TELA Bio, Inc., a commercial-stage medical technology company, focuses on providing soft-tissue reconstruction solutions that optimize clinical outcomes by prioritizing the preservation and restoration of the patient's anatomy. It provides a portfolio of OviTex Reinforced Tissue Matrix (OviTex) products for hernia repair and abdominal wall reconstruction; and OviTex PRS Reinforced Tissue Matrix products to address the unmet needs in plastic and reconstructive surgery, as well as OviTex for Lapar
2-Year Price History
Quarterly Financials & Projections
| Period | Rev | EBITDA | OpIn | NI | OCF | FCF | CapEx | Cash | Debt | Shares | ROIC | IntCov | EV/EBITDA | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Est | 2028-Q1 | 24.0 | -7.2 | -- | -9.6 | -- | -5.3 | -0.1 | -1.8 | -- | -- | -- | -- | -- |
| Est | 2027-Q4 | 26.0 | -5.2 | -- | -7.8 | -- | -3.1 | -0.1 | 3.5 | -- | -- | -- | -- | -- |
| Est | 2027-Q3 | 24.0 | -6.7 | -- | -9.1 | -- | -4.3 | -0.1 | 6.6 | -- | -- | -- | -- | -- |
| Est | 2027-Q2 | 22.5 | -7.9 | -- | -10.1 | -- | -5.6 | -0.1 | 10.9 | -- | -- | -- | -- | -- |
| Est | 2027-Q1 | 21.5 | -8.6 | -- | -10.8 | -- | -6.5 | -0.1 | 16.6 | -- | -- | -- | -- | -- |
| Est | 2026-Q4 | 23.5 | -6.6 | -- | -8.9 | -- | -4.2 | -0.1 | 23.0 | -- | -- | -- | -- | -- |
| Est | 2026-Q3 | 21.5 | -8.2 | -- | -10.3 | -- | -5.4 | -0.1 | 27.2 | -- | -- | -- | -- | -- |
| Est | 2026-Q2 | 19.8 | -9.5 | -- | -11.5 | -- | -6.9 | -0.1 | 32.6 | -- | -- | -- | -- | -- |
| Act | 2026-Q1 | 19.1 | -10.5 | -10.5 | -12.3 | -11.2 | -11.3 | -0.1 | 39.5 | 55.9 | 57.3 | -75.4% | -5.1x | -- |
| Act | 2025-Q4 | 20.9 | -6.7 | -6.7 | -9.0 | -4.9 | -5.0 | -0.1 | 50.8 | 55.7 | 51.7 | -39.7% | -4.1x | -- |
| Act | 2025-Q3 | 20.7 | -7.2 | -7.6 | -8.6 | -5.7 | -5.9 | -0.2 | 29.7 | 42.0 | 45.4 | -62.0% | -6.0x | -- |
| Act | 2025-Q2 | 20.2 | -8.4 | -9.1 | -9.9 | -7.9 | -8.0 | -0.1 | 35.0 | 41.9 | 45.4 | -64.3% | -7.1x | -- |
| Act | 2025-Q1 | 18.5 | -9.7 | -10.5 | -11.3 | -9.7 | -9.8 | -0.0 | 42.8 | 41.8 | 45.3 | -63.8% | -8.0x | -- |
| Act | 2024-Q4 | 17.7 | -7.8 | -8.4 | -9.2 | -7.5 | -7.8 | -0.3 | 52.7 | 43.1 | 40.1 | -42.2% | -6.1x | -- |
| Act | 2024-Q3 | 19.0 | -8.8 | -9.4 | -10.4 | -9.0 | -9.1 | -0.1 | 17.3 | 41.5 | 24.7 | -90.2% | -6.5x | -- |
| Act | 2024-Q2 | 16.1 | -11.0 | -11.6 | -12.6 | -10.7 | -11.0 | -0.3 | 26.5 | 41.4 | 24.7 | -106.3% | -8.3x | -- |
| Act | 2024-Q1 | 16.6 | -4.1 | -4.8 | -5.7 | -14.4 | -14.7 | -0.3 | 37.1 | 41.2 | 24.6 | -35.0% | -3.1x | -- |
| Act | 2023-Q4 | 17.0 | -11.4 | -12.3 | -12.9 | -11.1 | -11.3 | -0.2 | 46.7 | 42.8 | 24.5 | -80.0% | -8.5x | -- |
| Act | 2023-Q3 | 15.1 | -9.4 | -10.2 | -11.0 | -7.0 | -7.1 | -0.1 | 58.2 | 41.8 | 24.5 | -56.1% | -7.0x | -- |
| Act | 2023-Q2 | 14.5 | -9.3 | -10.4 | -10.8 | -11.3 | -11.4 | -0.2 | 65.3 | 41.7 | 23.2 | -50.2% | -7.2x | -- |
| Act | 2023-Q1 | 11.9 | -10.6 | -11.3 | -12.0 | -11.6 | -11.7 | -0.1 | 30.1 | 41.6 | 19.2 | -98.6% | -8.5x | -- |
| Act | 2022-Q4 | 11.6 | -8.6 | -9.4 | -10.0 | -11.0 | -12.0 | -1.1 | 42.0 | 41.5 | 19.2 | -66.3% | -7.3x | -- |
| Act | 2022-Q3 | 11.2 | -9.5 | -9.5 | -10.7 | -7.7 | -7.9 | -0.3 | 54.2 | 40.1 | 16.8 | -58.4% | -9.2x | -- |
| Act | 2022-Q2 | 10.4 | -11.2 | -10.2 | -12.7 | -11.7 | -11.9 | -0.2 | 27.7 | 40.0 | 14.6 | -102.5% | -12.0x | -- |
| Act | 2022-Q1 | 8.2 | -9.8 | -9.8 | -10.9 | -10.4 | -10.8 | -0.3 | 33.0 | 32.0 | 14.5 | -111.6% | -10.8x | -- |
Multiples vs the company's own history — cheap or rich relative to itself? Historical fiscal years, then TTM, then forward projections (E). Forward rows hold today's price against projected earnings, so the multiple compresses if the company grows into it.
