Galderma Group AG (GALD) Earnings Call Transcript & Summary

Welcome to the Galderma H1 '24 Financial Results Call. The press release, along with our financial statements, was published at 7 a.m. Central European Standard Time today and can be consulted on our corporate website at any time. Today's presentation slides as well as a recording of the webcast will be made available on our website after the call. As this is our first financial results call after the Q1 trading update, which covered only net sales, let me take this opportunity to share with you principles of our financial reporting. A detailed overview can be found in the appendix of this presentation. We provide revenue disclosure by product category and geography, U.S. and international, but we do disclose profitability metrics as a single segment. Our financial disclosure choices reflect our growth-focused, integrated dermatology strategy, which drives value creation by leveraging product and channel synergies across the portfolio as well as efficiencies from a common platform. Please be advised that today's presentation contains forward-looking statements, which should be treated with the appropriate level of caution as advised on this slide. Let me now introduce today's webcast, which is scheduled for 1 hour. Dr. Flemming Ornskov, CEO of Galderma, will provide a performance update for the first 6 months of the year, including commercial and innovation highlights by product category and geography. Thomas Dittrich, CFO, will then introduce the H1 financial results and the financial outlook for the full year. Both Flemming and Thomas will be available to answer questions from the financial analysts before Flemming provides final remarks to close the webcast. With this, I would like to invite Flemming to share H1 highlights and provide the performance updates. Flemming, over to you.

