Building the World’s Largest Independent Global Dermatology Company

Dr. Grant Stevens

Hello everyone and welcome back to the Technology of Beauty. Where I have the opportunity to interview the movers and the shakers of the beauty business, and today is no exception. Today, however, is a very, is a first. Today's the first time I've had a guest back in the studio. I get a chance to go back and ask about, What's been happening in the last couple years?

Our guest was the 19th guest on this program and we've had over 50 programs already. So this is a really a great opportunity for us to get back and interview Flemming. He prefers to be called Flemming, right? That's absolutely true. Okay. And Flemming is the CEO of Galderma. Correct. Absolutely. And he is here in the studio in Manhattan Beach, and I am so happy to have you here.

Thank you so much. It's been what, a year and a half since you were here?

Flemming Ørnskov

Yeah, about a year and a half. First of all, thank you so much for having me. Yeah. A lot has happened both in the world and in Galderma, so happy to tell you a bit about that.

Dr. Grant Stevens

Yeah. Isn't that true? It's been, it's been such a crazy time for all of us in the last year, plus year and a half, whatever it's been, so.

Let's let's jump in. What's happened to you in the last year and a half? Let, let's make it personal, then we'll get granular to Galderma. How have you been, how's your family been? You get through Covid. Okay. Yes.

Flemming Ørnskov

I managed, I don't know how many tests I had. I've been negative on. A hundred tests or something like that.

I think statistically that's probably impossible, but it's absolutely true. I never contracted covid. I never had a positive test and I probably was the one who traveled the most during the whole covid to all parts of the world. So yeah. What'd you attribute that to? Well, I was one of the first to get vaccinated.

I'm now up to injection number four, so a booster and booster. And I think I was always very careful wearing masks, particularly on flights taking all the relevant hygiene precautions that you need to do. But of course some of that is also luck. I'm absolutely sure.

Dr. Grant Stevens

And good genes? Maybe. Yeah. Who knows Good immunity?

Well, it's hard to argue with success. I also haven't been infected, so I'm pretty happy also that I've been around so many people who've had it.

Flemming Ørnskov

Yeah. And I think, you know, I've had some cases. Also in my staff where I would say it's pretty, pretty serious. Sure. Particularly with you know, the pulmonary implications and people feel really quite sick and some of them, it take some time to recovery.

So I feel extremely happy that I didn't have that happen to me.

Dr. Grant Stevens

I bet. Well, I've got a number of things I want to ask you about. Let's start with Alastin. You — Galderma and you purchased Alastin. And tell me a little bit about your thinking about that. And I love Alastin incidentally, as you know.

Flemming Ørnskov

So Alastin was an educational effort on my part initially because as you know, I started October 1, 2019. I have not worked in the aesthetic space. One way of learning the business was to travel a lot, in, particularly in the US, speak to customers, speak to doctors, healthcare providers movers and shakers in the industry.

And multiple times people mentioned Alastin as something we should take a look at. And then when I looked at our portfolio and our strategy, I looked at kind of the pure procedural approach the pairing approach. I read about them the Fantastic Science 25 publications. I also, of course, watched that they won many awards in style, best of beauty, cosmopolitan Ready, beauty, and many others.

They won awards. So I started to take a look at them. I asked the business development team and said, okay, what would be the fit? Would that be possible? And then we engaged in the discussion and I would say I was super pleased that it happened in January of this year. And I can already now see growth has accelerated.

We're now planning for rollout outside the US. They're only in the US and in Canada. We have to file in certain countries the business model. Mainly physician dispensed works in some countries and others, it becomes more of an DTC play. So we're working all that out.

Dr. Grant Stevens

, that's good. I'm happy to hear that you have it and that it's gonna be an international brand.

That's very exciting. I understand you have some fascinating announcements about your phase three studies. Do you wanna share that with us by any chance?

Flemming Ørnskov

Yeah. So in Las Vegas, we disclosed the data for a compound that I'm really excited about. It's a compound called QM 1114. So it's an in-house developed botulinum toxin A it's fully liquid ready to use all of the work, all of the studies done in-house and by my colleagues.

So we have. 4 late stage clinical trials . It's about 1,900 patients, and we disclosed in Las Vegas the two first of those trials called Ready one and Ready two. So both of them met primary endpoints, so that is a composite index for improvement. Both by investigators and by the patients. At month one and month six highly statistical significant.

