InMode Ltd. (INMD) Earnings Call Transcript & Summary

Okay. Good morning, and thanks for joining us for our next session here in the medtech track of the UBS Global Virtual Health Care Conference. And hopefully, it's the last time we have to use one of those prefaces. And I'm joined by management from InMode. It's an exciting growth company in the aesthetics space. We have a number of members of the management team joining us here today including Moshe Mizrahy, the Chairman, CEO and Founder; also Dr. Michael Kreindel, who's the CTO and Co-Founder; Yair Malca, the CFO; Shakil Lakhani, the President of North America, the largest commercial organization for the company; and Dr. Spero Theodorou, the Chief Medical Officer. So we should be able to answer all of your questions. A great breadth of roles here and [indiscernible] control. So first of all, I just want to thank all of you guys for joining us. It's always a pleasure to speak with you, and welcome to the presentation.

Thank you, Matt.

Okay. You're not normally this shy, Moshe.

Okay. So here we go. So let's start off with a few questions. It's a fireside chat format. If you have ones that you'd like me to ask, just send them in through the presentation or the e-mail, and we'll get to them as well. But let me just kick things off. And Moshe, I'll ask you just about the last few quarters here. InMode's growth has really accelerated. Maybe just parse out some of the attribution of the different growth drivers in your performance, including some of the demand that we're seeing from recovery and people focusing on their health and aesthetics. And then also, we've got a lot of great new innovative products.

Yes. Thank you, Matt. Thank you. Well, let's start with 2020. 2020 was a very challenging year for us. I mean we started the year, and we gave a guidance of $196 million. And then all of a sudden, in the middle of March, the crisis started, and we were idle March, April and May, and the market came back in June, and we had a good third quarter and the fourth quarter. And finally, we closed the year with $206 million, $10 million more than the original guidance that we gave. And that even if we are -- we lost almost 2.5 months, I would say, offsetting. Now people ask why? Because not all the aesthetic companies did the same. I mean if you judge Cutera, Venus and others, they lost business in 2020. I would say that we had some luck in 2020 because the 2 major technologies that we brought to the market, the minimal invasive and the Hands-Free was very attractive in the corona crisis. The Hands-Free devices, which we launched just before the corona started in the beginning of 2020, maintain social distancing, that's exactly what the patients want and that's exactly what the doctor wants. So it works well for us. And the second major technology, the minimal invasive, everybody knows that people don't want to go to the hospital today. And of course, even before the corona, they didn't want to go to the hospital, but it's during the corona, the hospital associates with the disease, and they prefer to do minimally invasive and ablative procedure in the doctor office. And that also works good for us. And the third and the fourth quarter was very strong compared to any other year. Typically the slow -- the third quarter because December is slower, and the fourth quarter is the strongest one. Now as far as driver, engine -- growth engine, I believe we have basically 4 growth engines. One, in existing markets where we have clearances of regulatory body, we're growing because we are expanding the customer base. That's one. The second growth engine is the new product. We're introducing 2 platforms every year. I mean in 2020, it was the Hands-Free and the Morpheus. And this year, it will be the Empower and hopefully, the Envision as well. So these 2 platforms also contribute to the growth. Third is getting more regulatory approval. I will explain. For example, in China today, Matt, we have only 2.5 platforms approved, and ANVISA Brazil, only 2 platforms out of the 9. So at any given time, we have close to 15 to 17 different regulatory projects anywhere in the world that we need to file and submit in order to widen the portfolio in any given country. And that's what we are doing. And that's -- once we get additional regulatory approval for another platform, that'll expand our business. And the fourth driver is the disposable, okay? In the last 4 quarters, in between the second quarter of 2020 to the first quarter of 2021, we tripled the numbers of disposables that we sold, from 25,000 disposables to 75,000 disposables. That's a good sign for us because that means that the doctor is using the system constantly, and second, that means that the doctors is doing more and more treatment with the platforms that we bought. So although right now, the disposable are about 12% of our business, but eventually, once we get into the 20,000 system installed base, it might go to [ 20-80 ] as well. So these are the 4 growth drivers that we'll maintain all the time. And we used to grow $50 million a year. This year, the guidance is $280 million. So it's almost 40%, $80 million a year. And I believe that in the next year, '22 and '23, we will repeat the same growth rate. Did I answer your question?