| Year | Price | Rev Gr | EBITDA % | EBITDA | EV/EBITDA | EV/FCF | P/E | P/S |
|---|---|---|---|---|---|---|---|---|
| 2022 | 11.50 | — | -94.3% | -39 | n/m | n/m | n/m | 3.9× |
| 2023 | 6.62 | +41.1% | -69.5% | -41 | n/m | n/m | n/m | 3.1× |
| 2024 | 3.02 | +18.6% | -45.7% | -32 | n/m | n/m | n/m | 0.9× |
| 2025 | 1.18 | +15.8% | -39.8% | -32 | n/m | n/m | n/m | 0.8× |
| TTM | 0.97 | +13.5% | -40.5% | -33 | 0.0× | 0.0× | 0.0× | 0.0× |
| 2027E | 0.97 | +16.3% | -0.3% | -0 | 0.0× | 0.0× | 0.0× | 0.0× |
EBITDA in reporting-currency $M. Historical multiples use year-end market cap (split-adjusted price history); TTM & forward years use today's.
AI Analysis
LLM Evaluations
TELA Bio is a deeply distressed pre-profit medical device company burning $10-12M per quarter with negative equity, 12%+ cost of debt, and massive dilution overhang from 12.6M pre-funded warrants. Revenue growth has decelerated sharply from 16% in FY2025 to 3% in Q1 2026 despite a 35% increase in headcount, revealing severe diminishing returns on commercial investment. The company is effectively locked out of meaningful U.S. market share by BD's dominant bundling contracts, and ASP compression from product mix shift undermines the unit growth narrative. With ~25 months of cash runway, another dilutive capital raise is highly probable, further destroying common equity value. The stock trades at 0.55x revenue, but even this appears expensive given the negative equity, absence of any path to near-term profitability, and the structural competitive disadvantage against BD. This is a capital destruction story where common shareholders bear the maximum downside risk.
Latest Earnings Call
Transcript Summary
TELA Bio reported Q1 2026 revenue of $19.1 million, a 3% year-over-year increase, while unit volume for OviTex grew 16%. The company's European business was a standout performer, growing 41% due to strong U.K. adoption. Management emphasized that the U.S. commercial reset is complete, with a fully staffed sales team of over 90 territory managers. Productivity is expected to inflect in the second half of 2026 as recent hires hit their six-month tenure. The launch of OviTex LTR, a fully resorbable hernia reinforcement, is expected to be a major growth driver. Despite a slight dip in OviTex PRS revenue due to surgeon concentration risks, the company is pivoting to a high-density hospital strategy to diversify its user base. TELA Bio reiterated its full-year guidance of at least 8% growth and announced a major reconstitution of its Board of Directors to include seasoned medtech leaders. With $39.5 million in cash, the company believes it is well-positioned to reach its next growth phase as the sales team matures and clinical evidence continues to support the OviTex portfolio's efficacy over synthetic alternatives.
Valuation & Metrics
Market Stats
TTM Financial Snapshot
DCF Fair Value Estimate
Forward Outlook & Risk
Short Interest
Options
| Strike | Call Bid/Ask | Call OI | Put Bid/Ask | Put OI |
|---|---|---|---|---|
| $2.50 | --/$0.45 | 7 | --/$2.50 | 50 |
| $5.00 | --/$4.40 | 0 | $1.50/$4.90 | 0 |
| $7.50 | --/$4.40 | 0 | $4.00/$7.50 | 0 |
Forward Projections & Estimates
Employees
Cash Runway
Institutional Ownership
Headline & net flow
In Q1 2026 so far (quarter still filing), institutions are net sellers — bought 2.1% of float, sold 3.5%.
Ownership composition
Top holders
| Fund | $ value | Cost basis | Δ QoQ | Δ YoY | α life | Fund AUM |
|---|---|---|---|---|---|---|
| Essex Woodlands Management, Inc. | $4.8M | $4.66 | +$0 | +$2.2M | -5.1% | $251M |
| Nantahala Capital Management, LLC | $3.2M | $4.05 | +$20K | +$785K | -2.3% | $1.60B |
| Stonepine Capital Management, LLC | $1.6M | $4.00 | +$164K | +$348K | -5.5% | $113M |
| SILVERARC CAPITAL MANAGEMENT, LLC | $1.4M | $4.56 | −$241K | −$317K | +0.0% | $843M |
| VANGUARD CAPITAL MANAGEMENT LLCPassive | $955K | $0.62 | +$955K | +$955K | — | $4.04T |
| DAFNA Capital Management LLC | $893K | $3.02 | +$0 | +$0 | -5.2% | $434M |
| PERKINS CAPITAL MANAGEMENT INC | $879K | $3.04 | +$13K | +$315K | -1.5% | $105M |
| UBS Group AG | $657K | $3.08 | −$273K | +$452K | -0.3% | $562.11B |
| CITIGROUP INC | $465K | $2.84 | +$0 | +$0 | -0.3% | $156.55B |
| Sio Capital Management, LLC | $395K | $3.01 | +$0 | +$4K | -1.2% | $694M |
| BlackRock, Inc.Passive | $289K | $2.46 | +$2K | +$25K | -0.2% | $5.69T |
| GEODE CAPITAL MANAGEMENT, LLCPassive | $282K | $5.87 | +$58K | +$67K | +2.3% | $1.61T |
| WealthTrust Axiom LLC | $234K | $1.31 | +$34K | +$234K | +0.2% | $406M |
| VANGUARD FIDUCIARY TRUST COPassive | $131K | $0.62 | +$131K | +$131K | — | $395.83B |
| UP STRATEGIC WEALTH INVESTMENT ADVISORS LLC | $110K | $3.42 | +$0 | +$0 | +0.1% | $159M |
| NORTHERN TRUST CORPPassive | $108K | $5.65 | +$0 | +$68K | -0.2% | $755.34B |
