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 and a one-time voluntary field action [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 2025, with an installed base of 718 systems, representing 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 coordination around customer success and procedure growth [7] - A dedicated launch team has been formed to drive consistent launches and improve downstream utilization [7] Management's Comments on Operating Environment and Future Outlook - Management acknowledged that Q4 financial performance was lower than anticipated but emphasized that changes made are critical for sustainable high growth and a clear path to profitability [21] - The company is resetting 2026 guidance to $390 million-$410 million, representing annual growth of 27%-33% [10] - Management expressed confidence in the long-term growth and profitability trajectory despite short-term disruptions [18] Other Important Information - Cash, cash equivalents, and restricted cash totaled $285 million as of December 31, 2025, providing a strong balance sheet to support strategic priorities [16] - The company plans to provide a detailed multi-year look at financial guidance during the upcoming Investor Day [11] Q&A Session Summary Question: What unfolded in Q4 regarding handpiece sales? - Management indicated that the softness in handpiece sales was influenced by customer purchasing behavior and the elimination of bulk purchase discounts, leading to a more aligned sales model with procedure volumes [24][25] Question: Why is there confidence in the back half of 2026? - Management explained that as the sales force matures into the new alignment, they expect to see benefits in procedure growth, particularly in the second half of the year [29] Question: What is the confidence in achieving a 1-to-1 ratio of handpiece sales to procedures in 2026? - Management stated that historical data showed handpiece sales were typically higher than procedure volumes, but they are now modeling a 1-to-1 ratio based on recent changes in business practices [34][35] Question: What was the impact of the field action on gross margin? - Management clarified that the field action was a one-time, non-recurring event that had no patient safety issues and was contained to Q4, impacting gross margin by approximately 240 basis points [37][38] Question: Is there any customer dissatisfaction due to the end-of-quarter bulk purchase deals being discontinued? - Management reported no anticipated customer dissatisfaction and noted that ordering patterns have remained stable despite the changes [42] Question: What is the stability of the sales force after the commercial restructuring? - Management confirmed that the sales team has remained stable with no higher attrition, and the restructuring is expected to enhance customer relationships over time [44][48]