You had to have more than a two point improvement on this composite index. We also looked at the onset, so median onset was two days. But if you look in the actual study for frown. 39% reported effect after day one and 34% for crow's feet. So very impressive duration out to six months. So fully liquidized, I think really a change.

It makes it simpler to administer. You don't need all these reconstitution time and I think. as the use of neuromodulators expands. I think also the reliability, the predictability, the safety is very important. So, and also most important, if we looked at the patient satisfaction at month one, it was 97%.

And at month six it was 86%. So I think you get onset, you get duration, you get convenience and highly statistical results. So I think we could not be more happy. We've invested 200 million euros almost the same in dollars at risk, where built a state of the art manufacturing site in Sala in Sweden.

And so we are ready for the next phases, which of course also are challenging, which is. Filing approval, manufacturing inspection. And I think we know these of course, challenging phases to go through, but I'm super confident.

Dr. Grant Stevens

And what's the timeline as a provider, myself or as a consumer of the product, what are we looking at?

Flemming Ørnskov

We looking, oh, it's probably a few years out. That's probably what you have to calculate with. Also if there's any delays in approvals of the manufacturing side, although we are doing everything possible and drawing learnings from others that have had challenges there. But sure we have. Totally unique in-house new oleum toxin, a stain strain that is stable.

And so we are very confident that we will also get through those phases.

Dr. Grant Stevens

So I can better understand this this pre-mixed liquid, it's, it comes to the practitioner, we draw it right out of the vial and administer it. We don't have to touch it.

Flemming Ørnskov

Yeah. So QM 1114 is in-house developed by Galderma.

Okay. We just launched in Europe. Actually. We quite recently had the launch meeting a similar fully liquidized toxin. Or neuromodulator, which is developed by Ipson, which as you can say, simplified is the liquid form of disport or aslu as it called in some countries. And that's called illusions and.

The same thing. We've seen very fast onset fully liquidized and high, high satisfaction and interest. So if the interest with, with illusion is a mirror of what we will see with QM 1114, which I think has. An even stronger profile, very attractive product for a rapidly growing segment of the market.

Dr. Grant Stevens

Yeah, that's very exciting. Well, congratulations.

Flemming Ørnskov

Well, it's also a little bit of how can I say? It started with qm and then when QM became part of Galderma, the team continued, I think both to set up manufacturing. do these clinical trials even during Covid 1900 patients. Lots of challenges to complete the study.

And if you look at the results and the outcome and onset duration and patient satisfaction, I'm really proud of the team.

Dr. Grant Stevens

You should be. So now we've talked about Alastin, and that was an acquisition. We've talked about the new toxin in that you developed in-house. What can we expect from Galderma in terms of m and a future m and a over next three to five years?

Flemming Ørnskov

Yeah. So I think if I may take a step back. So I took over in 2019, October, right? The first order of business was actually built a company. This was a division within Nestle, so we had to strengthen it. HR set up stronger in-house manufacturing. Make sure that we had all the processes. So we basically had what I would say a large startup that we had to turn into a fully fledged company.

So we spent a lot of time with that 47% of our sales in the us but in many countries outside the US we didn't have the right, so we had to go and. Work with distributors, getting the rights back. We launched our products. We just got into China with a broader portfolio. We are now with four regions, Asia Pacific, Latin America, Europe and Canada together.

And then the US is one region by itself. So we had to build out all of those regions. Wow. Setting it up, getting the distributors in many cases, taking back the business, getting the rights to the products we had in the us. So all of that is still in progress, but simultaneously we look at m and a and in the prescription business.

So we've talked about the aesthetics business in the prescription business. We have launched one. A homegrown acna product called Ale about a year and a half ago. And we just got two approvals in the us one at the beginning of the year for a product called Twilio. That's for Acna. That's a very unique technology.

Combining products that normally could not be combined. And Benzo peroxide. So that's just been launched and we just got approval for a rosacea product called Sate. Microencapsulation technology, a huge unmet need. I think there's about 16 million softwares in the US alone for rosacea.

Still significant unmet need, and both of those products came through acquisitions. It's Israeli company called Seil, where we acquired the rights to those two products. So we continue to be extremely active.

Dr. Grant Stevens

Boy, I'll say. And you're gonna be everywhere in the world. Will you be everywhere in the world.

Aesthetics portion of the Galderma brand. So you're gonna take aesthetics to China and Asia and everywhere.

