TELA Bio Q4 2025 Earnings Report

TELA Bio EPS Results

• Actual EPS: -$0.16
• Consensus EPS: -$0.18
• Beat/Miss: Beat by +$0.02
• One Year Ago EPS: N/A

TELA Bio Revenue Results

• Actual Revenue: $20.87 million
• Expected Revenue: $21.04 million
• Beat/Miss: Missed by -$172.00 thousand
• YoY Revenue Growth: N/A

TELA Bio Announcement Details

• Quarter: Q4 2025
• Date: 3/24/2026
• Time: After Market Closes
• Conference Call Date: Tuesday, March 24, 2026
• Conference Call Time: 4:30PM ET

TELA Bio (NASDAQ:TELA) (NASDAQ: TELA) is a commercial‐stage medical technology company headquartered in Malvern, Pennsylvania. The company is focused on developing, manufacturing and commercializing regenerative medicine and advanced soft tissue repair solutions. By integrating proprietary biomaterials and processing technologies, TELA Bio aims to offer products that support the body’s natural healing processes in wound closure, hernia repair, reconstructive surgery and other surgical specialties.

The company’s product portfolio includes acellular dermal matrices, hemostatic agents and tissue scaffold systems. Its flagship offering, TELAPro™, is an acellular dermal matrix designed for abdominal wall reconstruction and complex soft tissue repair. In addition, TELA Bio markets fibrin sealant systems and surgical films that serve as adjunctive tools for hemostasis and tissue regeneration across a variety of surgical and wound care settings.

Operating primarily in the United States, TELA Bio collaborates with surgeons, wound care specialists and research institutions to advance clinical protocols and broaden the applications of its platform technologies. Its manufacturing facility in Plymouth, Minnesota, adheres to rigorous quality and regulatory standards, supporting scalable production. Guided by a leadership team experienced in medical devices, biomaterials and commercial operations, TELA Bio is focused on expanding clinical adoption and growing its product pipeline in the regenerative medicine market.

TELA Bio Q4 2025 Earnings Call Transcript

Key Takeaways

• Positive Sentiment: Company completed a major commercial rebuild, expanding to roughly ~90 sales reps (40% hired in the last six months), new sales leadership, territory realignment and a redesigned 2026 compensation plan intended to drive deeper account penetration.
• Positive Sentiment: Financial momentum: TELA delivered 16% revenue growth in 2025 with a record Q4 of $20.9M and strong unit growth (OviTex units +20% Q4, +22% FY), and guided to at least +8% revenue growth in 2026 with Q1 ~ $18.5M.
• Neutral Sentiment: Improving unit economics and balance sheet: gross margin rose to 68% for the year, LiquiFix revenue more than tripled year-over-year in Q4, and the company ended 2025 with $50.8M cash after refinancing debt and raising capital.
• Positive Sentiment: Product and clinical progress: launched OviTex LTR (long-term resorbable), advanced the LiquiFix fixation product, enrolled first patients in the hiatal hernia ECHO trial, and promoted an experienced CMO to support surgeon engagement and evidence generation.
• Negative Sentiment: Near-term execution risks remain: guidance is deliberately conservative due to large cohorts of new reps still ramping, mixed-product ASP pressure from shifting procedure mix, contract conversion complexity, territory restructures and Q1 seasonality/weather disruptions that could pressure short-term results.

Presentation

[Operator]

Good afternoon, ladies and gentlemen, and welcome to the TELA Bio fourth quarter and full year 2025 earnings conference call. At this time, all participants are in listen-only mode. A question-and-answer session will follow the prepared remarks. As a reminder, this conference call is being recorded. I would now like to turn the conference call over to Louisa Smith from Investor Relations.

[Louisa Smith, Investor Relations at TELA Bio]

Thank you, Jonathan, and good afternoon, everyone. Earlier today, TELA Bio released financial results for the fourth quarter and full year ended December 31, 2025. A copy of the press release is available on the company's website. Joining me on today's call are Antony Koblish, Chief Executive Officer, Jeffrey Blizard, President, Roberto Cuca, Chief Operating Officer and Chief Financial Officer, and Jim Hagen, Senior Vice President of Strategic Operations and Marketing.

[Louisa Smith, Investor Relations at TELA Bio]

Before we begin, I'd like to remind you that during this conference call, the company may make projections and forward-looking statements regarding future events. We encourage you to review the company's past and future filings with the SEC, including, without limitation, the company's annual report on Form 10-K and quarterly reports on Forms 10-Q, which identify the specific risk factors that may cause actual results or events to differ materially from those described in these forward-looking statements.

[Louisa Smith, Investor Relations at TELA Bio]

These factors may include, without limitation, statements regarding product development, pipeline opportunities, sales and marketing strategies, and the impact of various additional risk factors as identified in our regulatory filings. With that, I'd now like to turn the call over to Tony.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Thank you, Louisa, and good afternoon. Thank you for joining TELA Bio's fourth quarter and full year 2025 earnings call. For today's call, I'll open with a summary of what we accomplished in 2025 and thoughts on our forward-looking strategy. Jeff will then walk through the foundational changes we implemented in the commercial organization and how we anticipate they will impact our future performance.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Roberto will review our financials, and then we will open it up for Q&A. 2025, and the third and fourth quarters in particular, were periods of meaningful strategic change across the entire organization. Following Jeff Blizard's appointment as President in June, we undertook and executed a significant rebuild of TELA Bio's commercial foundation while maintaining our commitment to improve our operating discipline and continuing to advance our pipeline strategies.

[Tony Koblish, Co Founder and CEO at TELA Bio]

We made meaningful changes to the U.S. commercial organization while delivering 16% full-year growth and achieving record fourth-quarter revenues. The ability to maintain that momentum while executing such fundamental change in the organization is a testament to the caliber of our team and the value proposition of the OviTex product portfolio. We enter 2026 with the largest, most effective field team in the company's history and a commercial strategy designed to drive durable, predictable growth.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Demand for our products remains strong, and the opportunity in hernia repair and plastic reconstructive surgery has not diminished. The foundational changes we undertook in 2025 were aimed at ensuring we have the commercial infrastructure to consistently and effectively capture that demand.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Revenue growth in 2025 was fueled by strong performance in our European business, further adoption of our IHR, LPR, and LIQUIFIX product lines, and the continued contribution of our tenured reps in the U.S. The strategic investment we have made in high-caliber candidates with the right profile has been an underlying tenet of the commercial rebuild. A meaningful portion of our approximately 90-person sales force is still early in their tenure, with 40% of the reps having joined TELA in the last six months.