Yes. And a lot of good stuff in there that I'd love to dig in more on and follow-up on. One thing I wanted to start with was just thinking about the backdrop and the sustainability of the current demand because we have seen people gravitating to aesthetics more as a category, especially some of these minimally invasive solutions where you really specialize. So maybe talk about how long some of this COVID boom might last? And what the new normal is in terms of demand that you could see going forward?

I think, Matt -- I think I should take this question. Moshe, you want me to take it?

Yes, yes. Of course.

Yes. Okay. So Matt, obviously, the COVID boom, it's very common. Everyone talks about it's doom faced, all that sort of thing. But I think what we saw during that time was general change in the psyche of patients. So in other words, patients that already had plastic surgery, and this is coming from the American Society of Plastic Surgery statistics. The ones that have already had a history of plastic surgery, 27% of them who were on the fence of that group or had a little bit or tried it will continue and increase what they normally would have. So that's existing patient population that probably during the boom, basically was more keen to have more things done. But what's really interesting is -- and we've been saying this right off the bat is the fact that new patients are coming in and the market has expanded. And that's about -- the estimation is about 13% to 14% increase of patients that never [ had ] plastic surgery before. And I think it is during this pandemic, a lot of people are sitting there and thinking about their lives and things and all these things that actually, "You know what, I'm going to buy that car." Car sales are up. "you know what, I'm finally renovate my house because I'm living here," that goes up. And finally, "I want to change a new chapter in my life and maybe through this, and I no longer feel guilty about having that plastic surgery operation that I've always wanted." So those 3 headwinds, what -- not headwinds, those tailwinds are actually going to continue in my respect the whole different change in the way things are done. The fact that Zoom [ at this point did ] virtual consultations for plastic surgeons has become the norm makes it so much easier. There's so much to click, roll over out of the bed, click the button, and next thing you know it, they're getting an opinion on what's been bothering them forever. So the whole process of making a [ point ], walking in, into the door, all these things. And I'll be happy to say we tried this 10 years ago, and I'm a practicing plastic surgeon, as you know, Matt. We tried in New York 10 years ago, and we used Skype at that time. We thought this would be perfect for international patients. What happened is because it's New York City, everyone next door was in the office and was using it because they're just too lazy to walk over. So we've made it so easy, we anticipate this tailwinds to last until that extra population of patients are absorbed. That'll give us another easily 24 months, 12 to 24 months in my opinion. I hope that answers your question.

Got you. Yes, that's great. And I have 2 follow-ups on that. So I wanted to ask you, a, can you articulate more how remote has helped your practice? We've heard from some doctors that is actually increasing values because of that convenience or reducing cancellations. So that's the first one. Why don't we start there?

Well, that's a really good question, Matt. Any new format, right, it takes time. What happened is this acceleration during COVID is what really helped. You look at other specialties and other systems, you look companies like Teladoc, so it's becoming the norm and generalized. So cosmetic, usually, it's a little further ahead because it's cash based, things have changed. No question about it. Now are all the patients verified as well as the leads are verified as we'd like it to be compared to the past? Not as much, right? It takes -- if you're going to show up at a plastic surgeon's office, chances are, you're committed to do something. So that kind of patient is a lot more focused, obviously, and a lot more sort of committed. However, if you look at patients that are trying and doing this way now with Zoom, it's not that they're less committed. They're younger in age. So not only has a demographic. With 35 to 55 is sort of [ demographic ] that are really good at, but we're seeing age drop a lot and that's because technically for them, that's the norm. For them to get on a Zoom call, look for plastic surgery or whatever it is, they'll commit as opposed to someone who's older, who still wants to come in and [ see ]. Now remember, these are not just "educational tools." It's no substitute for an in-person consultation, but it removes so much barriers, psychological and fear barrier and now you're in your house to actually connect with them.

Got it. Got it. Yes. The other one I had is...

[indiscernible].