Emil, thank you very much. And also from me, welcome to Galderma's, which is actually our first full financial results since we became a public company, so it's a particular pleasure. And as I will lay out shortly, the results is also a pleasure to present today. So since we got listed on the SIX Swiss Stock Exchange on March 22nd, we're now also part of the so called stock indices, and that includes the STOXX 600 Europe. And actually, we've been there since a month, and we will also be part of what is called the SMI MID Index, which is an index of the largest and most liquid public companies that are listed in Switzerland, and that will happen as of late September. So even more good news to share. But I'm sure you're dialed in because you want to hear about the results, and I won't keep them from you. So let's look at the key highlights. So record net sales of $2.2 billion for the first 6 months. And as you will see, a very strong growth momentum with 10.8% year-on-year growth at constant currency. What is also, for me, in particular, very pleasing is it's a broad-based growth across our product categories and geographies, and we'll go into more details about that in the next section. It's also very important that it's not only about growth. We have also shown significant ongoing improvement in the underlying profitability of the company, and that's been driven by ongoing chasing efficiencies and achieving operating leverage. And I think it's very important to note that H1 was supported also by the phasing of nemolizumab, which, of course, given the good progress we are making with the regulators on this brand, we expect to ramp up a bit in the second half. So we feel very confident in the outlook and have hence decided to update the full year guidance on the net sales basis on the very strong start that we've seen through the year, so we are guiding towards the upper end of the range on net sales growth. And as you may recall, we gave a range of 7% to 10% at constant currency, and we're absolutely confirming our guidance on core EBITDA margin in line with 2023 at constant currency. But let's now move into a little bit more details on net sales and also a little bit more about some key strategic highlights regarding the platform and the outlook for the first half of 2023. So let me just -- '24. Let me just now tell you a little bit about the overall results. As you can see, 2023 first half was very strong. But first half 2024, even stronger. So we had a net sales of $2.2 billion, so that is up 10.8% on constant currency. Growth was driven by volume but also complemented by a very favorable mix. It remains a very attractive growth runway that is strong for Galderma. And when you ask yourself what is that driven by, it's driven by execution of a very clear growth-focused integrated dermatology strategy. And we are clearly leveraging the position in many underpenetrated markets, which we will continue to see as a source of growth for our future. But let's now go into talking about our individual businesses. So Injectable Aesthetics, which is our largest product category, continued its very strong performance globally, gaining share in neuromodulators as well as in fillers and biostimulators. So net sales for the first half of the year were $1.1 billion, with year-on-year growth of 13.4% on a constant currency basis. Growth continued at a high level during the first 6-month period of the year after having normalized the phasing impact of the first quarter, also posting sequential growth quarter-on-quarter. And you do recall that the first quarter year-on-year was supported by a somewhat low 2023 comparable base. So very strong first half. For the first half of the year, both Injectable Aesthetics subcategories performed strongly. Neuromodulator net sales were USD 622 million with year-on-year growth of 16.6% on a constant currency basis. And the other category -- subcategory, fillers and biostimulators, had net sales of USD 517 million, which represented a year-on-year growth of 9.8% on a constant currency basis. Now you may wonder what drove this growth. So let's dwell a little bit into that. And it's very clear that growth was driven by a very strong brand performance, but we also saw strong scaling execution across our entire Injectable Aesthetics portfolio, including increasing penetration in terms of geographical reach, portfolio breadth as well as one of our key success factors, ongoing health care professional education and training. But being leading in innovation also means that you are a leader in introducing new products and services. Again, a key driver for the very strong H1 performance. Introducing QM-1114, also called RelabotulinumtoxinA, which is our next-generation neuromodulator, and it now has a wonderful name, namely Relfydess, because it's been having its first marketing approval in Australia during a Therapeutic Goods Administration for the treatment of both frown lines and crow's feet. So we expect this and other launches to take place in the first half of 2025, of course, subject to additional regulatory approvals for other markets so we can get also to the relevant production scheme. Talking about production, Galderma's Uppsala site already received the license update from the Swedish authorities, which will authorize us in future to manufacture Relfydess there. We also, and I'm sure that's of great interest to you, we continue to make great progress on remediating the U.S. FDA's complete response letter. It's very important when you think about Relfydess that this is the first and the only ready-to-use liquid neuromodulator that is created by Galderma's proprietary PEARL Technology, which provides not only sustained results for 6 months. But it also has a fast onset of action as early as, yes, you'll hear correctly, day one. But not only did we focus on Relfydess and all the promise in multiple more countries, we also launched Restylane VOLYME in China that is designed for contouring and volumization of the mid-face. We also continued to engage in building the whole platform for liquid neuromodulation, especially in Europe where we already have Alluzience. And we had our first-ever Liquids Live event in Switzerland