[Tony Koblish, Co Founder and CEO at TELA Bio]

This has not been a function of rep turnover, but rather an investment in commercial expansion and in recruiting talent with the right profile for the sales model we are building. We already see the newest reps meaningfully outperform their predecessors in the early stages of their onboarding, and we are encouraged by their promise to execute our commercial strategy more effectively.

[Tony Koblish, Co Founder and CEO at TELA Bio]

In the fourth quarter, we accelerated efforts to bolster our U.S. commercial team by advancing recruitment to meet our sales headcount target and by putting the infrastructure in place to support those new hires. That included investing in training, rolling out new sales enablement tools, launching a new U.S. sales leadership structure, and redesigning the 2026 compensation plan to align with our growth strategy and expectations. Heading into 2026, we are focused on two strategic growth priorities.

[Tony Koblish, Co Founder and CEO at TELA Bio]

First, and most importantly, we are committed to sustaining the momentum we achieved in 2025 and achieving further U.S. and European sales growth through improved talent, processes, and commercial leadership. Jeff and his team have made incredible progress so far, and this will continue to improve as the new commercial organization matures and tenured sales reps begin to hit their stride.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Again, I'll let Jeff provide further detail on the specifics, but I'm confident in the new commercial foundation we have laid. Second, we have been and will remain hyper-focused on offering the best soft tissue reconstruction product portfolio on the market. Product innovation is at the core of TELA's identity, and we anticipate announcing additional product launches throughout the year to drive greater share gains in the expansive U.S. market.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Demand for our innovative solutions is there, and I believe we have built the commercial infrastructure supported by an expanding portfolio that can consistently capture that demand. To that end, we were pleased to announce the promotion of Dr. Howard Langstein to Chief Medical Officer effective March first. Howard joined TELA nearly two years ago and has been instrumental in how we engage the surgical community.

[Tony Koblish, Co Founder and CEO at TELA Bio]

With over 30 years in plastic and reconstructive surgery, he understands this market from the inside out, the procedures, the unmet needs, and what surgeons are looking for. As TELA's CMO, he will drive surgeon awareness, support clinical education, and help generate, disseminate, and translate growing body of data behind OviTex into a broader market understanding and acceptance. On the European side, our teams are stable, tenured and delivering above plan.

[Tony Koblish, Co Founder and CEO at TELA Bio]

The competitive market in Europe differs from the U.S. with pricing and the bundling dynamics, and we are encouraged to see rapid adoption of OviTex in the U.K. and the Netherlands. We are winning share based on patient preference and the efficacy of our products in these markets, not because of pricing discounts or volume requirements set by hospital administrators.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Moving forward, we have a purposeful investment plan to expand our presence within continental Europe and see it as a meaningful contributor to growth in the coming years. Overall, Q4 results reflected a commercial organization in transition, but we remain proud of all this team has and will continue to accomplish. We executed a major commercial upgrade in the back half of 2025, while simultaneously achieving several other key milestones for the company.

[Tony Koblish, Co Founder and CEO at TELA Bio]

In that six-month period, we launched OviTex LTR, a new addition to our portfolio that offers durable support during healing and provides surgeons with a tissue-based alternative to synthetic mesh. We enrolled the first patients in our hiatal hernia trial ECHO, which will strengthen our clinical evidence base and deepen our access to alternative surgeon call points in a primarily robotically performed procedure.

[Tony Koblish, Co Founder and CEO at TELA Bio]

We reinforced and upsized our debt facility, strengthening our balance sheet for the road ahead. Finally, we upgraded our board of directors with new expertise. In summary, 2025 was a year of deliberate foundational change that required discipline and conviction. That is behind us and we enter 2026 with our eyes towards the future. With that, I would now like to turn the call over to Jeff for a more in-depth review of our commercial strategy and restructuring. Jeff?

[Jeff Blizard, President at TELA Bio]

Thanks, Tony. As Tony laid out, I don't want to lose sight of the fact that amid transformational reorganization, we grew revenue by 16% and delivered our third straight quarter of sequential growth. We exceeded $80 million in total sales for the full year 2025, all while maintaining operating discipline and improving our operating leverage. The changes that we undertook since coming on board last June could have created significant disruption in productivity and growth in any organization.

[Jeff Blizard, President at TELA Bio]

That didn't happen here. It speaks volumes to the commitment of the entire TELA team and the dedication to the patients and customers we serve. I'd like to take some time to provide a detailed review of the specific changes in our commercial organization that Tony referred to.

[Jeff Blizard, President at TELA Bio]

I'll also highlight the progress we made year to date because of these changes and how they set us up for meaningful inflection moving forward. Number one, we upgraded and redesigned the U.S. commercial leadership team. By implementing a new sales general manager structure, we brought on decision-making closer to the customer and empowered teams to respond to customer needs in real time. Two, concurrently, we addressed silos within the commercial organization that had been slowing cross-team collaboration.

[Jeff Blizard, President at TELA Bio]

We strengthened our sales leadership bench by upgrading five key senior roles. These changes were implemented to increase accountability in the field, improve coordination across our hernia and PRS segments, and drive more consistent execution across our commercial footprint. Three, we've rolled out formal promotion pathways within the commercial organization, creating vertical career mobility that rewards our top performers and incentivizes meaningful contribution within the organization.

[Jeff Blizard, President at TELA Bio]

Four, we redesigned the sales talent profile in the U.S. and accelerated our hiring. We hit our 76 territory manager target back in the third quarter, and as of today, we have 88 quota-carrying territory managers in the U.S. with 1 additional hire imminent and 5 open positions that we're actively sourcing. This means we won't require any further incremental hiring for the remainder of the year. The team that we need to hit our 2026 targets are largely in place.

