Financial Data and Key Metrics Changes - Total revenue for Q4 2025 was $76.4 million, representing a 12% year-over-year growth [12] - U.S. revenue for the quarter was $66.6 million, reflecting a 10% growth compared to the prior year [12] - Gross margin for Q4 2025 was 60.6%, down from 64% in Q4 2024, primarily due to lower-than-expected U.S. consumable revenue [15] - Net loss for Q4 2025 was $29.8 million, compared to a net loss of $18.9 million in Q4 2024 [16] - Adjusted EBITDA was a loss of $19 million in Q4 2025, compared to a loss of $10.3 million in the prior year [16] Business Line Data and Key Metrics Changes - Completed approximately 12,200 U.S. procedures in Q4 2025, representing approximately 69% year-over-year growth [12] - Handpieces sold totaled 9,400 units at an average selling price of approximately $3,340, reflecting a 5% price increase compared to Q3 2025 [12][10] - Total U.S. handpiece and other consumable revenue was $34 million in Q4 2025, representing 16% growth compared to Q4 2024 [12] - Sold 65 new HYDROS systems in Q4, with an installed base of 718 systems, a 42% increase compared to year-end 2024 [14] Market Data and Key Metrics Changes - International revenue in Q4 2025 was $9.8 million, representing year-over-year growth of 25% [14] - The company expects 2026 total U.S. procedures to be in the range of 60,000-64,000, representing growth of approximately 39%-48% [17] Company Strategy and Development Direction - The company is shifting operational focus towards increasing procedure volume, expanding margins, and achieving profitability [6] - A new integrated regional structure for the commercial team has been established to ensure better alignment and accountability [7] - A dedicated launch team has been formed to improve the consistency and effectiveness of new system placements [7] Management's Comments on Operating Environment and Future Outlook - Management acknowledged that the financial performance in Q4 was lower than anticipated but emphasized that the changes made are critical for sustainable high growth and profitability [21] - The company is confident in its long-term growth trajectory despite short-term disruptions from the sales organization realignment [18] - Management expects to provide more detailed multi-year financial guidance at the upcoming Investor Day [11] Other Important Information - The company has eliminated the practice of providing discounts on bulk purchases, which is expected to improve pricing discipline and align handpiece sales with procedure volumes [9] - The average selling price for handpieces is expected to increase to $3,500 in 2026, reflecting a 9% improvement over 2025 [18] Q&A Session Summary Question: What unfolded in Q4 regarding handpiece sales? - Management indicated that customer purchasing behavior was influenced by previous bulk purchase discounts, leading to unexpected softness in handpiece sales [24] Question: Why is there confidence in the back half of 2026? - Management believes that the new sales organization structure will pay dividends as relationships with customers are rebuilt [28] Question: What gives confidence in a one-to-one ratio of handpiece sales to procedures in 2026? - Management noted that historical data showed handpiece sales were typically higher than procedure volumes, but recent changes have aligned these metrics more closely [34] Question: What was the impact of the field action on gross margin? - A one-time field action contributed approximately $1.5 million in costs, impacting gross margin by 240 basis points [38] Question: Is there any customer dissatisfaction due to the end of bulk purchase discounts? - Management has not observed any customer dissatisfaction and believes that the focus on procedure growth will mitigate any potential issues [42] Question: What is the stability of the sales force post-reorganization? - Management reported that the sales team remains stable with no significant attrition, although some adjustments are necessary as new relationships are established [44]