Flemming Ørnskov

So we are already in China now with aesthetics. Okay? So we've got juice port approved in China, and we have a few of our Restylane versions of fillers available. We continue, we have our consumer brands there.

We also have prescription brands that is by a partner there. So yes, the plan is to grow everywhere. Latin America is probably where we, on a relative scale, are the strongest Europe we're building out really fast as it is. Asia-Pacific is where we see some of the highest growth. So yes, the plan is to be everywhere.

But for instance, China, I would say we're just at the beginning. Okay.

Dr. Grant Stevens

Well, you're one busy guy, the worst kept secret in aesthetics. What can you tell us about the IPO? So if there isn't gonna be an IPO Yeah. Well, first of all, everyone wants to know. And everyone wants, yeah.

Flemming Ørnskov

First of all you know, I'm, I'm flattered by the interest, but I think the first thing I need to say, and people need to understand that since I took over in October, 2019, day one, I started to run the company as if it were a public company.

It's really important for me. in terms of reporting, financial structures, systems, processes, the rigor, the compliance, all of that. So the company is run as if it already were a publicly listed company. , but the, the key for us is together with the investors we have assessed what are the best options for Galderma because we are very fast growing company.

We don't need the IPO proceeds for funding the growth, but we think that probably an IPO is the best next step for a large company. This will be a large IPO for a large company like Galderma and we're, you know, monitoring what's going on in the financial markets. But the company is ready. But you know, we are not dependent on a specific timing because we have funds enough to fund our very rapid growth with what we already have.

But, you know, we continue to monitor what is happening in the global markets.

Dr. Grant Stevens

So then do I hear you say you will be doing an IPO? If the timing is right. The markets are right. You don't really need the money per se, but...

Flemming Ørnskov

Yeah, I think together with the owners, we see an IPO as probably the preferred. Next stage for a company like Galderma, but we are not under any time pressure. We have the funds, but we will continue. If the markets are right, we probably will be ready. Okay.

Dr. Grant Stevens

That's exciting. Yeah. Now when we look ahead in aesthetics, We've talked about the toxin. How about any new areas within aesthetics that you can tell us about?

Be it either device or injectables, topicals and so forth.

Flemming Ørnskov

So yeah, so it's important to just give a little bit of a flavor of what we are. Like as a company. Sure. So it's very important to understand that. So the US is our most important market, 47% of the sales. We have three businesses within Galderma.

We have a business, which is what we call therapeutic dermatology, which is prescription products mainly. There we're number one in acne and rosacea globally. Then we have a very strong derma cosmetics business where cetaphil will be known. We have other OTC brands. That's our second franchise. And the largest franchise is the Aesthetics franchise, right?

Where of course we are focused on injectable aesthetics with fillers and with Neuromodulators and. We're now investing significantly in the college and stimulating field where we are number one, and in two other areas we're number two. So I would say the main thing for me right now is to build out the aesthetics portfolio globally to continue to launch more and more.

Versions of our, for instance, our fillers. So I think since we spoke, we've launched Restylane Kiss. Yes. I think was one of the best launches in the industry. Indeed. Then we launched Restylane Define for chain augmentation, and then we launched Restylane Contour for Midface. We got a new formulation approved for sculpture.

So we've been pretty busy and now we just disclosed the data for QM 1114. So, already with what we have in-house and all the projects we have, we, we have for the foreseeable future enough. And then we just acquired Alastin, which is probably more akin to our derma cosmetics business. , because of the way it, in many countries will be sold in the US it's physician, administrator but in many other countries, more like a dtc.

So I think for now we have what. But you know, we keep an eye on what's going on, but really for me, the focus is growth. Geographic expansion and maximizing the products we have because as I mentioned, in a lot of countries, we either were not in the market, didn't have the rights to the market, or just entering into.

Give you an example. The Middle East, we have our filler. We don't have access to the neuromodulator at this stage. So there are a lot of markets where if we had the full portfolio, we could do even better.

Dr. Grant Stevens

And is that because of regulatory constraints in these countries that you might have it or is...

Flemming Ørnskov

No, these are the ways distributor issues or these are the ways.

Galderma obtained the rights to products, for instance, from Ipson or what was given to other distributors. So all of this is, as we now build our organization, the plan is to take that in-house and develop it ourself. But in many cases, if you're a distributor and you're a very successful, you don't give away the business for free.

So we have to have a lot of negotiations, both with the distributors and of course also with Ipson.