[Jeff Blizard, President at TELA Bio]

Tony touched on how we evaluate our field teams by distinct cohorts and how we assess their performance by tenure and productivity ramps. Roughly 40% of the U.S. field team has joined us in the last two quarters.

[Jeff Blizard, President at TELA Bio]

They're in the early phases of their ramp up, and we expect that they'll contribute incrementally each quarter of this year as they build out account relationships and gain clinical familiarity. An additional cohort, those who've been with us between 6 and 18 months, have gained meaningful traction, and the vast majority have reached a productivity inflection point. They're actively building account relationships while improving clinical acumen. We expect their contribution to ramp meaningfully each quarter.

[Jeff Blizard, President at TELA Bio]

Finally, we've maintained a very solid base of tenured reps who, on average, deliver over $1 million per year and consistently meet or exceed targets on a monthly, quarterly, and annual basis. This cohort accounts for approximately 35% of our current rep count. 5, as part of the redefinition of our sales talent profile, we've shifted our approach to recruitment.

[Jeff Blizard, President at TELA Bio]

We've been very successful not only in our ability to retain top performers, but then in our ability to attract and hire strong candidates. We increased our investment and focus on sales training and with a goal of reducing time between hiring and commercial effectiveness. The candidates we're bringing in demonstrate stronger performance and higher scores on all evaluation criteria versus any prior cohort.

[Jeff Blizard, President at TELA Bio]

The profile we're recruiting combines high intellect, perseverance, the ability to build deep and lasting relationships and develop strong clinical acumen over time. This is a change from our previous recruiting strategy, which placed greater emphasis on years of soft tissue sales experience. The caliber of our newest reps is beyond anything TELA's ever seen. We're becoming a destination now for candidates who fit a clear profile for success in the commercial model that we're building.

[Jeff Blizard, President at TELA Bio]

Naturally, as we place less emphasis on prior soft tissue experience, there's a ramp-up period while new hires come up to speed through our clinical education programs. What we're seeing, however, is that our investment in sales training, this new profile of rep gains clinical proficiency quickly. Once they do, their drive and hustle translate into a higher level of contribution than prior cohorts.

[Jeff Blizard, President at TELA Bio]

While we're still expecting most new hires to reach full productivity within 6 to 9 months, we believe their impact and maturity will be greater. 6, we've developed and rolled out a new sales enablement technology that draws on better market insights to help our sales leaders and reps better prioritize and target their activity. 7, we have designed and implemented a new 2026 compensation program that incentivizes deeper penetration in target accounts.

[Jeff Blizard, President at TELA Bio]

This represents a change in our geographic coverage, where we are now matching rep density with high volume institutions to cultivate multiple users per site. Instead of a wide and shallow approach, we're going deeper to generate sustainable recurring revenue opportunities. Our new comp plan is now explicitly aligned around that strategy. Additionally, this philosophy expands beyond the comp plan itself. It also minimized the geographical areas that reps needed to cover, maximizing efficiency and supporting better operating expense optimization.

[Jeff Blizard, President at TELA Bio]

As part of this renewed approach, we're also ensuring meaningful executive presence in the field. Tony was calling on strategic accounts as recently as last week, and others and I are doing the same. It's a signal in the organization to our customers where our priorities lie, building deeper, more meaningful physician relationships.

[Jeff Blizard, President at TELA Bio]

Eight, we've adjusted our sales and marketing focus to center on the mechanism of action of OviTex and the science that fundamentally differentiates our portfolio. Surgeons have embraced our data and the long-term patient outcomes it demonstrates. The source material, OviTex, and the way it integrates within the body differentiates us from any gen one biologics, synthetics or biosynthetics, and it's foundational to the why surgeons adopt OviTex. We also increased our sales and marketing focus on LIQUIFIX with great support from our partners at AMS.

[Jeff Blizard, President at TELA Bio]

LIQUIFIX is not only a better fixation solution. We've seen it open doors with hernia surgeons who may not yet be familiar with OviTex. Finally, number nine, we've instilled spending discipline within the organization, which has allowed us to fund more customer education and training events.

[Jeff Blizard, President at TELA Bio]

This helps us meet customers where they are in their adoption life cycle, while simultaneously improving operating margins. How does this all come together with respect to driving revenues? For the full year 2026, with each of the three cohorts performing as expected, we're confident that we will grow revenue over 2025 by at least 8%. For the first quarter, to which much is already completed, we expect that we'll deliver revenue of approximately $18.5 million.

[Jeff Blizard, President at TELA Bio]

The breadth of change that we execute in six months was significant, and we recognize what it takes to sustain this level of momentum going forward. Our goal was to have everything in place by the end of Q1 so that the second half of 2026 reflects this full benefit.

[Jeff Blizard, President at TELA Bio]

We are well on pace, and as of today, all significant material changes have been implemented across the entire organization. We've set our revenue guidance to account for some of the inherent variability that may arise given the scope, scale, and speed of changes I've just laid out. We believe that particularly in the second half of this year, the annualization of our commercial restructuring and the ramp of our newest cohort, combined with the pipeline and clinical investments, position us to be able to deliver achievable and sustainable results moving forward.

[Jeff Blizard, President at TELA Bio]

I'll now turn the call over to Roberto for further details on the fourth quarter and full year financial results.

[Roberto Cuca, COO and CFO at TELA Bio]

Thank you, Jeff. Revenue for the fourth quarter of 2025 increased 18% year-over-year to $20.9 million and grew 16% for the full year to $80.3 million, with revenue from OviTex growing 12% and OviTex PRS growing 20% for the year. The growth was primarily due to the addition of new customers, growth in international sales, and the U.S. launch of larger PRS units. Growth was partially offset by a mix shift in our hernia product line as we saw an increased share of smaller sized IHR units.

[Roberto Cuca, COO and CFO at TELA Bio]

OviTex unit sales grew 20% for the quarter and 22% for the year, while PRS unit sales grew 12% for the quarter and for the year. LIQUIFIX revenue more than tripled over the fourth quarter of 2024, reflecting early commercial traction as we expand adoption alongside our core OviTex portfolio.