| Embree Financial Group | $73K | $1.30 | +$4K | +$65K | -0.3% | $847M |
| STATE STREET CORPPassive | $39K | $9.05 | +$0 | +$0 | -0.2% | $2.89T |
| PNC FINANCIAL SERVICES GROUP, INC. | $33K | $6.98 | +$0 | +$0 | +0.3% | $173.16B |
| RENAISSANCE TECHNOLOGIES LLC | $33K | $3.56 | −$47K | −$119K | +1.2% | $63.91B |
Trading behavior
▸ Compare to holder-profile behavior (across all their stocks)
Biggest decreases this quarter
New buyers this quarter
Top-5 holders · 71.5%
Top Holders Over Time
5-year share-count history (top 10 holders by peak, incl. exited) + price
Analyst Coverage
| Quarter | Revenue | EBITDA | Net Inc | EPS | EPS Range | # Analysts |
|---|---|---|---|---|---|---|
| 2025 Q3 | 22M | 3M | -11M | $-0.19 | $-0.19 – $-0.19 | 2 |
| 2025 Q4 | 21M | 3M | -10M | $-0.18 | $-0.18 – $-0.18 | 3 |
| 2026 Q1 | 19M | 2M | -11M | $-0.18 | $-0.18 – $-0.18 | 3 |
| 2026 Q2 | 20M | 2M | -10M | $-0.17 | $-0.17 – $-0.17 | 3 |
| 2026 Q3 | 23M | 3M | -8M | $-0.15 | $-0.15 – $-0.15 | 3 |
| 2026 Q4 | 25M | 3M | -7M | $-0.13 | $-0.13 – $-0.13 | 1 |
| 2027 Q1 | 22M | 3M | -8M | $-0.14 | $-0.14 – $-0.14 | 1 |
| 2027 Q2 | 22M | 3M | -7M | $-0.13 | $-0.13 – $-0.13 | 1 |
| 2027 Q3 | 25M | 3M | -6M | $-0.11 | $-0.11 – $-0.11 | 1 |
| 2027 Q4 | 27M | 3M | -6M | $-0.11 | $-0.11 – $-0.11 | 1 |
Corporate
Executive Compensation (2018-2019)
Insider Trading (last 12mo)
| Date | Side | Insider | Title | Shares | Price | Dollars | Owned $ |
|---|---|---|---|---|---|---|---|
| 2025-11-17 | BUY | EW HEALTHCARE PARTNERS FUND 2, L.P. | 10 percent owner, other: See Remarks | 3,604,000 | $1.11 | $4.00M | $8.56M |
Order Flow (FINRA, ~3w lag)
Revenue Breakdown
Revenue Segments
| Non-US | $3.7M | +42% |
Filing Risk Analysis
Filing Risk Scores
TELA Bio, Inc.: Negative Equity and Restricted Liquidity Signal a High-Risk Dilution Death Spiral
Counter-Thesis
Counter-Thesis & Recent News
TELA Bio reported a significant Q1 2026 earnings miss in May 2026, with an EPS of -$0.21 (missing estimates by $0.05) and revenue of $19.1M (missing the $21.28M consensus). Management slashed full-year 2026 revenue growth guidance to 'at least 8%,' a sharp decline from the previously expected 15%. This follows a Q4 2025 revenue miss and a major downgrade by Piper Sandler from Overweight to Neutral, citing concerns over the company's 'steep ramp' required to meet even lowered targets (Sources: Investing.com, Seeking Alpha, March-May 2026).
The core bear case centers on severe growth deceleration and lack of a path to profitability. Revenue growth slowed to just 3% YoY in Q1 2026. Despite an aggressive sales rep expansion (targeting 97 reps), the company is seeing diminishing returns as unit growth (13%) is decoupled from revenue growth (3%) due to ASP compression. Net losses widened to $12.3M in Q1 2026. With a negative free cash flow of -$26.7M and a staggering debt-to-equity ratio of 913.3x, the company remains a high-risk 'value trap' that may eventually require a dilutive capital raise despite management's denials (Sources: GuruFocus, Ticker Nerd, 2026).
Financial health metrics are deteriorating: gross margins contracted to 66% (down from 68%) due to higher charges for 'excess and obsolete inventory' and a shift toward smaller, lower-priced units. Interest expenses have surged to $2.1M due to a new, larger credit facility with Perceptive. Furthermore, the stock has plummeted roughly 49% in the last six months, and the recurring need to blame 'product mix headwinds' for revenue misses suggests a lack of pricing power (Sources: Seeking Alpha, Jefferies/Investing.com).
TELA is effectively locked out of the U.S. hernia repair market by incumbent Becton Dickinson (BD), which controls 65-77% of the market. TELA’s own December 2025 lawsuit against BD admits that BD uses 'monopoly-like' bundling contracts and GPO exclusivity to block OviTex from hospital shelves. Despite OviTex being priced roughly 33% lower than BD’s Phasix, TELA has failed to exceed an 8% market share in the U.S. resorbable market, illustrating the massive barrier to entry posed by dominant players (Sources: Bloomberg Law, Fierce Biotech).
Sentiment among hospital administrators and surgeons appears constrained by institutional inertia and contractual obligations. While management touts 'positive feedback' for OviTex LTR, the 'U.S. product mix headwinds' indicate that customers are opting for the smallest, lowest-margin units or remaining loyal to BD's established ecosystem to maintain bundling discounts. The 3% growth rate suggests that the value proposition of TELA’s sheep-derived matrix is not compelling enough to trigger a large-scale shift away from synthetic or established biologic incumbents (Sources: Seeking Alpha, GuruFocus).