and a GAIN Summit, which took place just in June of this year. And as education is so important to our success, as you will see from results, we also had new trainings, new offerings, including new techniques, treatments with Restylane and Sculptra, but also in the very important and rapidly growing category of patients that are experiencing rapid weight loss, such as you can see from GLP-1 usage, which, as you know, will cause both sagging and aging of the facial skin. Innovation is very important. But equally important is scaled execution also driving our very strong results. Let me give you one example of Thailand. Broad activation, very strong, actually record uptake for Sculptra, including consumer activation with city banners promoting the brand, having QR codes on it that can direct you to authorized injectors and nearby clinics. Other examples of this scaled execution, as we call it, included China, where we saw very strong growth in Injectable Aesthetics through increased reach and a more breadth in our portfolio, and we'll go into that in a short while. But even in the U.S., a market we've been in, of course, much longer than we have been in China, we saw continued strong performance. Actually, we celebrated our 15 years anniversary with Dysport, and we reached a record share for neuromodulator. It's also important to keep in mind that this is the second major anniversary we got to celebrate this year because we also had the 25th year anniversary for Sculptra. But it's also very important that Restylane continues to be recognized for the very differentiated and superior set of outcomes that you get through treatment with Restylane and with the rest of the very broad winning portfolio. So we won the recent Cosmopolitan Best Filler Award and the Restylane Kysse NewBeauty Best Lip Filler Award speaks to scaled execution and innovation combined. Let's now talk about another category that is showing very high growth for us, namely Dermatological Skincare. Also here, we continue market outperformance, particularly with Cetaphil in international markets and of course, with Alastin in the U.S. which is also now being rolled out internationally. For Dermatological Skincare, net sales for the first half of 2024 were USD 675 million with a year-on-year growth of 11.8% on a constant currency basis. Let's talk about the U.S. U.S. had growth that was rebalanced after the first quarter phasing impact of Cetaphil, continuing to perform well despite some market softness in the U.S. skin care market. We adapted to new market trends and we shifted the commercial strategy to more digital execution and more e-commerce, which immediately showed up in additional growth for us. Internationally, where we had a very strong performance, Cetaphil and now also since recently, Alastin, both grew double digits. Galderma continue to drive tailored strategies in key markets to deliver growth, particularly in markets like China, India, the Philippines. But we also, in our international markets of Brazil, Canada and U.K. and Ireland, had fairly strong growth, just to mention a few of many, many examples. When you then say how was this growth derived in a market that may have some [ shorting ], focused execution is the key word. We had incredible focus on sampling. We shifted more focus to digital and e-commerce activation on a broad base. And as we did also in the aesthetics field, we rely on a constant rollout of new innovation and scientific engagement with not least, dermatologists. The continued strong momentum that we saw in China was also here a focus and a commercial strategy that was emphasizing digital activation and e-commerce as well as delivering new SKUs as we will showcase a little bit later. So we continue to perform strongly and gain market share in the very large Chinese market. And given we are relatively new there, we're just at the beginning and so far have low penetration with significant upside. You may say, again, give us some more detail about this. And as you saw with aesthetics, the 2 things that are very important are constant flow of innovation and a very growth-minded commercial execution. So if you look at the innovation in Dermatological Skincare, you will see we had lots of new introductions. On the face, we had 2 high-potency serums for Cetaphil in the U.S., Vitamin C Serum and Ceramide Serum, that are complementing the routine that is called cleanse, treat and moisturize and protect, which we have rolled out in the U.S. We also, in the international market, had very targeted expansion also with innovation. We had the Cetaphil Baby line in Asia. We had a tailored product in China, which is Cetaphil Baby intensive moisturizing cream, and we had acne patches for Cetaphil in the U.S. and Australia. Of course, if you talk about consumer, you could not avoid mentioning Alastin. The C-Radical Defense Antioxidant Serum had very strong differentiation from other competitors. It's already won multiple awards, including the 2024 Shape Skin Awards and the 2024 NewBeauty Awards for Best Vitamin [indiscernible] and also the '24 Best Beauty Awards for Best Face Serum in the New Face Products category. So consumers are also showing not only through users but also through voting for this as very strong innovation. Also here, innovation is coupled with digital and e-commerce execution, and we continue globally to focus on e-commerce and shift a lot of our marketing dollars to digital and influencer marketing. Let me give you some example. We are increasing our influencer-first digital efforts, particularly in the U.S., with very visible campaign around Face of Cetaphil and a very successful Super Bowl activation as we also mentioned briefly in the Q1 call. Another example was Cetaphil in India, a very strong market for us, which capitalized in the first half on local trends with men's skin care going viral and becoming one of the top trending topics on social media platforms in India. Cetaphil in India was also recognized by Marksmen as the 2023/'24 Brand of the Year. The robust e-commerce growth that we are seeing worldwide were particularly strong also in the U.S. on Amazon, which is one of our fastest-growing channels overall. Similarly, in