Yes. The other follow-up I had was, I think people might not appreciate, once somebody gets something done, they're more likely to be a repeat customer. Could you talk about any data you have on that? And you have all these different solutions. So how does the fact that people are now kind of coming into the fold bode well for them getting that repeat procedure or mobile procedures?

Right. Very good question. And the minimally invasive line and body type, the numbers fall back just the same way they fell back in the old days when Shak and I were [indiscernible]. We did a study on that. We published about 1,000 patients that we did, and we saw the trend. And because it's under local, in the office, with technology, your average patient gets 3 [ different ] areas done a year. That means almost an average of 2 to 3 visits a year. So this format of minimally invasive approach, it's almost like the Botox of surgery, right? You get Botox 3 times a year, every 3 months or every 6 months, depending on how dilute your plastic surgeon does it. But the bottom line is, they come and they'll view it as a treatment versus a big operation where they get knocked off [ doing ]. So that really helps. Now in the noninvasive components, Matt, that's been designed to do fairway, right? We have 3 to 6 [ patients ] coming in, and we say, hey, listen, 1 year maintenance. But we educate patients that no matter what you do, this is not forever. You have natural aging occurring. So a year later, there's no contraindication out to have it 2 years later for the noninvasive depending on where they're at, but they're going to have a natural aging process. We educate them ahead of time on the type of results. And the noninvasive, obviously, not as aggressive as a minimally invasive. But overall, the packaging of minimally invasive procedures in format, which is local, fast, quick, short downtime, in the office benefits us to the increase in numbers because less of a commitment, time and effort for the patient to have it done. I'm not saying it's like laser hair removal, but it's certainly -- that's the way we've packaged it and it's working.

Got it. Thanks, Spero. That's really helpful. Let's turn back to Moshe. I wanted to ask him about the growth going forward. Moshe, in the past, you have talked about growing $50 million a year. Now you're guiding to $80 million, which seems like a more sustainable number for the company based on your statement. Can you talk about how you've grown your scale? How the things like OUS expansion and the new products are enabling that and giving you confidence in being able to do those kind of numbers in the future?

Well, if you want to measure it percentage-wise, when I said that we will grow $50 million a year, from $50 million to $100 million, it was 100% and then from $100 million to $150 million, it was 50% and from $150 million to $206 million, we grew about $60 million a year. And this year, close to $80 million. I would say that we should maintain about 30% or a little bit above that percentage year-over-year. Now the growth, as I said before, will come from those 4 growth engines. We're investing heavily right now on the outside U.S. market. OUS market is getting more and more attention. We hire more direct sales people in those subsidiaries that we established in Europe, France, Spain, U.K., also in India and Australia, where we have direct operation. We now build a company in China. China is a different animal. You cannot go direct. You need to combine between direct and indirect, and we're doing it right now. In Beijing, we have a distributor. Now we are going to have a subsidiary in Guangzhou and it will -- we'll combine between them. So the fact that we're getting more and more approval in the countries outside the U.S. will expand the market in those territories faster than in the United States. I have to say that I will be very happy that if Europe, Asia and South America will overcome the crisis, they're not yet. But hopefully, in 2021, they will get the vaccine, and 2022 will be a normal year. So if we want to plan some focusing for the year [ ahead ], I would say that growing in between $70 million and $80 million in 2022 is achievable, taking into consideration all the stuff that we're doing and the fact that we're getting into the gynecology market and probably to the ophthalmology and later on in 2022, hopefully, to the ENT and others. We will be able to maintain that kind of growth while maintaining the profitability structure. I know that many people asking how come we're doing 85% gross margin. But I said that before, it's a must for us. Every product that we develop and engineer must have 85% gross margin. So that will enable us to spend more money on marketing and sales and maintain 40%, 42% net profit -- net profit as well.

Very good. Thanks, Moshe. A lot to unpack there. I think before I go to some of those topics again, I wanted to ask you about consumables. And I think before you mentioned, consumables have been increasing. I think you've got a couple of quarters now of record consumable sales. And that's a good sign for utilization and demand. And then also, over time, you mentioned that consumables could rise as a percentage of the mix. So maybe could you touch on the recent consumable trends and the strength you're seeing there? And then as consumables rise with mix, what implications does that have in terms of the ability for you to project your business and on the margins?