Full Earnings Call Transcript
Full Earnings Call Transcript — Q1 • 2026-05-12
Operator: Good day, everyone, and welcome to TELA's First Quarter 2026 Conference Call. [Operator Instructions] Please be advised that today's conference is being recorded. I would now like to turn the call over to Louisa Smith. Please go ahead. Louisa Smith: Thank you, Carmen, and good afternoon, everyone. Earlier today, TELA Bio released financial results for the first quarter ended March 31, 2026. A copy of the press release is available on the company's website. Joining me on today's call are Tony Koblish, Chief Executive Officer; Jeff Blizard, President; Roberto Cuca, Chief Operating Officer and Chief Financial Officer; and Jim Hagen, SVP of Strategic Operations and Marketing. 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 quarterly reports on Form 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. 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'll now turn the call over to Tony. Antony Koblish: Thank you, Louisa. Good afternoon, and thank you for joining TELA Bio's First Quarter 2026 Earnings Call. I'll open with a summary of what we accomplished in the first quarter and our perspective on the road ahead. Jeff will then walk through some updates on progress in the commercial organization and our continued execution against the plan we laid out last quarter. Roberto will review our financials, and then we will open it up for Q&A. Last quarter, we laid out a framework detailing the decisive steps we have taken to reset our commercial strategy, and Q1 results show early proof points that our strategic plan is working. We currently have the largest, most effective field team in the company's history and have achieved the hiring targets necessary to deliver against our operating plan. Our sales territories are fully staffed with exceptional talent and new hires are ramping up to productivity levels on expected time lines. The remainder of '26 will be about executing on our redefined strategy and the task ahead is to translate our U.S. commercial reset into measurable success. The foundational work is behind us, and we are at an inflection point that should become increasingly visible in our results through the remainder of the year. Beyond upgrading our U.S. field team, there are several favorable tailwinds that gives me confidence in delivering a strong second half of 2026. To start, on April 1, we initiated the full U.S. commercial launch of the OviTex long-term resorbable reinforcement portfolio, which we are calling OviTex LTR. This product is one of the only fully resorbable tissue-based hernia repair solutions on the market. Surgeons and patients are increasingly demanding solutions that deliver durable long-term outcomes while minimizing exposure to permanent synthetic materials. With OviTex LTR, surgeons now have a full suite of products that offer the critical structure and strength required in the early phases of healing while avoiding the long-term risk of residual plastic material in the body. We believe OviTex LTR will be instrumental in attracting new surgeons who have yet to adopt OviTex by offering them and their patients a more effective, fully resorbable solution. We have priced OviTex LTR comparably to the rest of our hernia portfolio, preserving the value proposition for both surgeons and hospital administrators. Early feedback in the field has been overwhelmingly positive, and we believe that LTR will be a meaningful contributor to this product portfolio. Second, we saw breakout performance in our European business with revenue growth of 41%. And as a reminder, this growth is driven entirely by our hernia portfolio as we are still in the regulatory process of bringing PRS to the market in Europe. We saw exceptional performance in the U.K., where we continue to deepen our presence, win new accounts and gain clinical administrative buy-in, driven by our value proposition and product efficacy. As we start to scale within Continental Europe, we have found distinct unmet needs in those countries, the most pronounced being the demand from government-run health care systems seeking novel ways to optimize costs and patient outcomes. TELA is well positioned to win in these market dynamics. A strong validation of TELA's value proposition came through the NHS Supply Chain's value-based procurement evaluation, which selected OviTex for use in complex ab-wall procedures. Through independent analysis, the NHS found that OviTex has the potential to reduce the need for revisional operations for hernia recurrence, lower the prevalence of postoperative complications, improve patient well-being and generate cost savings compared with other biologic mesh options. We believe these findings are transferable across health systems and see a clear opportunity for our products to perform just as well in additional EU markets. Finally, the quantity and quality of evidence supporting OviTex continues to grow. Most recently, a meta-analysis was presented at SAGES comparing OviTex with other mesh options for ventral hernia repair. The authors were highly respected surgeons, well-known thought leaders in the space, and they concluded that OviTex is a safe and effective option for ventral hernia repair with significantly lower recurrence rates. These data emerged alongside the publication of results from a large real-world European registry evaluating a resorbable competing product, which showed recurrence rates exceeding 20%, consistent with several other studies of that product and nearly 10x the recurrence rates observed across the OviTex portfolio. Before turning it over to Jeff, I'd also like to address the strategic Board changes we announced in late April. Four of our long-serving directors, Doug Evans, Kurt Azarbarzin, Vince Burgess and Freddie O'Brien will be stepping down following our Annual Shareholder Meeting on June 9. We are deeply grateful for their contributions and the strong foundation they helped establish for TELA Bio. Coming on to the Board will be Joe Capper, who is expected to serve as Chairman; Guy Nohra, Guido Neels and Paul Thomas. Each of them has deep industry experience in scaling medtech companies and navigating strategic transformations. Bill Plovanic and Betty Jo Rocchio will stand for reelection at the annual meeting and will provide valuable continuity as we reset our Board composition. I am looking forward to working with this new Board and believe that it will position TELA to execute with greater speed and focus as we advance our commercial strategy and drive towards sustained profitability. We exit Q1 with a strong foundation from which we can deliver against our commitments in 2026. To summarize, we have a fully staffed U.S. commercial team and expanded portfolio that includes one of the only fully resorbable tissue-based hernia portfolios on the market, continued evidence supporting the significant benefits of OviTex, a European business that is driving exceptional performance and a reconstituted Board of Directors to help us achieve our next phase of growth. With that, I'll turn it over to Jeff for a more detailed look at commercial execution. Jeff? Jeffrey Blizard: Thanks, Tony. On prior calls, I laid out a detailed overview of the steps we've taken to recalibrate the commercial organization. And I'd like to spend some time providing updates on our progress. As Tony mentioned in his comments, our U.S. commercial organization is fully staffed now at our