China, very strong e-commerce growth as we'll also cover a little bit later. Innovation, focused execution, strong focus on digital and e-commerce is very important, but we can never forget that we rely on a strong relationship to the health care professional community. So with strong scientific engagement with them and the consumers they serve, we leverage our integrated dermatology strategy also through additional sales force detailing and significant more health care professional education, even to the extent that we've set up a Galderma Sensitive Skincare Faculty, which will guide us in our ongoing activities with KOLs, education and research. Well, let's talk a little bit more about Therapeutic Dermatology. Of course, all in focus for you with nemolizumab, I'm absolutely sure. But let's just focus on the products we already have. Despite ongoing genericization, which mainly affected U.S., we still showed growth, particularly driven by international markets. Net sales for the first half of 2024 were USD 388 million, which is a year-over-year growth of 2.2% on a constant currency basis, personally, I think very strong given the significant genericization, mainly driven by international markets that are more than offsetting the anticipated lower volume in the U.S. with the rapid genericization happening for a few brands there. But also, the U.S. performed well. But of course, it is important not to expect that Therapeutic Dermatology, when we exclude nemolizumab, that will be a contributor to growth. So what you saw here is strong performance, but we expect the growth to kick in once we launch nemolizumab. Talking about nemolizumab, much anticipated, I'm sure also by you. And at a time this morning, you could also see the recent publication in Lancet. More to come about that. But I can assure you that the launch preparations for nemolizumab, as are the interactions with the regulators in the U.S. and elsewhere, are progressing very well both for prurigo nodularis and for atopic dermatitis. Of course, you know about the filing acceptances in the U.S., including the priority review for prurigo nodularis. But we also have announced for Europe, Australia, U.K., Singapore, Switzerland and now also filing acceptance for Canada, so you see continued very strong progress. One aspect of the preparation of the launch is, of course, the whole regulatory pathway. Another is, of course, to make our organization and markets ready for our entry. And first and foremost, in the U.S., we've set up the required infrastructure, whether it's commercial, medical, market access, and we are working with teams that have a lot of expertise bringing blockbuster product and biologics also in this category to market. We, of course, already had significant reimbursement and provider discussions in the U.S. and as well as the KOL engagement, both progressing extremely well. The product is much anticipated. There is significant unmet need. And even in terms of the patient aspect, we've set up a patient services hub that is being completed and also are setting up what is necessary for the specialty pharmacies. In key international markets, we are also having the teams in place, again, people with significant experience in launches, market access and medical aspects. As mentioned, this morning, and you could say the timing was perfect, we had ARCADIA 1 and 2 trials presented in the very prestigious Lancet. And if you have time, you should look at the results, 48 weeks data, very impressive results, both on itch, skin indications and sleep, so also setting us up very good for the effect we have in adolescents and adult patients with moderate to severe atopic dermatitis. We also did a small proof-of-concept study for Galderma in chronic kidney disease. The good news is it totally confirmed the fast onset, the very strong safety. But looking at it and barely missing the primary endpoint, we have said that although it shows very good onset, although it confirms the safety and tolerability profile of nemolizumab, and this is in a very tough-to-treat, very sick population, we have so many other opportunities that at this time, we've taken the decision to deprioritize this [ re-purposed ] program and focus on some additional very exciting indications. More to come on that later. Let's now talk a little bit about geography and performance. Not surprisingly, we have noticed our very strong and very broad-based performance in international markets. Across international markets, we've seen continued double-digit growth momentum with strong performance in many, many markets. Of course, China will stick out. But you also have India, Thailand, Brazil, the U.K., Mexico, and also the U.S. continues to show a very good performance despite softening market conditions. I know there's a lot of talk about China these days. But for us, China is just at the beginning. We have very strong growth in Injectable Aesthetics and in Dermatological Skincare. We spotlighted this because others are more subdued about China. We are very optimistic. We're at the beginning. We've seen very robust growth trajectory with double-digit growth in both Injectable Aesthetics and Dermatological Skincare. And it was in H1 that was based on strong brand performance and execution. As we build up the organization as we penetrate the market, we've expanded the sales force to cover additional cities. We are reaching more Tier 2 cities, not least for Injectable Aesthetics. We've sharpened and improved our performance in digital and e-commerce for Cetaphil. We have very strong performance during the recent 618 campaign period. We focus on what we call Cetaphil big white jar, which is now ranked the #1 moisturizer on Tmall. And we brought consistent innovation into this very attractive market. And we brought Restylane VOLYME and Cetaphil Baby into the market with great uptake. There's some softening, of course, in the consumer market. But we've shifted to market share gains, more penetration, more execution, larger sales forces, and we're absolutely sure that this will have significant room for growth for us in the future. And with that, I'll ask Thomas to give you a little bit more detail on the financials.