Dr. Grant Stevens

And we don't have that in the States, you know, I mean, we meaning docs like myself and even pro other providers, extenders, we don't think of it as distributors. We think of you as the, you, you're the company, right?

Flemming Ørnskov

No, no. We, of course, in the US and everywhere we have full control, but other. We are dependent on you could say middlemen. And the other thing we've also had to do during this last 18 months, you said what we've been busy with we have phenomenal growth. We had 2000 and 20. We were about a 3 billion business.

Barely. Okay, now it's 3.6 plus. And rapid growth, you know, we're double digit, top line, double digit, bottom line growth, significant. Expansion in our margins, which we've used. We've increased R&D from low single percent to almost double digit. I haven't even mentioned to you in addition to.

all we've done in the aesthetics field and what we've done in the derma cosmetic field, including the Alastin acquisition, we have the most expensive program in the history of Galderma, which is a so-called IL-31 called nemolizumab, which is an antibody for atopic dermatitis, which is a very large market as well.

So we have a very broad portfolio and we've built an integrated R&D organization, which I think we're the only people that have, we have a totally. Integrated R&D organization where we can develop a product in the range of seil. We can develop products that are for the static space, or we can develop high-end products for the therapeutic dermatology space.

So including, two biologics QM 1114, homegrown biologic and nemolizumab. We licensed it early on from Chugai, and now it's in phase three. We should see the phase three later this year. So we've been super busy and also spending a lot of money on R&D, much more than Nestle spent.

Dr. Grant Stevens

Yes, that's impressive. And all during covid.

Flemming Ørnskov

During covid, we had to change the way we did clinical trials. We had to have you know, call in patients or send nurses to the homes. Lots of things. We had to change things around digitally. We had to get permissions to certain changes of the protocols and that. Two phenomenally large programs.

One in IL-31 with Nemolizumab, the largest program we've ever run. We spent over 120 million on that last year alone. And then QM 1114 plus all the other products that we've been super, super busy this year alone. Galderma will be launching 22 new products or product formulations around the world.

Dr. Grant Stevens

That's unbelievable. Well, congratulations. And you have had a growth, you say, of over 20% it sounds like.

Flemming Ørnskov

Yeah, we've had very strong growth and you know, the we've had double digit growth both on top and bottom line. But what I'm also very proud about is that the team was able, to make the vision more efficient.

You know, we included or introduced systems that would allow us to take, I would say spending away from headquarter related things and put them into R&D and commercial execution and medical training. Our training with gain, our training our Aspire program record years in all aspects. So, shifting the money to customers to R&D.

Part of the the clear strategy. And I think that's been driving our phenomenal growth. And as you can imagine, we've also had significant share. In many categories, but you know, we're, I think we're just at the beginning. I think we've built the foundation. The company is harming along. I think we've built a very efficient integrated derm platform.

We can play in three extremely attractive segments and. We can cross-fertilize.

Dr. Grant Stevens

That's very exciting. Now early on when we saw the brief dip during covid in the aesthetics industry, not Galderma per se, we were concerned. Then we saw the rise, and then we thought, is this gonna continue? Is this backlog?

Is this, this storehouse a warehouse effect? And it appears as though it's not. It appears as though there, there's actually more demand and more interest in both surgical. As well as non-surgical aesthetic services. And if you look at the different companies such as Galderma, they've all, almost all without exception, but there have been a few of course, but for the most part the companies have done better post covid.

There appears to be. An increased interest in taking care of oneself. There also appears to be a shift down in terms of early age. It seems like it's, the entry level is, seems like a little younger, and there's another sort of phenomena going on with this whole business of prepaid or used now pay later kind of subscription.

Kind of approach. I'm kind of curious how you think about this market change. Is it more per person? Is it more persons? Is it both? How do, how, how do you see the aesthetics market rolling out over the next few years?

Flemming Ørnskov

Yeah. I would say that when Covid hit. And we immediately saw office closures in the aesthetics business, and we saw plummeting of sales.

Of course you needed a bit of stamina. Also, our investors were a little bit nervous about how long would that be? I'm always someone who sees this as an opportunity, so I shifted digitalization faster than ever in the company. So, launched Wrestle Kiss, which is our best launch. By then, it's later.