Yes. I mean, Shakil, do you want to answer as we go to North America, and I will add after you?

Yes, sure, absolutely. Yes, Matt. So we've seen -- as Moshe said, we've seen a lot of growth with -- specifically with the consumable side of the business. We have a very good post-sales support team that we put together I mentioned on the last earnings call that they're finally speeding up. We're starting to see [indiscernible]. In North America, at least, we're seeing a lot of usage, which is good, as Moshe mentioned. We have a lot of physicians that are not only using the technology that help practices increase their revenue, but also actually continuing [indiscernible] on our end. Moshe, do you want to go on the international?

Yes. Matt, we are now introducing the Morpheus8 full body platforms in the outside U.S., in the ROW market. Consumable of the Morpheus is the biggest part of the consumables that we are selling. We waited until now because we didn't want to launch these platforms in Europe or in Asia during the COVID crisis. We want to spend the marketing money, but we're doing it right now with a lot of training in Europe. South America, Brazil just started to buy this platform and the Morpheus8 since they received the regulation, the clearance. Also in China, we got the regulation, and we're starting. So basically, as far as consumables, I see the ROW growing percentage-wise, even faster than the United States. Every other platforms that we develop, for example, the Empower or the Envision, we have 2 or 3 different consumables in each of those platforms, which is also good for the consumable business. For example, the Empower, and I'm sure that Spero will talk about it, has 4 different disposables; the Envision, 3 different disposals. Disposable has become a major part of our business and will continue to grow.

Understood. And on the margins, is it a big difference between the consumable margins and the capital margins? And could you articulate how the mix will change that in the future?

Well, Yair, you want to answer that?

Sure. So yes, the margin currently is lower on the consumables. As Moshe mentioned, our overall plan of gross margin is 85%. On the consumable -- services consumable, it's a little bit lower, it's around 70%, but we are working on an initiative to improve it over time.

I mean, Matt, let me add you something here. Although the consumable margin is lower, but don't forget, we don't have marketing expenses on the consumables. And we have very little sell expenses on the consumables. Regarding margin, when we sell direct, we have the highest margin as platform. When we sell through distributors, distributors will only recognize the transfer price. So it's lower. And consumable, it's also lower. The combination, the average of everything altogether, it's around 85%.

Got it. Understood. Okay. Great. So we touched on this a couple of times, and I think it'd be a nice time to transition and talk about Empower. The new launch for the company moving into women's health in gynecology. Maybe just frame for people all the different components of the Empower system. Talk about what you're excited about and remind us when to expect the launch and how that's going?

Spero, can you take it?

Sure. So again, just for the new investors who have not known the history of us, Matt, as you know, although over 2 years ago, the FDA [ spun down ] the whole women's health industry and a lot of the companies left. And at that point, what we did instead was with [ Moshe's support ] we doubled down on our study. And we thought this is a segment that's not going to go away. It's huge potential for it. So about 2.5 years of studies and all the things that we're working on for research, we're going to come to fruition right now. I can tell you, and I'll let Shak comment a little bit on the different type of the hand pieces and everything. But I can tell you right now that -- with confidence that 15% of women have an issue with stress urinary incontinence, that's pure stress urinary incontinence, which is mechanical in nature, typically. So in that instance, subgroup of patients, we're seeing some long-term results. And basically, we've achieved a lot more, and we're far way ahead than anyone else [ out in the market ]. And I'm saying that with a lot of confidence based on what we're -- preliminary studies are showing. Having said that, we're getting some very good results also for all the [ symptoms ] of overactive bladder. And I'm not saying we have a solution for it, but overactive bladder, Matt, as you know, is a $5 billion industry with no real solution. And it's plagued by -- there's Botox, there are -- slings are gone, the gynecologists used in the past are [indiscernible] because of litigation. So it's a whole sector begging for a solution. There's implants, of course, and we are looking at that very carefully, and that's our ultimate goal. So if we can disrupt $5 billion existing industry with Medicaid things and all the things that are out there already, with what we're working on, that would be great. And in the meanwhile, on the basic stress urinary incontinence and some good results as well as genitourinary syndrome of menopause, on those elements, we're seeing some wonderful results and extremely happy patients. We're slowly positioning these machines in our best doctors across the country, strong KOL network. It takes time with gynecology, and Shak will talk you about because he has experience with MonaLisa [indiscernible]. But we have a lot of confidence going forward, and I'm pretty -- I'm quite confident that we're going to hit this one out of the park. Shak?

