“Freeze the Fat Away … Quick 40% Profit” (Hilary Kramer)

by Travis Johnson, Stock Gumshoe | January 10, 2012 2:32 pm

Identifying the New "razors and blades model" medical device company recommended by GameChangers

I’ll admit right up front that there’s something appealing about this company’s service, at least for your friendly neighborhood Gumshoe … who is a bit more roly-poly than he might like.

It’s Hilary Kramer pitching to us again, teasing us that she’s recommending a company that can “freeze the fat away” and that should be a long-term winner … but also a short term play with an expected “quick profit” of 40%.

And apparently this isn’t just a teaser campaign pick, but it’s also a current selection of the newsletter — the ad, which I got yesterday, says that it’s a new recommendation in “today’s issue.”

But I’ll let her words entice you …

“an exciting new stock that will deliver explosive growth as it revolutionizes the battle of the bulge.

“When you look at the lists of New Year’s Resolutions, year after year, losing weight always makes it to the top!

“But while we like to look good, we don’t always like to put in the hard work and sacrifice it takes to make it happen (which is probably why it stays on the list year after year!).

“It’s no wonder that liposuction and tummy tucks are both in the top five aesthetic surgeries….

“Today’s GameChanger hits the sweet spot of this huge and growing market with an excellent alternative to surgeries like liposuction and tummy tucks.”

Sounds impressive, right? I’m sure it’s wonderful to cure cancer or diabetes or to treat and counsel families suffering from debilitating problems, but aesthetics is a nice, cleaner business without as much stress — I imagine many doctors are just as happy blasting away a little fat or some wrinkles as they would be treating disease … your patients like it, they’re generally wealthier than average and pay their bills, and there are fewer insurance headaches.

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And better yet, we’re told, this is a “non-invasive procedure” — which sounds impressive. Even the vain and the frustrated don’t necessarily take kindly to the idea of possibly risky surgeries or scars to get rid of their “love handles.” If I’m not even willing to stop eating candy bars to lose a few pounds, I’m definitely not willing to undergo surgery.

Here’s what they do, in Kramer’s description:

“This game-changing new procedure, approved by FDA a little over a year ago, literally freezes the fat away. This proprietary system freezes fat cells, causing them to die off over a few-month period.

“Your body just naturally disposes of the dead cells. There are no incisions needed, and no anesthesia is required. It’s an outpatient procedure with minimal discomfort. In fact, many people return to work after having it done.

“The business is very much a ‘razor and blades’ model, which is typical of medical device companies. The ‘razors’ are the systems doctors need to perform the procedure; the ‘blades’ are fees and supplies associated with each procedure, including disposable supplies that allow physicians to use the equipment for a fixed number of procedures before they have to buy more.”

I know we’ve heard it many times, but I looooove the “razors and blades” model — it doesn’t work every time, of course, but if you can find a company that’s implementing it well and pricing it right the long-term rewards can be remarkable. Just look at Intuitive Surgical (ISRG), a company that has been teased many times over the years, and which I regret selling years ago — revenue growth ramps up in the early stages, albeit in a “lumpy” fashion, as the expensive machine is sold to doctors, then more machines begets more procedures, and each procedure requires a disposable set of supplies, so as the installed base grows the demand for the supplies grows.

If you can sell the “razors” or the base equipment at a profit eventually, so much the better — but often the first phase of growth in the installed base comes at a substantial cost, which is worn down over time by the high-margin supplies business that continues to grow on a larger and larger base of machines. And of course, you have all of these doctors who spent a lot of money to invest in a fancy new machine, so they’re motivated to market their services and increase their usage.

Of course, for big-ticket medical devices this only works over the long term if the machine is really unique (and therefore marketable, with a differentiated service or outcome), and it really works well, and doctors and patients both like it and seek it out — preferably by brand name.

So which one is this?

Well, you may already be able to guess it — it’s a recent IPO, and it’s a pretty unique and marketed concept — but it hasn’t gotten all that much press in the investor community that I’ve seen. Just to make sure, let’s gather a couple more details from the teaser ad:

“The company received FDA approval for its system in September of 2010, and early acceptance has been impressive, resulting in rapid revenue growth. In the first four months after approval, revenues jumped to $25.4 million from $1.5 million in 2009. Growth exploded through the first nine months of 2011 with revenues of $49.3 million. Revenues from sales of the system increased 219%, and procedure fees increased 597%.”

And we’re told that the stock “soared” from the IPO by about 40%, but pulled back and is now under the initial offering price. Kramer doesn’t specifically say from whence she pulled that “quick 40% profit” that she’s looking for, but says that it’s a “great time” to buy because “sales are really kicking into high gear.”

So who is it?