We've actually done even better with the two recent launches of Define and Contour. But that was the best launch ever. It was an all virtual launch. They, everything was virtual. The detailing, the reps were sitting at home, the, you know, working with us. We worked with the providers that way. So it was all, so I shifted everything and then all the game.

record numbers in terms of training with our gain. So that's the Galderma aesthetics you know, network for, for training. The injection network. Yep. And there we saw the shift to digitalization, the meetings very, very significant chains. Also inside the company, the way we advertise, the way we interact with physic.

The way we started to also be more e-commerce in other parts of our business. So for us it was a little bit of a short term shock , but it was a dramatic stimulus to digitalize the company faster than we've ever thought. So we came out. I would say flying. The other thing I used the town too, which was, it was a relatively short downtime a few months, was to not lose track of continuing the QM trials to continue to build out, to continue to get rights to the aesthetics products around the globe.

So for us, Yes. Growth accelerated significantly afterwards. Two other things I've seen is cause people ask, is this sustainable? What's going on? Right? I think that the initial thing, as you also mentioned, so if I look at our database, aspire, which is our loyalty program, Average age was about a year and a half ago was 48.

Now it's 46. So you see a significant shift down. Yep. If I look at Aspire, the enrollments, it's up 91% since 2020. 91%. So it's double. Yes. So we would, on an average month, 20, would've about 30,000 enrollments. Now we have 60,000 enrollments last month. So we're seeing greater interest more treaters, more consumers or patients.

And we're also seeing, as you said, that there's a, a bit of an age shift. Also, don't forget the two fastest growing segments is plus 65 and at 25 minus so there's also a lot of demographic changes if you look in a bigger picture, because I see the same around the world. It's clear that people's interest in taking care of the.

Dramatically up the acceptance of minimally invasive aesthetic procedures dramatically. We do all kind of market research. Dramatically improved, I think across all age groups. Yes, yes. Okay. Natural beauty is of course, a, a big theme. So so, so that's thing. And what you see in Asia, and you see in Latin America, middle class growing, income growing and more aesthetics.

There's a clear link with that. And what we've also seen, Premiumization, the consumers are going for premium service, premium offering. So I think a lot of trends that are going in the right direction. Is this long term sustainable? Maybe not at this very high level we have right now because, you know, historically it has shown that if you get into a recession, which we may or may not get, then maybe there will be a little bit of a slowdown.

But I think the demographic. Here is, I would say, really shaping a difference in this, in this industry.

Dr. Grant Stevens

In San Diego at the Aesthetic Innovation Summit or ais, we had a number of speakers and we addressed this issue of the effect of the recession if we were to have one on aesthetic spending and all, and there are some who believe that aesthetics may be one industry that won't be negatively affected. When you look at the Great Depression, there was the idea if a woman had two pennies, she'd spend one on bread, as you know, and one on lipstick. And then we look at the recession as the last recession we had, aesthetics continued.

There was a little downturn, and then boom, it went back up. And now with Covid, we're looking at it again. And it will be interesting to see if, I mean, hopefully we don't go into a steep recession. and hopefully the markets have turned around and will continue to go in the that direction. But it will be interesting for me, I'm sure, and for yourself as a corporate person and for me as a provider to see what patients will actually do, what people will do.

My own prediction is they'll vote with their feet and they'll take care of themselves, and I'm still bullish on aesthetics because I've watched the people. and I've listened to them and they don't wanna go without their Botox or their Dysport or their Xeomin or their toxin. They don't want to go without their lipstick.

They want to look good all the time, and they're willing to give up things for it.

Flemming Ørnskov

Yeah, and I think, you know, I think when you are in a position like mine, you know, I don't want to be the victim of whatever happens economically or demographics. I think the most important is to. What can I do? And together with my team and what we can do is, and what we've seen fueling our.

Really stronger than market growth has been constant flow of innovation. You know, Restylane 25 years, but Restylane Cares, Restylane, Contura, Restylane define, you know the addition of Alastin now QM 1114, and in our prescription business and in our consumer business with set, we continue to launch new things.

So the fact that you continue to innovate is, in my opinion, the best way of. As a company to position yourself because we were a late starter to the aesthetics field and many countries we just got into. And I think we have lots of opportunity and I think when we see strong performance like in Latin American and others, we grab share as well.

So I'm confident of our growth. But it's also a strategy for us. We have to grow through better offerings, continued offering better services, getting into more countries and continue to expand the portfolio and premiumize our offerings. And I think as long as we go down that path, I think even. If times get more challenging, we still will have very robust growth.