[Roberto Cuca, COO and CFO at TELA Bio]

European sales accounted for 15% of total revenue or $12.1 million in 2025, a 17% increase from $10.3 million in 2024, reflecting the traction we are seeing in key markets and our continued investment in expanding access globally. Gross margin was 66% for the fourth quarter and 68% for the full year, compared with 64% and 67% for the prior year periods, respectively. The improvement was driven by lower excess and obsolete inventory expense as a percentage of revenue.

[Roberto Cuca, COO and CFO at TELA Bio]

Sales and marketing expenses were $14.5 million in the fourth quarter and $63.2 million for the full year, compared to $14 million and $64.6 million for the prior year periods, respectively.

[Roberto Cuca, COO and CFO at TELA Bio]

This was mainly due to commissions rising with stronger revenue in both periods, offset by lower compensation, severance, consulting, and travel costs for the year. General and administrative expenses were $3.8 million for the fourth quarter and $15.7 million for the full year, compared with $3.6 million and $14.7 million for the prior year periods, respectively. R&D expenses for the fourth quarter were $2.1 million, and for the full year were $9.2 million compared to $2 million and $8.8 million for the prior year periods.

[Roberto Cuca, COO and CFO at TELA Bio]

Loss from operations was $6.6 million in the fourth quarter of 2025, and $33.8 million for the full year compared to $8.4 million and $34.1 million in the prior year periods.

[Roberto Cuca, COO and CFO at TELA Bio]

Net loss was $9 million in the fourth quarter and $38.8 million for the full year compared to $9.2 million and $37.8 million in the prior year periods. We ended 2025 with $50.8 million in cash and cash equivalents, having further strengthened our financial flexibility by refinancing our debt facility and raising incremental and equity capital. As Jeff described earlier, for 2026, we anticipate revenue growth of at least 8% over 2025, with Q1 2026 revenue of approximately $18.5 million.

[Roberto Cuca, COO and CFO at TELA Bio]

We expect that operating loss and net loss will continue to decline for both the year and over the quarters of the year, although there is likely to be some step-up from the just past fourth quarter to the first quarter, particularly in light of the revenue progression that we typically see over this period. With that, I'll hand the call back to Tony for closing remarks.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Thank you, Roberto. As we have done in prior quarters, I'd like to end with a patient story to ground us in the impact of our mission. A 57-year-old patient actively being treated for chemo required treatment for a hernia repair in the intercostal region. The surgical team concerned about where the hernia was located because it was near chest tubes decided that OviTex Core, with the 4 layers being thin enough, unlike a traditional biologic, would provide less seroma and was the best choice because of Core's resorption profile and its optimal size.

[Tony Koblish, Co Founder and CEO at TELA Bio]

The patient underwent an underlay procedure. The surgeon said that the patient is doing great and is extremely pleased to have OviTex Core available for this very sick patient.

[Tony Koblish, Co Founder and CEO at TELA Bio]

The surgeon commented, in quotes, "We believe that OviTex is the only product that can be used in conjunction with the use of chemotherapy due to the way it rapidly incorporates its porous nature and its functional remodeling of healthy tissue." This is another great example about how OviTex can be used in the most complex of cases with excellent outcomes. Before we open the line for questions, I want to take a moment to recognize the entire TELA team.

[Tony Koblish, Co Founder and CEO at TELA Bio]

In the back half of 2025, this organization undertook a fundamental rebuild of our commercial structure while continuing to grow revenue, serve customers, and maintain operating discipline. To sustain momentum through the transition of this magnitude reflects the quality of the team and the strength of the products.

[Tony Koblish, Co Founder and CEO at TELA Bio]

The changes we made in 2025 were difficult but necessary, and we entered 2026 with the strongest commercial team the company has ever had, and I look forward to what's ahead for TELA Bio. Jonathan, please open the line for questions.

[Operator]

Certainly. Our first question for today comes from the line of Caitlin Roberts from Canaccord Genuity. Your question, please.

[Caitlin Roberts, Director of MedTech Equity Research at Canaccord Genuity]

Hi. Thanks so much for taking the questions.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Sure.

[Caitlin Roberts, Director of MedTech Equity Research at Canaccord Genuity]

I guess starting off with the fiscal year top line guidance for at least 8%, just a little bit more color on why it was below what you guys noted on the Q3 call, and if you could provide some cadence to that guidance for the year, that would be great.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Yeah, I'll start it off, and then I'll turn it over to Roberto. Our thought here is given the change that we've implemented, wholesale change right across almost every dimension, that we thought it would be prudent to set the guidance where we did. There's so many new reps and new moving parts that are in place right now. We wanna give ourselves the best chance to do a great job this year.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Given that our territory manager break-even point remains about 6 months-9 months, and we've hired so many new reps that we're sort of flip scaling into, cascading into the year, we just think there's a lot of variables, and we wanted to make sure that we're giving ourselves plenty of room to allow these reps to mature and drive.

[Tony Koblish, Co Founder and CEO at TELA Bio]

We really like the contribution from the 40% new reps so far. It looks like they've stepped up quite a bit as a percent contribution over Q4, but we wanna make sure that we're giving ourselves that time and flexibility. You know, there's some other factors that we have in place, I think, that give us confidence to do a good job this year.

[Tony Koblish, Co Founder and CEO at TELA Bio]

That is the fact that for the first time in the company's history, we are right on the mark with the number of reps we wanted to hire and at the right time, right? In the past, we've sort of been stuck between 63-68 reps. I feel like that was where we were stuck no matter where our target is. This new commercial leadership team has done a great job of getting those folks in place.

[Tony Koblish, Co Founder and CEO at TELA Bio]

We've got a product that we think is powerful, that's gonna launch April first fully. It's been in limited release. It's our long-term resorbable OviTex product, which should give us a great match-up with the leading biosynthetic out there, Phasix. I do think that's gonna be mostly additive to the portfolio, along with some cannibalization from our permanent portfolio. I think one of the foundational drivers that we can rely on going forward is European performance.

[Tony Koblish, Co Founder and CEO at TELA Bio]

This has been very consistent, and I do think that they're gonna allow themselves to grow consistently over time, and we very much look forward to adding PRS to their portfolio for sales, hopefully by the end of this year or early next year. You know, one of the big factors that we have here, Caitlin, in this guidance set is contract conversion, right? Our sales force has been very focused on getting contracts in place, and we haven't done as well as executing into those agreements.