Yes. No. So Matt, that [indiscernible] in setting up a distribution network for the GYN world, we've done it before. We know how to successfully implement. A lot of these procedures do lead to other OB/GYN's or women's health and wellness specialty [ existence ], actually adding other procedures into their office. We go in with something that's relevant to their scope of practice, and then slowly, we add [indiscernible]. We've -- like Spero said, we've done it before. We're pretty confident [indiscernible] we roll it out and what we do in terms of growing it to start and [indiscernible].

Got it. Okay. Let me touch on 2 topics. One is, Spero, you started off by talking about the history there. And so there may be some customers who are uncomfortable with this idea because of that. Can you talk about how you're able to get them more comfortable? What are you doing to invest behind the platform and message things like the safety and the results?

That's a very good point, Matt. And that hesitation [indiscernible] it was real. It did have across the industry and affected us as well. We start off with a doctor because that's our client. And the messaging needs to come through them regarding safety. So when we have studies that we published that show safety and efficacy, that's critical to giving the backbone to the physicians to talk to their patients. And the way we've set up marketing, the way we set up our messaging has always been sort of a Jimmy Buffett kind of presentation away, back in the days. That all these followers that we give to strategic, right? I say Jimmy Buffett because I think he was the first one who invented social media, right? So -- and then that groundbreaking swell of information and safety goes out there. And then as far as consumer is concerned, yes, we obviously do some consumer marketing. We do have some plans to do that as well. But there's a lot of constraints when it comes to women's health on the marketing aspect and the way the media is presented. So we have to be careful there as well as we're just limited. So we allow their results to speak themselves. That's what we're known for, Matt. And we're known for stuff that works. So if stuff works, it flies. And that flies through all our physician network and the patients demand it. And that doesn't [indiscernible] and say blue in the face that is safe, and I would never -- we try very hard to get it right the first time and we do a lot of testing. But at the end of the day, there's nothing better than all the patients getting on RealSelf and telling other patients what they went through. To start off, efficacy and safety is our primary thing. And especially safety on this one. We've been extremely working really hard with Mishka with all kinds of fail-safes in place and knock on the wood, so far, we haven't had a problem. So I'm quite confident. So the fact that we've launched BodyTite, which is a lot more invasive and a lot more intense, we have that backbone, how to keep stock, how to train them, the algorithm is in place where this is going to be okay, right? Are there going to be isolated incidents? Maybe. So far, we haven't seen it. But even if there are, we're on top of them immediately. So we have a system in place, Matt, to launch these sort of things all day long. So pretty proud of us for [ having that ].

Got it. Yes. Maybe just to hammer this point home, could you go back to -- for your women's health offering, how is it different than some of the laser or other energy offerings that were taken off the market? And then how did these additional features, additional handpieces and energies that you're bringing to women's health help you to drive better outcomes in more tissue contractions, things like that?

So I guess you -- I thought, Moshe, I thought you want to answer this. I'm happy to...

No, no, no. I think you will answer it.

Okay. So the question is basically what, Matt? Because that was -- I don't understand...

Yes. I wanted you to further delineate the difference between your products, which have stayed on market, how you're enhancing the offering versus some companies pulled their lasers or they pulled monopolar devices. So that was the big part.