Dr. Grant Stevens

I agree. Now, one thing I've also been impressed with, with the new Galer d Galderma, since you've been at the head, is your commitment to safety. And many, many of the watchers, or any of the viewers and listeners right now don't know that you're first and first a physician. Yes. That you are an md, you are a doctor, you're a physician, and I know.

As, as myself and the rest of physicians, we don't want to do any harm. We want to take care of our patients, and safety is the most important single thing for all of us. And to that end, you do have a program in which you educate injectors and you are committed to patient safety. And you mentioned it a moment ago, but could you elaborate a little bit on that?

Because many of the people listening and watching you right now don't know about your commitment to education and safety with injectables.

Flemming Ørnskov

Yeah. So when I came, the first thing, of course, I always look at in an area is do we have a strong record on safety? do we have the right processes? Do we have the right systems?

I significantly strengthened our pharmaco- vigilance, all of our systems for adverse event reporting. But I also said prevention is much better than having it. So we dramat. Increased the number of participants in our training, which is called gain. So that's the Galderma network.

Dr. Grant Stevens

So I want everyone to hear this is called GAIN. It's a big deal. Okay. So Galderma...

Flemming Ørnskov

So Galderma Aesthetics Injectors Network. So that's where we do all the training. And I've seen record. If I just look even in 2022, I thought we couldn't beat 21. First of all, we saw a lot of this going virtual as well, that there were a lot of these things.

And I think we have this year alone, at the beginning of the year, we've had 3,200. Healthcare providers that have been trained and I think we've had more than in peer-to-peer, in peer-to-peer programs. And we continue to have very, very significant growth, both in a number of programs and in the number of physicians that are attending.

Dr. Grant Stevens

Yeah, well, it's quite a commitment to safety and I'm very impressed. The other thing I want to thank you for is your continued commitment to the Aesthetic Society, the American Society for Aesthetic Plastic Surgery. You are committed and you are part of the Premier sponsorship, the premier partners, as you know, and when you came in, and I saw you originally a couple years ago, a year and a half ago, I asked if you would still support our Beloved Society.

This one right. and and you have, and I want to personally thank you, and I want to thank you also as a trustee and a past president for your ongoing support of ASAPS or the American Society for Aesthetic Plastic Surgery.

Flemming Ørnskov

Yeah. I think, you know, like first of all, you know, I've been on the receiving end when I was practicing medicine, and I think the issue is of course, that we wanna work with the professional societies, of course, with the key ones.

First of all, we learn a lot. That's where we get a lot of. Those are the natural partners for us as we continue to also make sure that treatments are safe and people are well instructed. And, and so I think this, these partnerships are incredibly important. And as I mentioned with Alastin, if there hadn't been a few of your colleagues that have also whispered in my ear that this was something I probably should take a look at, maybe my business development team who are super smart would've come to it by themselves, but I.

When they came to me, I certainly was a fertile ground for listening to them.

Dr. Grant Stevens

Yes, you definitely were, I remember it well. So is there anything else you would like to share with us about the future of Galderma that you can tell us? That is clearly you're committed to all three verticals and within the company and they're all, they all relate back to the aesthetics and the beauty business even.

Even the prescription vertical, it seems to me, because if you're putting on a prescription topical for acne, that's gonna result in less scarring. So it's really an aesthetic pursuit, even though it's prescriptive, you know?

Flemming Ørnskov

Yeah. So you know, I know that's for some people that have a different point of view.

If I look at the history of Galderma, it was established in. 1981 is a joint venture between L'Oreal and Nestle, so it's always been a consumer focused company at heart. 2014, Nestle took it over, bought out L'Oreal, and now it was called Nestle Skin Health. And then 2019 it was taken over by private equity and then we renamed the whole Galderma went back to the roots.

So it's always been a company that has been dedicated to skin and skin health. I think if I look at it, we have doubled down on some of the strengths since then. Investing more in R&D, getting you know, we're 90 plus countries right now, so we've dramatically increased where we are, but also in the markets where we are very strongly.

Like in the US we have we have 900 people here. Continue to employ more people. We have 300 alone in our headquarter soon to be in Dallas. We're in Forth Worth today. We have, you know, established a very strong medical affairs organization, which was not there when I came. And if I also look at our manufacturing, we have invested in all our four manufacturing sites and we'll probably will be adding at least one or two more.

