique users per week on Instagram. And that's the strength of our efforts that we plan to continue growing. But I have to say that, we think that in the past, in many countries, we have taken market share from others, not only because surgeons believe in our technology, but also because they see the excitement from women that come to their practices and ask them about our brand. So, of course, we are basing our efforts on our technology and the differentiation, but we have chosen to invest even more on them now.

Marie Thibault -- BTIG, LLC -- Analyst

Great to hear. And good luck out there.

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Thank you.


Thank you. I'm showing no further questions at this time. I would like to turn the call back over to the Company for closing remarks.

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

Thank you for joining us on today's call. We look forward to providing our next quarterly update in August. Have a good rest of the day, and please stay healthy. Thank you.


[Operator Closing Remarks]

Duration: 40 minutes

Call participants:

Juan Jose Chacon Quiros -- Founder and Chief Executive Officer

David K. Erickson -- Vice President of Investor Relations

Renee Gaeta -- Chief Financial Officer

Joshua Jennings -- Cowen and Company -- Analyst

Rajbir Denhoy -- Jefferies LLC -- Analyst

Marie Thibault -- BTIG, LLC -- Analyst

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This article is a transcript of this conference call produced for The Motley Fool. While we strive for our Foolish Best, there may be errors, omissions, or inaccuracies in this transcript. As with all our articles, The Motley Fool does not assume any responsibility for your use of this content, and we strongly encourage you to do your own research, including listening to the call yourself and reading the company's SEC filings. Please see our Terms and Conditions for additional details, including our Obligatory Capitalized Disclaimers of Liability.

Motley Fool Transcribers has no position in any of the stocks mentioned. The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy.

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