expected 2026 levels. Our attention shifts from recruiting and onboarding to development and execution. I mentioned in our last call that 40% of our field team was hired between the start of Q4 and the end of Q1. By the end of Q2, nearly 3/4 of those new hires will have reached their 6-month tenure at TELA. This is an important milestone as 6 months is when we typically see territory managers break even and cover their costs. Also, it's around the same time that we see productivity inflection points when territory managers generate revenue momentum after building relationships, establish clinical credibility and work through procurement processes while training the clinical team so that patients can be treated with OviTex. I'm very encouraged by the early results from our recent hires as they're performing well ahead of any prior class and early-stage indicators, including account conversations and clinical engagement scores. The profile that we're recruiting and training for is working. Their output will follow, and we expect them to contribute at an increasing rate in the second half of this year 2026. Previously, I also discussed how we were realigning territories to enable our field team to increase their presence in more densely populated regions with high-volume potential. We're prioritizing deeper relationships within the hospital, leveraging the entire portfolio to treat more patients across the institution. We see signs of success already in selling the full bag strategy, especially in hernia. OviTex IHR and OviTex LPR are our fastest-growing subsegments within our portfolio. This product mix shift is driven by U.S. market dynamics that are moving towards a less invasive procedure, especially those performed robotically. Our year-over-year unit growth rate of 16% in OviTex shows that we're gaining market share and demonstrates that surgeons recognize TELA as the best in hernia products. We are primed and well positioned to capitalize on procedural trends, whether they're shifting from robotic procedures as in the U.S. or towards open procedures as remains the predominant approach in the U.K. The launch of a long-term resorbable option across the entire hernia portfolio gives us even more optimism that we can continue to capture procedural share. We have only fully resorbable -- we have the only fully resorbable tissue-based product line that can compete in an open, laparoscopic and robotic repair across the entire spectrum of hernia procedures. Additionally, LIQUIFIX, with its greater than 50% year-over-year growth has been a meaningful addition to our field team as it offers our reps a non-penetrating fixation solution that helps engage surgeons who may not have previously been familiar with OviTex. Our U.S. sales strategy pivot to deepening our presence and expanding our implanter base in target accounts was validated by observed dynamics within OviTex PRS Q1 unit volume. The utilization of PRS declined in the quarter, driven by the absence of several of our highest volume implanters who are not performing surgeries due to various personal and professional reasons. This is precisely the concentration risk for our new commercial focus was designed and we need to address. We're incentivizing our sales force to mitigate these future risks like these by training additional surgeons within the same practice to use OviTex, thereby reducing our dependence on any one single implanter to help build a broader, more durable foundation for OviTex adoption. Finally, I want to highlight our European business and its 41% year-over-year growth. Several of the changes that we're making in the U.S. are modeled off the success that we saw within our European team. Notably, routine presence in the operating room, developing believers in the OviTex product line across multiple surgical specialties at target hospitals and leveraging peer-to-peer networks to educate surgeons on the unique mechanism of action within OviTex. Our European team continues to be an example of what is the right talent with enough tenure and what they can do with the product as effective and novel as OviTex. Surgeons want a product that provides early strength, delivers a durable repair, leaves nothing behind and is supported by our robust clinical evidence. The OviTex portfolio meets these needs. We now also have a commercial engine to get the product into more surgeons' hands. I'm confident that the outcomes we see in Q1 validate these changes that we implemented. We have an incredible team, and we're approaching the market in a more strategic, focused manner that will unlock significant opportunities for us. I look forward to updating you on our continued progress in the months ahead. And with that, I'd like to turn it over to Roberto for the financial review. Roberto Cuca: Thank you, Jeff. Revenue for the first quarter of 2026 was $19.1 million, an increase of approximately 3% compared to $18.5 million in the first quarter of 2025. Growth was primarily driven by our international business with international sales of $3.7 million, representing a 41% increase over the prior year period. OviTex revenue was $12.6 million, up from $12.1 million in the prior year period. OviTex unit volume increased 16% year-over-year with 5,800 units sold in the first quarter compared to 5,000 units in the first quarter of 2025. Dollar growth was partially offset by product mix. The proportion of smaller-sized units increased, compressing ASP for that line. We view this as positive, demonstrating our hernia portfolio has the breadth and clinical efficacy to meet surgeons' changing procedural needs. OviTex PRS revenue was $5.9 million compared to $6.0 million in the first quarter of 2025. Other revenue, which includes LIQUIFIX, was $600,000. Gross profit was $12.5 million in the first quarter of 2026, in line with the prior year period. Gross margin was 66% compared to 68% in the first quarter of 2025. The modest decline was driven by a higher charge for excess and obsolete inventory as a percentage of revenue. Total operating expenses were $23 million in the first quarter of 2026, essentially flat with $23 million in the first quarter of 2025. Sales and marketing was $16.5 million, down modestly from $16.6 million in the prior year, with lower commission expense partially offset by higher meeting and training costs. General and administrative was $4.2 million, up from $3.8 million, primarily due to higher professional fees. Research and development was $2.3 million, down from $2.5 million. Loss from operations was $10.5 million in the first quarter of 2026 compared to $10.5 million in the first quarter of 2025, essentially flat year-over-year. As we signaled last quarter, Q1 typically reflects a step-up in operating loss relative to Q4 due to seasonal revenue and spending patterns. Additionally, the first quarter of this year included certain compensation-related costs associated with the completion of our hiring build-out. We expect operating loss to improve markedly as revenue grows throughout the year. Net loss was $12.3 million in Q1 2026 compared to $11.3 million in Q1 2025. The increase was primarily due to higher interest expense of $2.1 million, reflecting our new larger Perceptive credit facility that was put in place in November 2025 versus $1.2 million in the prior year period under our prior MidCap facility. We ended the quarter with $39.5 million in cash and cash equivalents. As for our full year 2026 outlook, we are reiterating guidance of at least 8% revenue growth over 2025 with Q2 2026 revenue of approximately $20.0 million. I'll turn the call back to Tony for some closing remarks. Antony Koblish: Thanks, Roberto. As we've done in prior quarters, I'd like to close with a patient story that grounds us in the purpose behind everything we do. A female patient presented to a trauma center in Liverpool, U.K. following the fall from a height, the patient experienced severe multi-organ trauma, required damage control surgery, stage reconstruction and careful management within a challenging surgical field, where traditional solutions were limited. The local TELA Bio representative helped the surgeon identify the appropriate use of OviTex 1S to support the required reconstruction in a challenging anatomical and clinical environment. Due to the timely use of OviTex and the product's unique mechanism of action, the patient underwent a successful abdominal wall reconstruction despite a highly complex presentation. 