Right, right. Okay. Got it, Matt. Perfect. So we got to go back to what happened, right? When the FDA started sending letters out to everyone. So we got a letter as well, but our letter was for marketing. That was it because our Votiva device is our noninvasive offering for women's health, we've done thousands and thousands of procedures, and knock on the wood, we never had an issue. So for us, it was always about that. We didn't have any issues because our stuff was not ablative at the time. Now considering that we're going to be competing -- or sorry, "competing," we're going back to the fundamentals of lasers versus radiofrequency. So lasers can only go so deep. In the gynecology world, they go down to 2 millimeters depth. That's it. We can go deeper, safer and modulate things a lot more [indiscernible]. These micro injuries that occur for laser and they cause increase in the sort of the vaginal wall and symptoms that improve, that's great. [indiscernible] getting results with those shallow sort of "injuries." Then us, our equipment to go deeper and do more, you can imagine the results are longer lasting, they're going to be stronger. So as far as the competition is concerned, that has to do with what the existing foundation is out there right now. Now if you look at the monopolar device, that's not even close. The monopolar devices have not been able to achieve, and you've probably seen the different studies that have been stopped midway and restarted and so forth. They've not been achieved -- be able to keep the [indiscernible] results. As a matter of fact, you probably know, they have groups that statistically, one group wasn't different than the other. So we're not going down that path. We know we can go deeper with RF, and that's what we're using. And the fact we can control the temperature and control exactly how we apply at the exact degrees, thanks to Mishka's ingenuity, makes it safer and more reliable, just like [ BodyTite ] bipolar RF as we've been talking about over time. So the principles, from BodyTite bipolar, all those principles that we've learned and we've examined and we've done, we've brought them over into the gynecology world, and we have a control bulk heating of tissue, and we're very confident that, boy, no one is even close to be able to achieve that because, as you know, our plans are [indiscernible] sustained basic core technology. So that's a big differentiator, Matt. That's your first question.

And, Matt, just to add one thing here. When we received the letter in the middle of 2018, like all other laser companies, we took the opportunity, and we answered a detailed answer to the FDA, and we explained to them the differences. I believe we were the only company that received an e-mail from the FDA 1 month after giving us the clearance to continue to sell up to date. Even in the fourth quarter, we continued to sell the Votiva. Now I know that you want to know all the modalities of the Empower, but since it's a little bit confidential at that point until we launch that sometime in the end of August, we would like to keep it confidential for all kind of competitive reasons. Is that okay?

If we told you, Matt, we would have to kill you.

We wouldn't want that.

That's Shak's line.

Well, thanks for all that content. That's really helpful. And then the second part is, why don't we just talk about the timing of the launch? And any thoughts on the contribution that, that could have this year and beyond?

Shak?

Yes. So Matt, we're looking at some time in Q3, again. As Spero mentioned earlier, we try not to rush things out, we try to make sure that they're going [indiscernible] phased and it appears that we're quite strong right now [indiscernible] get it out the build force, get it from the [indiscernible] we want to just [ triple-factor ] things. So in Q3 at some point. And we look at it start being somewhat of a contributor. Obviously, right now, the Hands-Free and the minimally invasive are really tracking along very nicely. But we're fortunate to be in a position where we don't need the additional product [indiscernible]. Obviously, we're going to try to get it. So we'll obviously try [indiscernible] but I see it being a significant contributor probably next year and the year following. For the remainder of this year, we'll probably get some [ traction ]. Again, any time we do a launch, we do it very strategically. And as you've seen with Evoke, Evolve, Morpheus8, we tend to start off a little slow and really ramp it up. So we'll look at doing the exact same thing to ensure that we have proper distribution. It's a different type of sale, Matt. So with the women's health and wellness position, they really know they're stuff within their scope of practice, not something outside of the world of care. But you really need to know how to talk. Talk the talk with them basically. Again, we've done this before. So we know which avenues in this [ market ] but when you're looking at OB/GYNs, gynecologists, urologists, they're going to really want to know -- they're going to want our data [indiscernible] to make sure that it's going to [indiscernible] it's going to work. Now the ROI is [indiscernible] with everything going on with managed care, obviously, anything they can add on to their [ online ] create things for physicians out there. We support that. But more importantly, this is kind of a light feature that a lot of women are going to [ back ]. We're really excited [ about this ].