Thank you, Flemming. I'm also very pleased to share with you the details of our H1 financial results and the outlook for the full year. Let's start with the financial results. As you see on this slide, and as Flemming mentioned earlier, we delivered record financial performance in the first half of the year on a few aspects, not just sales. In terms of top line, we recorded net sales of USD 2.2 billion, a 10.8% growth rate year-on-year at constant currency, and 9.9% on a reported basis. After the first 6 months, this puts us slightly ahead of our full year guidance range. In terms of bottom line, we recorded a core EBITDA of USD 514 million, growing ahead of sales with a growth rate of 17.7% year-on-year at constant currency. The core EBITDA margin was 23.4% for the period, which came mainly from 2 sources. One, underlying -- increasing the underlying profitability. That is the profitability before we reinvest EBITDA into nemolizumab. And secondly, the nemolizumab spend phasing, which I will provide some more details on later on in the presentation. As for cash and balance sheet items, I am very pleased to share that we made significant progress on deleveraging. As of end of June, we reduced leverage to 2.6 turns and also repaid debt early post-IPO, which I will also provide more details on shortly. I'll now go on to discuss the core financials in more detail on the next slide, and let's start with the P&L. Looking at core EBITDA margin, it stands at 23.4% for the first half of the year, which means an increase of 90 basis points on a year-on-year basis and up 140 basis points in constant currency. If I compare this to our core EBITDA margin for the full year 2023, this represents a margin expansion of 30 basis points or an increase of 40 basis points at constant currency, tracking nicely in line or actually, I should say, slightly ahead of our expectations. Core EBITDA grew almost 7 percentage points faster than sales in the first half of 2024 at constant currency. So where did the profitability improvements come from? Two main drivers. One was operating leverage from the sales growth on top of our integrated scalable platform. And the second was the phasing impact from nemolizumab costs, which we expect to ramp up a bit more in the second half of the year. More details on this on the next slide. And as for gross -- core gross profit, yes, it grew somewhat slower than sales. Core gross profit margin was also slightly below the level of the full year 2023, and there are 2 sides to the story here. We have positive impact, mainly from better product mix and higher absorption in our plants and from increased sourcing efficiencies, which were more than offset by our targeted pricing actions, mainly in Injectable Aesthetics and Dermatological Skincare, in the face of tighter price competition in these 2 areas, which helped us to drive market share gains as well as due to some negative FX revaluation impact on inventory. Core net income grew 59.9%. This reflects our strong net sales performance for the period, the core EBITDA margin expansion I just mentioned as well as the benefit of lower interest expense following the reset of our capital structure post the IPO. I will now provide more details on our core EBITDA margin expansion on the next slide. Here on this page, you can see the comparison of our H1 2024 profitability versus full year 2023 and full year 2022, representing the, as we call it, underlying profitability of the business and the amount of EBITDA the business generated and which we then went on to reinvest over here into nemolizumab. As you can see, we have continued to improve our underlying profitability, which would be 27.7%, if you park mentally the nemolizumab cost outside. The improved underlying profitability was driven by operating leverage as we continue to scale our integrated dermatology platform, as I mentioned earlier. And you can see the impact of really fast growth enabled by a scalable platform globally over the past years. And this will continue to be one of our drivers of margin expansion going forward, not only this year but for years to come, along with the premiumization of our offering and the normalization of R&D spend in percentage of sales. Now beyond the increase in underlying profitability, the core -- the reported core EBITDA margin reflects the anticipated nemolizumab spend phasing, which is expected to ramp up in the second half of 2024 as we increase our prelaunch activities for nemolizumab more. For H1, the spend for nemolizumab was $95 million, representing 38% of the expected spend for the full year of, as we guided earlier, approximately $250 million. So now let's move on to an overview of cash generation. This slide here shows our cash position at the end of June and the key movements versus year-end 2023. As you can see, our cash position is slightly up. Let me walk you through key reconciling items of the cash bridge. Start with cash generated from operations. Following our normal seasonal sales pattern, we saw net working capital increase in the first half of the year. We expect it to stay at approximately this level for the remainder of the year. The $58 million of pre-IPO incentive settlement represents a onetime cash-out, predominantly related to the pre-IPO value creation bonus. On interest and taxes, the tax rate for H1 was slightly higher than initially anticipated due to one-off IPO items. This is fully reflected in our latest modeling metrics for the full year, which we have provided in the appendix of this presentation and in this morning's press release. Please note this was due to one-off IPO-related items. Hence, it has no impact on our midterm tax rate expectations. On CapEx and milestones, I'm pleased to report that 2 out of the 3 milestones and earn-out payments that were anticipated for the year were due in the period and have already been paid, leaving approximately $70 million expected to be paid in the second half of the year, subject to an upcoming regulatory milestone for nemolizumab, actually, FDA approval. And recall, we expect to pay a total of $175 million in milestones and earn-outs for the full year 2024. And on the financing cash flow, our H1 results allowed us to repay $100 million of debt early. That's a clear testament to our commitment to reduce debt and puts us on a very good path for our deleveraging goal at year-end. To discuss leverage, let's move to the next slide. Let me note here that Galderma is progressing very nicely on its deleveraging trajectory. As you can see from this slide, net debt has come down to $2.6 billion at the end of June with leverage reaching 2.6 turns, which is down 2.3 turns compared to the end of 2023 and 0.4 turns compared to the time of our IPO at the end of March. Post IPO, we also decided to repay $100 million of debt early despite the 2 milestones and earn-out payments of $108 million, which I mentioned earlier, which we also made in the period. This reflects our confidence in the business and its strong cash generation. For the full year, we now expect leverage to be towards the lower end of the previously communicated 2.25 to 2.5 turns range. In addition, the second half of the year will benefit from an improvement of about 50 basis points in the interest expense and gross debt, resulting in an expected interest cash expense of approximately $120 million for the second half of the year. Let's now turn to the full year outlook on the next slide. Based on the very strong momentum in the first half of the year, we are updating our full year guidance on net sales. For net sales, we are expecting to be towards the upper end of the previously communicated range of 7% to 10% growth at constant currency. For the group, we expect the first half of the year to have a slightly higher year-on-year growth rate compared to the second half given also the effect of a low comparable base in Q1 a year ago, as we mentioned on the Q1 call. Within the second half of the year, we expect to see a lower year-on-year growth rate in Q3 and then the seasonal reacceleration in Q4. As for core EBITDA margin, we are confirming our full year guidance in line with the 2023 core EBITDA margin at constant currency. This takes into consideration the planned ramp-up in nemolizumab spend and the continued improvements in our underlying profitability. As a reminder, we have also provided our latest expectations on the additional modeling metrics in the appendix to the press release published on our website. Here, I'd like to call out, again, the update on the leverage guidance for the full year, which is now towards the lower end of the previously communicated 2.25 to 2.5 turns range. And with that, let me emphasize that we remain very confident in our updated outlook for the full year 2024. This concludes the introductory remarks of Galderma's H1 financial results. With that, and before we close the meeting with Flemming's final remarks, I would like to hand back to the operator to open the call for questions. Sandra, can you please open for the first question?