[Tony Koblish, Co Founder and CEO at TELA Bio]

We're gonna shift that focus towards contract execution. We do know that there's a high degree of contracting complexity, right? Which does affect timing, which is another factor as to why we built the guidance the way we did, right? Contract implementation varies from hospital to hospital.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Even if you have a GPO contract in place, we're learning that every day. The way contracts are written in the U.S. further complicates things with, you know, a market share and a cross-product portfolio bundling and rebate structure. There is some complexity there. We wanna make sure that we give ourselves the time to execute into the contract footprint that we already have in place. Hopefully that gives you a flavor of what we're trying to do here on a bigger picture. We have a lot of factors of safety built in and a lot of potential upside, but we wanna be prudent.

[Roberto Cuca, COO and CFO at TELA Bio]

Let me just add two things, Caitlin. You asked about cadence for the year. We do expect the cadence for the year to be similar to that in prior undisrupted years, where you see a step up from the first to the second quarter, a smaller step up from the second to the third, and then a bigger step up again from the third to the fourth quarters. The step up from the second to the third being smaller is driven primarily by the summer holidays.

[Roberto Cuca, COO and CFO at TELA Bio]

We expect to see that pattern slightly amplified by the addition of all the sales reps that have come in over the course of the end of the fourth quarter and through the first quarter, who will begin becoming productive in about six months.

[Roberto Cuca, COO and CFO at TELA Bio]

We do still see that the most recent cohorts of sales reps hit break even just under 6 months, and then what Jeff and Jim call break out between 6 and 9 months, so become more than just break even positive.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Yeah.

[Roberto Cuca, COO and CFO at TELA Bio]

-profitable.

[Tony Koblish, Co Founder and CEO at TELA Bio]

All of these factors, Caitlin, they also add to the frustrations that everybody has had, including us in the past, about our forecasting accuracy, right? We wanna make sure, again, the word is prudent, to make sure that as we're going through all of this, you know, we feel very confident that we'll come out the other side with a much more predictable and forecastable business. Until we get there, we think it's best to be prudent.

[Caitlin Roberts, Director of MedTech Equity Research at Canaccord Genuity]

Understood. Maybe just one more from me. I think Tony touched on the contracting. You know, how many IDNs or GPOs have you transferred to, you know, really recategorize OviTex? You talked about that, you know, the last couple of quarters. What are your expectations to continue doing that this year?

[Jim Hagen, SVP of Strategic Operations and Marketing at TELA Bio]

Hey, Caitlin, it's Jim. I'll take that one. I think as Tony just said, our contracting focus while we continue to drive a focus on the RTM category, especially into site-level agreements, the team's done a really nice job in 2025 of getting many of those agreements signed. 2026 is an execution year. We have to translate that, move it through the hospital processes, where we have a lot of surgeon advocacy. We have to work it through the admin process and translate that signature now into patients and revenue.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Yeah. I think, you know, as new opportunities present themselves, such as Vizient, that's been delayed, we're certainly gonna go for that. We have more than enough footprint that we have to start executing on, as Jim said, before we just, you know, continue to drive agreements. I mean, we'll continue to do both, but we have to focus on execution within the agreements we have.

[Caitlin Roberts, Director of MedTech Equity Research at Canaccord Genuity]

Understood. Thanks so much.

[Operator]

Thank you. As a reminder, ladies and gentlemen, if you do have a question at this time, please press star one one on your telephone. If your question has been answered and you'd like to remove yourself from the queue, simply press star one one again. Our next question comes from the line of Frank Takkinen from Lake Street Capital Markets. Your question please.

[Frank Takkinen, Senior Research Analyst at Lake Street Capital Markets]

Great. Thank you for taking the questions. Wanted to follow up on the Q1 guidance a little more. Obviously heard all the comments about the structural changes you've made with the commercial organization and the disruption that has caused. Was just curious if there was anything else specific to call out with Q1. I know typically the seasonality is kind of up a few% or down a few% in some instances, depending on the year, just the double-digit down quarter-over-quarter. Curious if there's anything beyond the sales force comments you've made going into Q1.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Yeah. I'll start, Frank. I think my whole monologue on prudence for the year is transferable to Q1 as well. You know, I think we have one dynamic that I think has added to the general slow start that you see in hernia and plastic and reconstruction, which is typical in January and February. That is, which I didn't mention before, is part of what Jeff and Jim have done is the territories have been restructured to be smaller, right? To go deeper.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Which means there's been some splitting of territories. What we're encouraging is sales force efficiency, right? Which will help from time spent selling to T&E expense. We are gonna concentrate density of reps in smaller areas, preferably adjacent to high population areas that are already successful with us.

[Tony Koblish, Co Founder and CEO at TELA Bio]

That means we may abandon a little bit of the hinterlands and the smaller hospitals that are out in the perimeter. Not fully abandoned, but de-emphasize a little bit. That's gonna cause a little bit of you know a little bit of loss as we go through these shifts of splitting territories and creating more efficient density in the network.

[Tony Koblish, Co Founder and CEO at TELA Bio]

We wanted to make sure that we gave ourselves some room to work through that, which should mostly be taken care of, you know, through the end of the first quarter, and we should start to see some signals that we're coming out of that transition phase in Q2. Does that make sense, Frank? That's an addition, I think.

[Frank Takkinen, Senior Research Analyst at Lake Street Capital Markets]

Yep.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Yep.

[Frank Takkinen, Senior Research Analyst at Lake Street Capital Markets]

Yep. Yep, that's perfect.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Hey, Frank.

[Frank Takkinen, Senior Research Analyst at Lake Street Capital Markets]

I appreciate that.

[Jeff Blizard, President at TELA Bio]

Frank, this is Jeffrey Blizard. I just want to add one more point onto Tony, and the word disruption is something we've avoided here. We didn't call this a reorganization. Really, the focus has been on restructuring, right people in right roles, and making sure that we can have a focus on these key customers in key cities and also those academic programs that are hubbed in key cities.

[Jeff Blizard, President at TELA Bio]

What we found in not only the challenges in January that most companies were faced in was over 1,000 square miles of geography in the U.S. was impacted by that blizzard, and we saw a number of elective procedures be impacted by that. We've heard that from other programs and other companies that have had similar situations.