11 months out, the patient has no wound or mesh-related complications, thus avoiding additional surgeries and a prolonged recovery. This story is a great example of how OviTex when selected and appropriately used as the first mesh in a patient's treatment, helps achieve positive patient outcomes and reduces the future burden on health care resources. Before we open the line for questions, I want to take a moment to recognize the TELA team. Amid much change, we solidified our commercial foundation, launched a portfolio expansion that will benefit many patients for years to come, enrolled more patients in our clinical studies, saw our belief in OviTex reaffirmed through more published evidence and reconstituted our Board of Directors. That does not happen without a team that is fully committed to the patients and the surgeons we serve. I truly believe that we are set up for the next phase of our growth, starting with a strong second half of 2026. I look forward to what's ahead for TELA. Carmen, please open the line for questions. Operator: [Operator Instructions] Our first question is from Caitlin Cronin with Canaccord Genuity. Caitlin Cronin: Congrats. Would love some more color on your guidance philosophy for the Q2. Just given your new commercial strategy emphasizing density, was that disruptive in the Q1 as you expected? And do you expect this to have an impact in the Q2? Jeffrey Blizard: So, we used the first quarter to roll out not only a new strategy. We also had expanding territories, a revised compensation plan. So we threw a lot at our commercial organization and then still resulted in a quarter over -- prior year growth. As we sit inside here at TELA Bio, from what we went through changes in 1 quarter alone, not many commercial companies experienced that same amount of internal organization change. So we were very fortunate that the team really stayed focused on the patient and the outcomes and also prepared us for launching a brand-new product with LTR. So I think as we look at our training, our training has been redesigned for our onboarding classes, trying to ramp up that speed faster for the return on really them coming and joining the team, but ultimately, getting into these programs and establish relationships and being bedside. So we are at that critical mark now, between the 6- to 9-month onboarding time frame where we actually see that rate of return and feel really good about the second half. Antony Koblish: And I'd highlight one thing that Jeff said in the prepared remarks, which is that we're coming up now on a pretty substantial portion of our sales force hitting the 6-month period that hit or will be shortly hitting breakeven. And as Jeff said, there's an inflection point in their productivity at that point. So we expect towards the end of the second quarter, beginning of the third quarter for that traction to begin exhibiting itself and generating pretty significant revenues in the third and fourth quarters. Caitlin Cronin: Great. And you noted last quarter that the competitive environment in Europe differs a bit from the U.S., just given the pricing and bundling dynamics. Maybe just more color on that and how that's potentially helping the European momentum? Antony Koblish: Yes, I'll cover that, Caitlin. So Europe is a different structure, right, tend to have socialized medicine, for the most part. That would be a good description. A lot of what is done there is based on tender offers where the product is evaluated by a central agency for a value proposition. That would be both an economic and clinical value proposition. So it's a fairly straightforward assessment of all the different product opportunities, the data, how they're supported and what they cost. It's a much more complicated picture in the U.S. where there are cross-category bundles. There may even be wraparound rebate strategies and bundles, tiered pricing and just the mechanism that's put in place through the IDNs that roll up to GPOs and then the complex contracting strategies that large companies tend to use, it tends to make for a much more difficult and complicated situation and system, right? And believe it or not, in Europe, it's very understandable. And it's a wide-open market, if you've got the right product with the right data at the right price point, and I would classify that as value proposition, and we certainly have that. So I think that is a perfect representation of what's possible in the U.S. market once we start working through and have our restructured commercial strategy to break through some of those barriers and some of those opaque processes that are in place, right? That means smaller regions, smaller territories, more focus, more depth, not being as spread out as we used to be. So it's critical that we get more focused and tighter in our alignments, and that's really the main reason. Operator: Our next question comes from Frank Takkinen with Lake Street Capital Markets. Ian Arnt: This is Ian on for Frank. Congrats on the quarter. First for me, on the Q4 call, you guys had said that the 40% new cohort had stepped up nicely in Q4. And I was just wondering, did -- in Q1, did the productivity from that group continue stepping up at the same pace? Or did you see a more pronounced inflection in Q1? And how does that change how you're thinking about time to break out for that cohort relative to the 6- to 9-month benchmark? Jim Hagen: Ian, it's Jim. I'll take that one. So you're right, in Q4, when we were talking about the new hire cohort, we talked really about a leading indicator of testing scores that they were testing faster or higher than previous cohorts. And we have seen that translate in Q1 in terms of ramp time and productivity in their first 30, 60, 90 days enroll. From the metrics we look at internally, those are trending higher than previous cohorts, which gives us, again, that bullishness that these are the right people that we hired. We have continued to add additional people in Q1. So we are at our staffing levels for 2026 now. So just like the other cohorts, they're going to need time to ramp. We still believe that 6-month inflection point is real, like breakeven, as Roberto talked about. And from beyond 6 months, you start to see a nice upward slope in productivity. And so that's why all the points you heard from Tony, Jeff and Roberto, we are confident that the back half for us is set up strongly. Antony Koblish: Yes, that 40% of new reps will be through their 6-month