[Operator Instructions] We will now take the first question from the line of Thibault Boutherin from Morgan Stanley.

My first question is just on market growth in general. I just wanted to know how the market growth for injectables and Dermatological Skincare is playing out this year compared to your midterm market growth expectations that you said earlier. I think you were mentioning 6% to 7% growth of skin care market and kind of 7%, 8% growth for Injectable Aesthetics. So just wondering what you're seeing on the market right now versus this kind of midterm targets or other midterm expectations. Second question on injectable pricing. My understanding is that you took some price action to gain share in the U.S. So I just wanted to know if you could comment on pricing this year compared to historicals and how you expect pricing to evolve in the future on injectables? And also some maybe general comments on pricing dynamics ex U.S. for your key markets would be helpful. And then final question is just on the opportunities for GLP-1-driven demand for Injectable Aesthetics. Is it anecdotal today? Is it meaningful already? And are you seeing an acceleration of the momentum for this demand?

Yes. Thanks very much for your question. I'll start, and then I'll ask Thomas if he wants to add. I think it's, first of all, important to realize, even though I can hear you have a significant focus on the U.S., that the larger part of our business is international. So there are many markets like China, we mentioned Thailand and others, where we are just at the beginning of a trajectory and where the name of the game is market share gain. So if you talk about the U.S., there's been some slowdown in some segments of the U.S. aesthetic market. That has mainly been in the fillers. In international, we've seen it in some markets but not in all markets. In others, we continue to see very strong growth. But if you look at Galderma overall, the trend is market share gain, more penetration, rolling out its portfolio globally, which has been driving our growth. And specifically, over the coming years, we have significant market introductions, whether it is Relfydess going global, whether it's additional fillers going global, and whether it's Sculptra, which in many countries are still rather underpenetrated. Specifically in the U.S., you've seen that the filler market has some weakening. You've also seen some pricing pressure. But if you look at our results, you have not seen the same. In the neuromodulator, we've had very, very strong performance on the neuromodulators, both in the U.S. and outside the U.S. We continue to see very strong performance of Sculptra, U.S. and outside the U.S. So the way we've been able to compensate some of the softness has been by market share gains and by shifting in the U.S. some more activities to Sculptra and the neuromodulators in that situation. GLP-1, even though anecdotally, because in certain parts of the world like in the Middle East, this is highly penetrated, you hear the doctors say that a significant part of their patients mention this as a reason why they want particularly facial treatment. But globally, we're still at the beginning of that. So net-net, I think the aesthetic markets continue to be very attractive. Fillers, U.S., a few other markets, some slowdown. Others, we are still at the early days of penetration. Neuromodulators continues to do really well. Biostimulatory is really well. But the name of the game, U.S. and international, is new product introduction. And as we just mentioned, Relfydess, we think that is a very significant introduction into the category that next to biostimulatory is showing very strong growth. On the skin care market overall, there are some countries where you're seeing some softening, including in the U.S., but there's also a dramatic shift to different modes of selling like e-commerce, strong growth in Amazon. And outside the U.S., you are not seeing that trend. Particularly in Asia, you're still seeing very strong growth in the skin care market. So it's a mixed picture, but the name of the game is new product introduction, building out your platform, and building out your scale in more and more countries and then be the leader in innovation and KOL engagement.