[Frank Takkinen, Senior Research Analyst at Lake Street Capital Markets]

Yep, that's helpful. As we think about exiting this period where we're maybe returning to a steady state growth rate, how do you view the steady state growth profile of TELA over a longer period of time?

[Tony Koblish, Co Founder and CEO at TELA Bio]

Yeah, well, I think the markets that we serve are kind of mid-single digits%. We've been above market rate growth since inception. You know, I think we anticipate that we will be able to significantly outgrow the market. You know, the other interesting thing I think as you look at the data that we're presenting here is that our units for both PRS and hernia are high, right? Our growth rate on the hernia units, I think is 20% or 22%. 22%, right.

[Tony Koblish, Co Founder and CEO at TELA Bio]

That's a very good sign for the long haul, you know, given that that's the bulk of the procedure. Making inroads into those smaller piece procedures is super important. It does have an impact with mix shift and top line revenue, but that should straighten out as well.

[Tony Koblish, Co Founder and CEO at TELA Bio]

You know, we certainly believe that once we get to steady state, we should be back into the double-digit growth or beyond. You know, this is a way for us to give ourselves the to clear the decks. We've never done a change this comprehensive that affects territory planning, compensation plans to drive that. You know, this is so comprehensive, we're just giving ourselves the room to get back to that, double-digit plus growth. I think we have a great shot of getting there in the second half of this year, hopefully.

[Frank Takkinen, Senior Research Analyst at Lake Street Capital Markets]

Yep. Got it. That's helpful. If I could just squeeze one more in, as it relates to your point on unit growth that's been really solid, obviously, in both product categories. What's your latest thought on how we should think about when ASPs in hernia could start to flatten out and stabilize?

[Tony Koblish, Co Founder and CEO at TELA Bio]

Yeah, that's a good question. You know, I was looking at that before the call to prepare. One of the metrics I look at is what type of hernia procedures we're doing, right? I think for the longest time, we were about a 70% ventral company, and that is shifting. I think we always had about 10%-15% of inguinal. Right now, I'm just thumbing through it. I'll go by memory, and Jim can correct me if I'm wrong, but I think we're at about 50% of our business right now is ventral and 25% of our business is inguinal. 14% is hiatal.

[Tony Koblish, Co Founder and CEO at TELA Bio]

We were really a 10%-14% company on both inguinal and hiatal when we in the past, before this shift of getting more involved in the fat part of the bell curve of hernia procedures. Now we're already up to, we're down to 50% from 70% on ventral, and we're up from 10%-12% on inguinal, up to 25%. It's hard for me to say where that balance goes. There's almost 1 million inguinals done a year. We're gonna keep mining that until we hit some kind of a steady state, right? It's gonna have to do with the mix between inguinals and ventrals.

[Jeff Blizard, President at TELA Bio]

The other comment I would say on this one, Frank, is not just the type of hernia, but the modality of the procedure. As we see procedures moving away from opens into laparoscopic and robotic procedures, we're well positioned. That's also why you see our LPR portfolio outpacing much of our growth, along with IHR. I do think surgeons are voting with their preferences, using us more where procedures are going, which is laparoscopic robotic for us.

[Jeff Blizard, President at TELA Bio]

That ASP shift, to Tony's point, is gonna continue. We're gonna continue to see more of our volume moving to those lower pieces with an ASP that's a bit lower than we historically had been with the large opens. As I think Roberto will continue to remind everyone, that does not impact gross margins.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Right. Yeah, just to put a little finer point on it, Frank, what we're seeing is the start of robotic surgery starting to make more and more inroads into the open complex cases. We're there, you know, ready to serve those cases beautifully with our LPR products, right? Certainly, our inguinal product is robot compatible as well. We're well-positioned for how the hernia market's evolving. How long that takes, it's hard to say. I do think the future is gonna be higher unit growth volume.

[Jeff Blizard, President at TELA Bio]

More procedures, but smaller pieces. I think you're gonna start to see our 1S, 2S, and core start to give way to inguinal and LPR, and hopefully in the future, LIQUIFIX as being the main unit drivers going forward. You know, we'll certainly get all the opens that we can with our older portfolio. One more thing to add. I'm sorry, a little stream of consciousness here. The long-term resorbable hernia product has zero permanent polymer in it, and a lot of these old-time surgeons do have an allergy to putting anything permanent.

[Jeff Blizard, President at TELA Bio]

I mean, our product works beautifully in these cases, and many surgeons do, but there are just some category of surgeons that wants nothing permanent.

[Jeff Blizard, President at TELA Bio]

Our long-term resorbable product, I think, has a shot of opening up some of those more difficult complex trauma, complex abdominal cases down the line in the future, but that remains to be seen. I think the global trend is towards robotic for everything and smaller pieces, which favors our LPR product portfolio.

[Frank Takkinen, Senior Research Analyst at Lake Street Capital Markets]

Got it. Very helpful. I appreciate the color. Thanks, guys.

[Jeff Blizard, President at TELA Bio]

Thanks, Frank.

[Operator]

Thank you. Our next question comes from the line of Michael Sarcone from Jefferies. Your question please.

[Michael Sarcone, Equity Research Analyst at Jefferies]

Good afternoon, and thanks for taking the question. Just A follow-up on one of the first questions, and not to belabor this, but when you provided that kind of a at least 15% directional outlook in mid-November, you mentioned there was some built-in cushion in there. Just trying to get a better sense for, you know, what changed, understanding you're trying to be even more prudent and you wanna de-risk the guide. Did anything else change, you know, over the last three months around, you know, expected rep productivity ramp or anything like that? Just trying to get a bridge from the 15% to the 8%.

[Jim Hagen, SVP of Strategic Operations and Marketing at TELA Bio]

Yeah. Hey, Michael, it's Jim. I'd say one of the biggest things is really just the tenure Jeff and I had in role. We started in June. We had that call in the fall. We were in the midst of the change. I think what we've learned since then is it was a sizable change. There were multiple things we put on the field organization at the same time while we concurrently were hiring rapidly into the organization.