bed-in period or start-up phase by the end of Q2, right? So we're not seeing the full benefit of that cohort yet, but we see some good signals. Jeffrey Blizard: And Ian, this is Jeff. Just maybe for some further clarification. When we bring in a new hire, for the first 3 months, they're not in their territory. So we ship them all around the country, both in-house training, out with field sales trainers, across different regions so they can experience multiple procedures from different users before they ever step foot in at month 4 within their territories. So you figure 3 months just to understand the geography, the maps of the hospitals, how to get in, get access. So that takes a good 3 months to establish that. And then around month 6 or after 3 months of understanding their role within those hospitals is where we see that inflection point. So I just want to make sure that everybody understood that that's a typical... Antony Koblish: Yeah, and by that time -- our training process completes as well. Ian Arnt: Okay. Got it. And then just one more for me. Can you guys provide an update on the items you called out as factors of safety related to the 8% growth rate, specifically the contract execution timing, new rep maturation and territory splits and kind of how those are tracking? Jeffrey Blizard: So a couple, and I'll have Jim maybe look for some metrics as I maybe explain what makes us confident in that 8% is I think there's 4 main reasons, right? It's our current U.S. sales hiring and effectiveness being fully staffed at greater than 90 territory managers. We have 19 greenfield territories, so brand-new markets where we weren't even in, identified around key programs in key cities. Our EU performance, where they've come in quarter-to-date at 41%, but they're going to continue to trend above plan, especially given the fact that we've got a new sales leader there, one retired. We brought in an excellent sales leader there who's shoulder to shoulder with his team. We've got an OviTex LTR launch, which is really the Goldilocks device in its category, as we say here. And then finally, the evidence that's being published about some other competitive products in the space that we play in. So, we're bullish around that 8% number. Antony Koblish: Yes. The profile for our product is rising in the U.S. And I think we meet that opportunity with a fully staffed sales force with 19 or 20 new greenfield territories, right? So these are some of the elements that we've layered together to give us confidence. Jeffrey Blizard: And maybe the last comment I'd add too is, with what was not mentioned in our comments was the investment in medical education. And we continue to do that with adding labs, getting active programs built, peer-to-peer programs. And that's been -- that's where really the rubber hits the road in med device when surgeons can see this used up close and be in settings outside of their programs to ask questions and see how the supplies to patients. Antony Koblish: Yes, we got 40 surgeons coming together this weekend, and we've done several of these programs this year. So that's also loading the pipeline as well. Operator: Our next question comes from Michael Sarcone with Jefferies. Michael Sarcone: Just to start, I wanted to ask on guidance maybe a in different way. You've elaborated a lot on the drivers you've got at TELA and what gives you confidence, and that's really helpful color. I appreciate that. I guess, can you speak to the level of visibility into customer demand trends that you've got in the business as it stands today and just trying to attack that 8% from a different way here. Jeffrey Blizard: Yes. Michael, it's Jim. I'll take that one. So, we referenced not just the revenue performance, but the unit performance. And so in the hernia portfolio alone, we're seeing a 16% unit growth. So I think that hits the demand side of the equation you're talking about. Surgeons are voting with their procedures and they're selecting us more often. Now, that's also in the context of a U.S. market where we do see a trend towards less invasive procedures. We fortunately have the portfolio that's set up to adapt, whether surgeons want to go open, laparoscopic or robotic. With that drive towards laparoscopic and robotic, we do see our OviTex LPR and OviTex IHR side of the portfolio continue to grow. And we still see growth in 1S and Core. But that product mix shift is changing, I would say, kind of the overall picture of the revenue story. So units continuing to grow. So demand, we believe, is truly there. The mix shift will continue for the rest of '26. And so we do expect unit growth to outstrip revenue growth for the rest of the year. But it's what's giving us confidence to say market -- we're taking market share and surgeons are more and more adopting OviTex in these procedures. Antony Koblish: Yes. We're perfectly aligned with the robot, which is where the bulk of these hernias are going. Certainly, the simple inguinals, hiatals, simple ventrals, they're all there already. And more and more complicated procedures are going in that direction. So we have a product portfolio that can function and be highly compatible with the robot for each of those type of procedures. And at the end of the day, we want to be a full hernia supplier, which means we've got to be in 600,000, 700,000, 800,000 inguinals and all the simple procedures. That's where the volume is. And so we're very gratified to see the unit growth continues to be strong, right? Eventually, things will balance out and revenue growth and unit growth will catch up with each other. But right now, we're very happy to see unit growth strong. That means our IHR inguinal and our LPR, which stands for low-profile robotic are leading the way, which is the way it should be given the way the architecture of the market is setting up right now. Michael Sarcone: Okay. Really helpful. And then just on PRS, I think in the prepared commentary, you mentioned utilization declined due to the absence of some of your high-volume implanters. Can you talk about what's baked into the guidance for the PRS side of the business? Are you expecting to recapture some of that utilization through the year? And any color there would be great. Jeffrey Blizard: I'll start, and this is Jeff. Our ASP is really high in these products, but it's also comprised of a smaller percentage of our implanters. And when a few went out, maternity leave; for a few, vacations; oral boards were also during this first quarter, which we saw a drop in our PRS business. This is why we knew we had to reconstitute our strategy around building a user base and not dependent on these key users. So we'll see some of that in Q2 as we've done a sales force realignment by adding a bit more focus on PRS and expanding the bag here for our sales team. So that will give us more depth in these accounts, more users per site and ultimately, why we rescoped again our commercial organization efforts. We need these downturns to stop and not be reliant, especially if there are critical events that we didn't account for. Antony Koblish: Yes. We've got to overcome the rule of small number of implanters and high ASP on that product, Michael. So that's the way the design of the sales force is set up, right, deeper, more users per site versus what we've had in the past. That's the only way through that phenomenon. Operator: [Operator Instructions] Our next question comes from the line of Matthew O'Brien