Great. Great. Thanks, Shak. So you do have this kind of embarrassment of there's a lot of new products. And you mentioned Empower [indiscernible] Dr. Kreindel will slow down, I think, in terms of...

I don't think that's possible, Matt.

Yes. It's impossible, Matt. We can't keep up with him fairly.

Well, can you address -- I get a lot of questions on the legacy platforms and how much runway you still have with things like BodyTite, FaceTite, noninvasive. Could you talk a little bit about that as you're starting to layer on more stuff here?

Sure. So the way we've kind of worked it, Matt, is it's one thing -- and we've learned through experience from [indiscernible] been together for a long time. And so one of the things that we saw was how do you bifurcate [indiscernible] people look at the term bifurcate, they immediately think, okay, let's divide it up. What we've done is we've kind of bifurcated differently. So on this, this is one of the keys being able to actually close business and have very talented salespeople that can sell the right way with ethics and morals, but also aggressive in closing. And we've kind of -- we've actually bifurcated the lead generators, all the way up through closers. We have our best closers that can pretty much sell any different [ core product ] including, obviously, the legacy platform. So in doing that, we bifurcated the bottom up. We basically now have a bunch of different lead generators and [ closers ], whether it's Hands-Free, minimally invasive, the RF. We're going to continue to [indiscernible] for the time being, it's not broken, right? But I think right now, with the products, we still have a ton of runway. We've obviously benefited plastic surgery specialty more than anything else there or any other company that's [indiscernible] at least in the [indiscernible] but we also see that there's other noncore [ products ] that get into this. Therefore, we can [indiscernible] we want to make sure that we're doing it right.

Matt, just to add one thing on what Shak said. On the international market, the ROW, we're just starting with the BodyTite in China. We received the clearance last year toward the end of the year. And we received the clearance in Brazil, which is a huge market for plastic surgery also only last year. So some of the biggest markets for the BodyTite we are now in a very embryonic stage. So that's where we grow as fast -- that will grow fast as well.

Got it. Got it. Why don't we touch on international a bit more. It is a big growth driver. You've been investing a lot there and expanding going into some new markets. You called out in the beginning, you always have all these registrations going on. So to focus the question, what are the few key markets that you're really excited about or maybe some of the key approvals that you think could drive growth in these markets over the next couple of years?

Okay. Good question. I would say that -- I'll go territory by territory. In Asia, I believe the 3 major markets would be Australia, Korea and China. In Australia, we have subsidiaries, and we are growing steadily nicely. In Korea, we have a distributor, a great one. And we already installed something like 400 systems there in the last 2, 3 years. So they are growing nicely. In China, last year, we received the first, I would say, 2 to 3 clearances from the regulatory registration, and we started to sell in 2020, and we see growth quarter-over-quarter, and they do a great job. They launched the product. We have a distributor in Beijing. They draw all the East Coast of China and they train, and they get all kind of help from our office in Hong Kong, including clinical help and training help. So in Australia -- the 3 major countries that I believe in the next 2, 3 years in Asia will be Australia, Korea and China. We have some following in Japan and also in Thailand, especially in the COVID time. In Europe, I believe that the 3 major countries will be Germany, where we just changed distributors and we started work very aggressively on this market. U.K., we are almost in the rate of GBP 1 million per month, and we will continue from there. France where we start just started a subsidiary. We see some good sign in Spain. In South America, Brazil is the biggest market in South America. We have good distributors, very good distributors, specializing us. They got the FDA on the BodyTite and the surgical platform and they're going to launch it in the near future. Unfortunately, South America right now in the middle of a crisis with the corona. Everybody see what's going on in Brazil, Mexico. But even with that, we're selling and growing quarter-over-quarter. So these are the main markets. In addition, of course, to the U.S. and Canada.

Great. Thanks, Moshe. So we have a few minutes and I wanted to cover a couple more topics. One is Envision, that's the next big platform launch behind Empower. Could you talk about any early results and why you're excited about this? And again, it's another new market. So maybe just address how you're going to kind of attack this new call point?

I would say that, first, just to spread the platforms, I'll let Dr. Michael Kreindel explain what we're doing here. Michael?