So yeah, it's about fueling the very strong. The thing that of course you have to become very good at is supply chain management. That's probably for most people today that are sitting in roles like mine, that is probably headache number one and two, particularly when you have such a strong growth as we have, so, Early on, I was really pleased that I established together with my cfo, a very strong procurement double and triple sourcing not being relying on one country or one ingredients.

So I was super happy. All our four main manufacturing sites stayed open. We did double, triple, quadruple sourcing for a lot of our product. We made sure that we had access to api so the active product ingredients. we made sure we had access to packaging. So I would say we've come through these issues pretty well, but it is more costly.

it requires a totally different approach to your logistics, and you have to keep an eye on it because a lot of the ingredients in our products, whether it's in cetaphil, whether it's in other parts of like in the aesthetics business, they are in high demand and short supply. So you need to be really smart.

You need to build more inventory, you need to think ahead, but you know, we all, and you need to also think about how do I continue to make my manufacturing organization more efficient? So automatization. All these kind of things because labor is another, particularly blue collar labor in certain parts of the world is also really starting to be a shortage.

So there are a lot of things we had to learn, not only to grow and expand in many countries, but also to secure that we have the supply to fuel that very strong growth.

Dr. Grant Stevens

You are one busy guy, Flemming. That's an awful lot to manage. And you're absolutely right. I hadn't even thought about that. The supply chain, it affects us as practitioners.

Of course it affects. You didn't even think of that. You've got your hands full.

Flemming Ørnskov

Well, it's not only about me, I think it's team. No, I need to Having the team, the team team might you (crosstalk) no, no, no. Yeah. But I think, you know, like I, I would say that. The biggest challenge we had. If I look back you mentioned, wow, what about growth showing down and slowing down?

And what about, you know, the aesthetics business and all that. But if you really think about it, I think the biggest challenge we had during Covid was to keep four manufacturing sites. One in France, one in in Canada. One in Brazil and one in Sweden to keep them open. Just think about the environment where the Covid restrictions,

and how we would do that. Going to multiple ships. Keep, I'm so pleased. I think this is the biggest accomplishment we had during Covid was that the operations team managed to have. supply up and running all the time, but it required an enormous flexibility, adaptation to the new world testing all kind of safety measures.

But you know, I think that for most people and factories around us, were all close.

Dr. Grant Stevens

Well, congratulations. What a fantastic job you and your team have done. That's exciting. And also congratulations on your recent announcement. I look forward to hearing even more about the the progress with the studies and, and all your progress you're going to make both here in the United States as well as outside of the United States with the longer toxin.

And, and so forth.

Flemming Ørnskov

Well, I think, you know, for us it's you know, people always say, what's the end goal? Well, the end goal is for us, when people look across our businesses, that we will be the number one in the world. In the dermatology space. We won't be number one, at least not short to midterm in the aesthetic space, but we'll do everything possible to be a strong runner up.

We're number two in the fail statement. We're number two in the neuromodulator segment. We're number one in the Cardin stimulator, but I can assure. The competition that we. From L'Oreal in the derma cosmetic space from Allergan and multiple other players in the aesthetic space and what we're now going to experience rapidly in the prescriptions, in the therapeutic dermatologist space from Sanofi and others with Dupixent.

You know, I think we are ready and we get stronger and. The fact we have an integrated platform, the fact that we have you know, one R&D team, one manufacturing team, one backbone for the whole company, allows us also to cross-fertilize to become more efficient. But it also allows us to basically become stronger in the execution.

So I think that's for me. Very important. And then if you have noticed along the way, we've also upgraded a bit the brand. I think we look more premium. I think I get a lot of positive feedback, even indirect, flattering by people copying us. But if you look at the way we built the website, the way we built the corporate image, but it was very important for me.

I think we always had premium products and premium offerings. I'm not sure when you looked at us that you think we were premium. So I've kind of merged the two things. I think we looked premium today. It's also an obligation to continue to be premium in all of its aspects, the products, the safety, the execution, and how we interact with our customers and ultimately, Also how we interact with the consumers or the patients that depend on our products.

Dr. Grant Stevens

Indeed. And you've done just that. So once again, congratulations and thank you very much for joining us here in Manhattan Beach in our studio. And have a safe trip everywhere you go. I know you're a man of the world and you fly all over. So I'd like to thank all of you for also joining us today in this exciting technology of beauty episode where we had a chance to get to know Flemming for the second time and heard some really fantastic news that I know you've heard about.

It's a big deal. So congratulations and once again, thank you and thank you for joining us. Bye-bye.