with Piper Sandler. Matthew O'Brien: I'm sorry to beat this dead horse on the guide, but the back half ramp is steep. You guys have talked a lot about how you're going to get there. But if I look at 2023, when you had pretty stable sales force, especially beginning of the year. It definitely increased throughout the course of the year, but you had the same number of reps back then. And you did about 55% of revenues in the second half of the year back then. That's what you're calling for here in '26 with a sales group that's maybe a little bit more green than what you had back then. So what are you seeing maybe April, May, if you can talk about that at all, that gives you so much confidence? And then rep retention, obviously, is something that's fluctuated a little bit over the year, but tell us why the confidence in being able to retain this group? And then I do have a follow-up. Jeffrey Blizard: Yes. This is Jeff, and thanks, Matt, for this question. And I refer back to prior years of really from my perspective, I don't have that history. One is, I can assure you that there was not great data at that point, which we now have. We didn't have much process instilled and discipline, which we now have and a bit of a territory alignment organization, great key leadership and field leaders right now, which we didn't have and now we have. So if you're looking at prior years to current, again, I'd tell you that we're set up for success even versus what our goals have been, we've been really aggressive to do this quick over the last 2 quarters. Again, I don't think many commercial organizations would have implemented and sustain the amount of change we've implemented. So to me, I am confident in the back half of the year. Our training programs internally support this. So not only do we do medical education for our customers, but we also do it for our teams. We're giving them the right resources and tools. So Jim? Jim Hagen: Yes. Matt, I would say the 2 other parts, and Jeff mentioned the clinical evidence. In Jeff's remarks, he mentioned the data that came out in SAGES. I think it's not just the evidence, it's who's publishing the evidence. From 2023 until now, as we go up the adoption curve, we're seeing more influential and bigger named surgeons with large peer networks in the hernia space start to adopt our product. That peer network is a critical part of momentum build that we didn't have in 2023 that we're gaining now. And we also just launched OviTex LTR, which really is the matchup in the fully resorbable category, which is the largest growing category in hernia, which we didn't have in 2023. So I would say between the talent we brought in, the new part of the portfolio, the market dynamics, kind of more influential surgeons publishing data on us and adopting us are the tailwinds we didn't have in 2023, and that's kind of what gives us confidence for the back half of this year. Jeffrey Blizard: And Matt, maybe just to close was your question on retention. And our recruiting efforts have become streamlined through Jennifer Armstrong, our Senior Vice President of HR here. We have panel interviews that ultimately end with Jim and I doing the finals. And what we have found in our last about 30 hires is it feels as though and communicated to us that we're becoming a destination that a lot of people want to be on this team, given where -- what we have for innovation pipeline trajectory and the leaders that are in the field. So we've been very lucky that people are doing the research on us and these interviews are them wanting to be here. So a bit of that retention starts within the interview process. Antony Koblish: And Matt, I'd add just one additional thing, which is that in 2023, what you saw is a sales force that was pretty -- that was sized pretty similarly to that in 2022. So the growth that you saw over the course of the year in 2023 was with an in-place sales force. And so you got that 55% growth or 55% split of revenue in the second half versus the first half. The difference in 2026 is that we've added a number of sales reps at the end of the fourth quarter and the beginning of the first quarter who will begin to get traction, who will hit that inflection point that Jeff talked about right around the midpoint of the year, so the end of the second quarter, beginning of the third quarter, and we'll be adding to that growth and further producing disproportionately in the second half versus the first half. So it's that growth in the sales force that was completed at the end of last year and beginning of this that makes us comfortable with the, call it, skew between the second versus the first half in our guidance. Matthew O'Brien: Okay, appreciate that. And then a question for Tony. Tony, the Board changes are notable. I mean you're losing some really good executives, but you're adding some seasoned executives. I mean it's a pretty illustrious group with a long history in the space. How can they influence TELA over the next several years with their experience to help sell what's still the best product on the market by far? Antony Koblish: Yes. I think that's a great question, and I appreciate the lead-in for that. So look, our -- it's customary to refresh your Board, right? We're 5, 6 years post IPO, which is really when this Board came together, and we had some Board members on much longer than that. But I think it makes sense to refresh as the company develops and gets to a new phase of demand. And our previous Board served us exceptionally well, bringing us through those earlier phases. But I've got some experience with the new team coming in, and what's important about this new team is that they have a tremendous amount of experience in implant-based medical device biologic biomaterial products, right? Everybody that's coming in has really relevant experience, whether it's in hernia, whether it's in plastic and reconstruction or whether it's any implant-based biologic that has a mechanism of action, has a contracting profile, right? It's just a very tightly aligned group of new Board members that have the exact experience to guide us through this next phase. The alignment couldn't be better. And like I said originally, I do have experience with several of these folks working with them in past in different capacities as well. So to me, it's a very good fit for what we need going forward. Operator: Thank you. And this will conclude our Q&A session. I will pass it back to Tony Koblish for closing remarks. Antony Koblish: All right. Thank you very much, Carmen. This is an exciting time for TELA. We have a full complement of highly skilled commercial team members in the U.S. and U.K., one of the only fully resorbable tissue-based hernia portfolios on the market, more clinical evidence that clearly demonstrates the significant benefits of OviTex, a European business that is overperforming and can be a very good model and direct indicator of what's possible in the U.S. given time and pressure and development, and we have a new Board of Directors that's highly aligned with our mission and has the exact experience that we need to achieve our next phase of growth. So with that, I also want to thank the TELA employees whose dedication and commitment to patients, which is most paramount that we serve has created a strong foundation from which we can sustainably grow for years to come. Thank you very much. Have a great night. Operator: Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.