Yes. Envision, it's a new platform. And first, I want to tell a couple words about our R&D philosophy. Because we are working for private money market, it's completely different requirements from normal medicine because when patients pay money, 90% of patients must have good results. So it's put much more -- much higher requirements for the performance of the device than in normal medicine. Second one, we target an aesthetic medicine. And in other areas, professional doctors. But when you deal not with SPA, but with professional doctors, results should be seen in 1, 3 treatments, but it's not acceptable like 10 procedures -- 10 treatment session or like patients coming every month. It's also put a lot of pressure on efficiency and the performance of the device. The other element, as you see from our P&L, our R&D expenses are not that high in comparison to marketing and sales. So when we target such a new group of doctors like ophthalmologist or optometrists, we don't want to come to these markets with single procedure, with 1 treatment -- some 1 niche treatment modality. So we are thinking about some depths of product for the new professional markets. Envision should address that -- the need of people -- patients who come into ophthalmologists and optometrists. And we are developing a platform that supports multiple applications. Not all of them coming at the same time. And not all clinical protocols and applications are validated yet. But we are working with Spero hard to bring like some line of application over the next 2 years to this market. So -- also, this group of doctors, they're dealing with such applications, like dry eye that we are now focused. It's a multifunctional problem that requires -- address multiple elements. It's like inflammation, it's obstruction of meibomian glands and other, and we're working in all these directions. In addition, these doctors -- for these doctors, it's very natural to treat periorbital area including wrinkle, saggy skin and all -- most of the ophthalmologists are trained for some surgery. So it's also a market for our minimally invasive procedure addressing periorbital area. So we plan to launch this platform, supporting this line of multiple application -- applicators and technologies that will address the needs of this market.

Understood. Great. That's good. We're almost out of time -- a follow-up question I had was maybe, could we cover any of the early data or experience with ophthalmology and specifically dry eye and talk about why you're excited about it?

So okay, I will continue. We now run the multicenter study in North America, including U.S. and in Canada, the new handpiece was already approved by Health Canada. So some doctor already started to use it legally. So far, response is very good because in contrast to other technology, like laser and IPL based that's too dangerous to treat over the eyeball. We designed our technology just to be able to treat eyelids just in this sensitive area, limiting and optimizing penetration depth and heating profile. So far, response is positive. In addition, we have an optical energy available in our products that addressed like inflammation, rosacea that's often linked to the dry eye problem. In parallel, we are working in median plastic surgery on eyelid treatment with our Morpheus Prime technology. And results so far are very encouraging. And many doctors already use it to extend their procedure in their practices. Maybe Spero can add a little bit about it.

Yes. Thanks, Mishka. Matt, I think that our early data is showing that patients are, first of all, tolerating it very well. And second, they're asking for more after the study was done. Our results are at this point along -- over a year. But it looks like the patients are eager to have it more done. But as far as the objective results shows everything that we wanted to show from dry eye. So we're -- I think, again, it goes back to the ability to go deeper, Matt. The fact that we can go deeper and controlled with Mishka's technology, I think it's probably a more powerful way to unclog those meibomian glands [indiscernible] responsible for clogging. So everything before that, IPL was used. Again, not as effective. I mean, J&J has a product, as you know. That product is probably the one that's the most available out there among optometrists and all that. But again, not necessarily customized, one size fits all. So for us, it's customization because you know exactly where you want this probe and the ability to go deeper. Those 2 elements is what's going to set this apart. So we're very, very happy with the clearing and the results. And at this point, we're confident enough to launch this product and know that we're going to get [indiscernible].

Matt, one thing that we're still waiting for this handpiece is the clearance from the FDA. We're in the final stage of communicating with them on their answers. Hopefully, in the next 2, 3 months, we will get it.

Great. All right. Well, exciting stuff. It's good to see all of you and hear all the different perspectives. Great to see the business doing well, and we have a lot to look forward to these new platforms. So thanks for taking the time with us today, and take care, and we'll talk to you soon. Hope you have a great rest of your day.

Thank you, Matt.

Thank you. Bye-bye.

Thank you.

Thank you.

Thanks. Take care guys.