And now that's -- Thibault, if I can add to that because Flemming has really given the key drivers here. You see it also financially, right? And you see it financially because when I look at our growth, it's volume and then we have mix improvements. Mix improvement means people within a product range are prepared to move to a higher aspirational, more expensive, innovative, new, better price point. That's what we're seeing. So when your question is a little bit pricing, what does that mean? I mean we are not the discounter here, right? We have innovation that differentiates. With that, we can move people up. And then, of course, we are at liberty to reinvest some of that to drive market share gains, and that's what we're doing. But it's really that sequence of mix improvement that people are with you and want to go trade up in the Galderma ranges. I would like to point that out for you.

Thank you, Thomas. Thank you, Flemming, and thank you, Thibault, for the question. [Operator Instructions]

We will now take the next question from the line of Jo Walton from UBS.

For my question then, I'm going to ask a little bit more about nemo and the timing for nemo. So you should be getting your first U.S. approval shortly and your second one with the second BLA certainly this year. Are you still expecting not to launch until the first half of '25? Or could we see perhaps a soft launch ahead of that? Just to give us a little bit more sense of that time frame in which we could start to see even early revenues coming in for nemo.

Well, thanks very much for the question. Yes, I can confirm that the review of the file in the U.S. for PN and AD is progressing well. Timelines, unknown. One has a 9-month review. The other one has a 12-month review. I mentioned that we are preparing for the launch in the U.S. We're also progressing well in the many, many countries, an increasing number of countries, as we mentioned also in the press release where we have filed nemolizumab. European Medicines Agency is on a 12-month clock and things are progressing well there. So I think we have to differentiate your question into 2. So in the U.S., you first need to get marketing authorization. So let's focus on prurigo nodularis, which is probably where we first could expect that to happen. Then you need to make sure that when the physicians decide to prescribe the product that the product is ready. Check mark, we are ready. The second check mark is when they decide to give the patient a prescription for the product, then they go and fill it, that it's actually available. So there, we've done all the preparatory work that you can do. But there are some things you can only do, including final pricing, including final settlement on these specialty pharmacies and other things. That takes a little bit of time after you've got an approval. That's why we, you could say conservatively, have said that a meaningful impact on our growth and sales is probably only going to be seen in 2025. That's the background for this.

We will now take the next question from the line of Chris Shibutani from Goldman Sachs.