[Jim Hagen, SVP of Strategic Operations and Marketing at TELA Bio]

I would say our assumptions changed from when we had the Q3 call to now, just appreciating the change curve it takes to move an organization through all of that is a bit longer and more complex, I think, than when we originally planned it out. It's not saying it's not going well. It's actually going very well.

[Jim Hagen, SVP of Strategic Operations and Marketing at TELA Bio]

The prudence point to Tony is we are gonna give ourselves some more time to work through that change curve, get new reps up to speed and up to efficiency, where we need them through, and get our legacy team in the U.S. kind of through that change curve of new leadership, new comp plan, new territory alignments, so everyone's then hitting full stride, hopefully in the second half of the year.

[Michael Sarcone, Equity Research Analyst at Jefferies]

Got it. That's very helpful. Thank you. Maybe just one on the new kind of account targeting strategy. You talked about deeper penetration in existing accounts. Can you talk to us about, you know, some of the methods, you know, you plan to use to broaden out that penetration in existing accounts?

[Jeff Blizard, President at TELA Bio]

Sure. It's Jeff Blizard. The problem statement that we analyzed over the last few months was too many reps were dependent on one surgeon in one location. We talk about terms like stickiness to our business. In order to do that, especially larger programs that have anywhere from 3-7, sometimes even 9 general surgeons or multiple plastic surgeons per site, we couldn't rely on just one user.

[Jeff Blizard, President at TELA Bio]

With the way that the comp program was set up and the goals and objectives in 2025, the need for our territory managers to be spread far and thin was so that we could gain distribution, and they could work their comp program to the best of their ability. We realized that was a limiting factor.

[Jeff Blizard, President at TELA Bio]

That meant product was in hospitals without patients being covered, and that meant users were identified without another person on staff that had bought into the product or the proposal that this was a better device or product than the ones they were using. Having this as a focus point allows us to do better in servicing, teaching and training programs how to handle the product, being present and being bedside so the patients can receive optimal outcomes.

[Jeff Blizard, President at TELA Bio]

The compensation plan was built around that specifically. Smaller geographies as opposed to we had reps that were driving in the car 3-5, sometimes even 6 hours in the great state of Texas, that they found themselves racing across the state to deliver product, to be present for that one physician and that one program.

[Jeff Blizard, President at TELA Bio]

We know that this density rule will work, as well as having in many of those large cities, as I mentioned earlier, an academic hub, where now we can put people in to help support our fellows and our residents that are being trained as the next generation surgeons.

[Jim Hagen, SVP of Strategic Operations and Marketing at TELA Bio]

Michael, the only other thing I'll add to that in terms of how we're doing this is leveraging the full portfolio. As we just talked about on Frank's conversation, we grew historically through large open procedures with 1S and 2S. As we think about building depth within a hospital, we're talking about more users within that specific site. LIQUIFIX, as an example, gives us a new opportunity to engage a surgeon who may not fully believe in OviTex but wants an alternate fixation technique. That's a new in for us. Driving IHR and LPR go after those surgeons who are more proficient on the robot or focusing on the robot.

[Jim Hagen, SVP of Strategic Operations and Marketing at TELA Bio]

Our portfolio allows us to engage with more users within a specific hospital, and that's what we're asking our field team to do, is leverage the full bag. Drive more users per site, and that's one of the key metrics we're gonna measure them on this year. That creates the stickiness for us, and that's what allows us to go after the higher ceiling accounts, and drive a deeper share within those accounts, which for us, to Tony's point, that ability to have a more predictable top-line revenue, that's part of that formula.

[Tony Koblish, Co Founder and CEO at TELA Bio]

I'll just put a fine point on the end of Jim's comment. You know, if you're wide and shallow, and you got one surgeon four hours away, who's using your product, it's pretty easy to dislodge that surgeon, right, from his usage habit and patterns, when you're not present fully, and you got competitive reps looking to lever you out with contracting and rebates. We have to get five and six users in a smaller geography. That is really what we're setting ourselves up to do. You become much harder to knock down.

[Michael Sarcone, Equity Research Analyst at Jefferies]

Great. Thank you.

[Operator]

Thank you. Our next question comes from the line of Matthew O'Brien from Piper Sandler. Your question please.

[Matthew O'Brien, Senior Research Analyst at Piper Sandler]

Good afternoon. Thanks for taking the questions. I don't know, Roberto, or if somebody else can maybe talk a little bit about the impact of weather in Q1 because the number is so low versus what we were kind of expecting. I get it's Q1 and everything, and you're still going through this transition, but it's just so low that it then requires you to start putting up some numbers in the, especially in the back half of the year that we haven't seen out of the company.

[Matthew O'Brien, Senior Research Analyst at Piper Sandler]

It requires a lot of faith that you can be able to do that. Maybe just talk about those two components there, the weather impact in Q1 and then the what you're seeing that gives you confidence and should give investors confidence that the back-end loaded guide is achievable.

[Matthew O'Brien, Senior Research Analyst at Piper Sandler]

I do have a follow-up.

[Jim Hagen, SVP of Strategic Operations and Marketing at TELA Bio]

Matthew, it's Jim. I'll take the first half of that. I'd say it's two variables external to us in Q1. We're trying not to focus on external variables, but they are real sometimes. One, feedback from our field team is just volumes in January were low, right? I think there was just a market lull coming out of the holidays with, I think insurance premiums resetting, that was a real impact. As Jeff talked about, the impact of the storms on the East Coast with major population density did shuffle some elective procedures.

[Jim Hagen, SVP of Strategic Operations and Marketing at TELA Bio]

Some were lost, right, just were not happening. Some others got deferred out past Q1. We don't have, I would say, firm guidance for you on kinda what percentage impact that had to us.

[Jim Hagen, SVP of Strategic Operations and Marketing at TELA Bio]

Now, what we are trying to focus on is more what our controllables were in Q1, which is really where we spent that time on hiring, getting new people into the organization, getting them trained up and going, along with what we just talked about is that mix shift from shifting accounts from lower ceiling accounts and kinda lower density areas to higher ceiling accounts in more populous areas. I would say that probably had the more material impact for the performance from Q4 to Q1. Those are things we can control, and that's where I think our focus is.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Matthew, you know, we have snapped back quite well after poor quarters, right? I think it was 2024 Q4, right? We had a little bit of a raid on our sales force, and we snapped back very effectively in Q1 of 2025. You know, I think we've got enough factors of safety built in with the new product launches. You know, having a fully staffed sales force at 90 reps or a little over 90 reps in the next couple of weeks here, we've never been at that scale, and we've never been, you know, fully to our hiring plan this early in the game.