On the Injectable Aesthetics, if I could just return and ask for a touch more granularity in terms of this pricing and share dynamic. If you could perhaps quantify a bit and then contextualize in terms of how persistent this type of move would be on the forward. Second quarter, fourth quarter tend to be very seasonally strong. A major competitor did talk about enhancing their promotional efforts in the 2Q. Would you say that your pricing approach was to be on par or at a discount? And then as we think about on the forward and thinking about the maneuver and its impact on growth guidance and perhaps, this is most relevant to the U.S., how should we be thinking about that? Is that likely to be dynamic? Or from these price levels, does this frame a kind of trend?

No, thanks very much for the question. So again, because I know the question is focused on the U.S., keep in mind that the large part of our business is outside the U.S. [indiscernible] even stronger growth outside the U.S. on both fillers and biostimulatory products and neuromodulators. And as I mentioned, that in many countries outside the U.S., you're not seeing this dynamic that you're seeing in the U.S. So in the U.S., you are seeing some pressure that is focused mainly on the filler range. And particularly, companies that don't have a broad range of product will probably be more susceptible to do significant discounting, volume discount or other things. We have a very broad portfolio, so we can shift our effort to biostimulatory product, which is really high in demand, and to neuromodulators. So some of the price action, which we have been very conservative of not joining the trend, we can compensate by shifting to biostimulatory product and to neuromodulation. And then as you know, next year is also going to be a big launch for us in the filler range in the U.S. So we are focused on innovation, and we're focused on doing more training. But of course, we're not immune to a market that is maybe seeing some softening. The good news is the number of patients coming to the aesthetician offices in the U.S. has not significantly decreased. What they are getting treated with has shifted. There's a bit more laser. There's a little bit more other instrumentation. There's more biostimulatory product. There seems to be a constant growth in neuromodulator, but fillers seems to be a bit softening. So there, it's about positioning your fillers better than others, also in terms of focusing on lip filler, on other fillers, at contour and others and under the eye. So there is an impact, but I think we've been able to mitigate so far. So early days to see how this will play out.

We will now take the next question from the line of Emily Tedbury from Citi.

I just wanted to talk a bit about your strategy around QM-1114 once it's been approved in major markets regarding on focusing on new geographies, new patient pools and market expansion versus switching existing patients from Dysport.

Yes. First of all, thanks very much for the question. So we're, of course, in an enviable situation because of our relationship, a great partnership with Ipsen, we have access to an excellent portfolio, so we have Dysport or Azzalure. We've recently very successfully, I think, launched a liquid form of that called Alluzience, so we've also learned a lot about the benefits of liquid neuromodulators. QM is going to be a totally new game for us, but it's going to be an addition to the portfolio we have. So most likely, this will come to market in Europe and other countries before the U.S. As I said, we're still making very good progress on the complete response letter we got. But probably, we will only be able to file sometime in the first half of next year. We are ready also if the product gets approved in Europe and other countries. We are ready. It's a decentralized procedure. After we get approval, we have to make some adaptation to the manufacturing file because some of the complete response letter we got from the U.S., we adapted a bit the manufacturing process. So that takes some months. And then, of course, from a European Medicines Agency approval down to the country approval, that also takes a bit of time, which is why we also hear, even though we could get approval earlier, we're saying it's also a '25 issue in terms of impact on sales. The good news is when you have a portfolio and you have some very experienced doctors that you are catering to and patients also with a lot of experience, this is an additional option for patients. So as I mentioned, it works really fast, day one, and it has a 6 months duration. It has a huge advantage of being totally liquid. You don't need to reconstitute. And particularly in busy clinics, this may be very attractive. But we're going to continue to put equal emphasis on our full portfolio. And over time, I'm sure we'll play out what some patients prefer and some doctors prefer. But I'm very confident that this will lift the whole portfolio for us because that is exactly what we have seen where Alluzience is. It increases our overall market share, which I think is a huge benefit for us.

And in addition, if I may add, it's also a profitability enhancer because QM-1114, there, the royalty structure to Ipsen is capped at a certain level. And there are even geographies, ex U.S., big geographies, where we actually have to pay 0 royalty. So it's a double positive whammy, that's probably the wrong word then, but a double positive for us, not only on the growth side and the innovation side, but it significantly enhances profitability. And maybe that's one for Chris from Goldman, who asked the question. That's one to really focus on as you think about dynamics going forward on pricing.