[Tony Koblish, Co Founder and CEO at TELA Bio]

That's by design. Then, you know, I think the talent of the reps, you know, getting them through that 6-month bed-in period where they get productive.

[Tony Koblish, Co Founder and CEO at TELA Bio]

There's a lot of factors that are gonna help us and give us tailwind in the second half of the year.

[Roberto Cuca, COO and CFO at TELA Bio]

Matt, with regard to, you know, the back half versus first half, and confidence with that with regard to that, we've always grown quarter to quarter across the year. We have built our quotas, and expectations for, our existing reps, our tenured reps, and for new reps, based on that sort of growth. Even if we had not added the number of reps we did, in the first quarter, we would have expected to see growth across the year that would've led to that step up from the first half to the second half.

[Roberto Cuca, COO and CFO at TELA Bio]

That'll be amplified by the addition of these new reps who are, you know, gonna hit break even in about six months and then start breaking through and becoming, meaningfully productive in that second half.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Yeah, you have to remember, it's 40% of our sales force has been on board for less than six months. These are high-quality reps that we've hired and, you know, we're going through the process now of getting them bedded in and up and running.

[Matthew O'Brien, Senior Research Analyst at Piper Sandler]

Okay. Appreciate that. The follow-up is on, and I'm trying to square all the different numbers here between the LIQUIFIX and the OUS growth in the quarter is actually really good. When I start to carry that forward, I start to get some softer OviTex numbers for the full year kind of versus what you've been doing, and I'm not sure that makes a lot of sense just given the sales force expansion. Again, I know you wanna be conservative. It just leads you to the conclusion that there's something else going on that isn't quite squared away yet.

[Matthew O'Brien, Senior Research Analyst at Piper Sandler]

I don't know if there's a way you can kind of walk us through what you're expecting OviTex versus PRS versus other revenue and OUS, but just, you know, help me understand, you know, how the different product lines are gonna play out here in 2026. Thanks.

[Roberto Cuca, COO and CFO at TELA Bio]

I'll start. It's Roberto. I'll let Jeff and Jim jump in, and Tony. One thing to remember is that our Europe is purely OviTex sales, purely hernia sales.

[Tony Koblish, Co Founder and CEO at TELA Bio]

As we get solid growth from Europe, that's going to, you know, that's all going to be dropping to the quote-unquote, you know, hernia bottom line. We, you know, do expect to see PRS sales grow over the course of the year, in part from the launch of, you know, larger pieces, and, you know, potentially new technologies. It's not, you know, that we see either one of those softening up. You know, we expect to see LIQUIFIX continue to grow strongly, although it's going from a much smaller base, so it'll have a smaller revenue line impact. I'll let Jeff and Jim add anything to that.

[Jeff Blizard, President at TELA Bio]

Yeah. I think we're blessed with AMS's focus on us as a partner. They've made a huge investment in their clinical team to help us with product evaluations and trials. They've matched us. As fast as we're trying to get our organization set, so have they. I would say that, you know, with this focus we have, and we teased a little bit about it in our last quarter earnings, that we're headed towards an academic program. That's brand new to us in 2026.

[Jeff Blizard, President at TELA Bio]

Having the right leader, who we have, in Marissa Conrad focused on that, having a partner with AMS, that drives that product adoption in the general surgery residency and fellowship program, as well as the plastics. That's all, again, new.

[Jeff Blizard, President at TELA Bio]

Considering what the back half of this year looks like for new product launches, as well as not necessarily any more organizational disruption. That quote came earlier from you guys, but more as nuanced changes, always adapting and changing with the business that when they identify needs, we solve for it.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Yeah. Matt, I think what you're saying is, you know, you're looking at all the potential growth drivers, and it doesn't make sense that our OviTex business would grow less. I'm just gonna sum it up and just stick with the word prudent. Give us a chance to metabolize, you know, these territory changes, the new reps, the new products, all of it. Prudence.

[Matthew O'Brien, Senior Research Analyst at Piper Sandler]

Understood. Thank you.

[Tony Koblish, Co Founder and CEO at TELA Bio]

I don't see the hernia or PRS business collapsing in any way.

[Operator]

Thank you. This does conclude the question and answer session of today's program. I'd like to hand the program back to Antony Koblish for any further remarks.

[Tony Koblish, Co Founder and CEO at TELA Bio]

Thank you, Jonathan. Thank you. You know, the changes we made were thorough. I hope you got a sense of that. We've never cleared the decks to this level, right? I think in the past, you know, the changes have been a little from this place, a little from that piece, you know, incremental, 'cause we're, you know, striving to go wide and make numbers, right? We're taking a step back from that to recast this in absolutely the right way across every dimension, whether it's comp, focus, population density, rep density, everything.

[Tony Koblish, Co Founder and CEO at TELA Bio]

I think we have it set up correctly for the long haul. There's gonna be much less disruption from this point forward.

[Tony Koblish, Co Founder and CEO at TELA Bio]

We have it locked in the way we want it now, the way Jeff and Jim want it, and now we just gotta operate the machinery in the right way. We really appreciate your interest. Stay patient, and we look forward to what's ahead.

[Operator]

Thank you, ladies and gentlemen, for your participation in today's conference. This does conclude the program. You may now disconnect. Good day.

Participants

Executives

• Jeff Blizard, President
• Jim Hagen, SVP of Strategic Operations and Marketing
• Louisa Smith, Investor Relations
• Roberto Cuca, COO and CFO
• Tony Koblish, Co Founder and CEO

Analysts

• Caitlin Roberts, Director of MedTech Equity Research at Canaccord Genuity
• Frank Takkinen, Senior Research Analyst at Lake Street Capital Markets
• Matthew O'Brien, Senior Research Analyst at Piper Sandler
• Michael Sarcone, Equity Research Analyst at Jefferies