Thinkolator sez: Zeltiq Aesthetics (ZLTQ)

Which really is a new company with a new fat-killing technology — their product is called “coolsculpting”, and it basically takes advantage of the fact that fat cells are sensitive to temperature in a way that’s slightly different from skin cells. Their machine consists of a device that vacuums your skin (flabby sections, like a belly bulge or a “love handle”) into a cooling machine and drops it to a set temperature for an hour. This temperature, which is above freezing, apparently does no lasting damage to the skin cells but kills a portion of the fat cells — and kills them in a pleasant and natural way (the process is called apoptosis) that allows them to just be slowly disposed of by the body (no traumatic desctruction that causes stress or scarring, apparently).

It’s meant for “stubborn” problems like the guy who has lost 25 pounds and looks good, but still has stubborn pockets of fat in the love handles or lower back that won’t respond to exercise or dieting; or the new mom with a recovered body but a lingering fat pouch. They’re trying to be very clear that this is for folks who have already done the hard work, but for whom it hasn’t resulted in quite the level of body perfection they were looking for — many folks call it “body sculpting.” It’s not a cure for someone who has a 20 pound pouch of fat in his belly and doesn’t want to go for a jog (insert frowny face for yours truly), it’s a way to make your hard work look better. We can debate whether it’s healthy to have more ways for a society to encourage aesthetic perfection, but certainly there are lots of companies in lots of industries making lots of money as they try to make us feel better about how our bodies appear to the outside world. The device is FDA approved for “flank fat” (that’s not their term) — basically, muffin tops and love handles and persistent back flab.

Zeltiq was funded by private equity for a pretty rapid development phase that had them getting marketing approval for their device and procedures in Europe in 2009 and in this country from the FDA in September 2010. Once they had a couple of months of sales in the hopper, they filed to go public last Summer and actually had their IPO in October 2011. The IPO raised a bit under $90 million by selling about eight million shares (and, importantly, the company raised the money and therefore has the cash to finance growth — it wasn’t just the founding shareholders and early investors who sold in the IPO, though those insiders did sell 307,000 shares as part of the IPO). Coincidentally, that’s pretty close to the company’s “accumulated deficit” of about $80 million (roughly speaking, that’s the money they’ve run through in ~6 years of developing the system).

The financials (their first 10-Q is here[1]) are a little odd looking because they haven’t filed yet as a public company — their September filing before the IPO was essentially for the prior holders of the convertible preferred shares (which were apparently all converted into common stock at the IPO), though you can of course get the basics on revenue and earnings from these filings. I presume that those convertible shares, which now make up about 3/4 of the ownership of the company after conversion, were held by initial investors and insiders. There’s also a pretty good slug of options out there for potential future dilution, though that’s common for a new company. The lockup period for insiders is six months from what saw of the IPO filing information, so there could be some selling pressure if insiders are anxious to sell starting in mid-April.

The “Razor” in this case is their CoolSculpting device, which is a little machine on wheels that does the chilling, and the “razor blades” are the different size cooling vacuum pad assemblies that you can use, disposables (like gel to cover the skin, etc.) and the CoolCard that basically makes the machine work (each card has a certain amount of uses embedded in it, and the machine and controlling software only work with the card). So far, as of the last nine months, about 70-75% of revenue comes from the machines and the rest from CoolCards and supplies. The geographic dispersal is similar — about 70% North America, 30% rest of world (presumably that’s almost all Europe, though they also have other distribution, including in Brazil, global capital of plastic surgery). I don’t know what other competition there might be for this specific technology, but they seem to have good control over their particular intellectual property — they have an exclusive license agreement with Mass. General, where doctors developed the patented process (that license lasts the life of the patent, which is currently expected to expire in 2023, and there are milestone and royalty payments due to Mass General — including $6 million they owed as a milestone payment in December for the IPO and an ongoing 7% sales royalty).

The company says they are targeting a global base of 4-5,000 physicians who meet their “target characteristics,” some of whom might buy more than one system. So far, they have an installed base of 812 units as of September 30 — if you do the math, that means the installed base increased by 594 units in the first three quarters of 2011 (they had 218 units before that). 183 of those were sold in the third quarter, so they are not seeing big booms of sequential sales growth (thus the “seasonal weakness” they mention — doctors on vacation in the summer, etc.), though the year-over-year numbers are very good — in large part because, of course, they didn’t sell much of anything in the US before FDA approval in late 2010.

System sales revenue was roughly $35 million for that nine-month time period, so we can infer that the initial system investment is something like $60,000. Which is a fair chunk of change, but certainly not huge for an aesthetics practice where they’re already doing plastic surgeries and liposuction (and, of course, tiny compared to the cost of some medical equipment).

The company says they “shipped 44,000 procedures” to their customers in the third quarter last year, though I don’t believe they’ve disclosed what company revenue is per procedure or how many they expect to do in a given quarter. They did say that their expectation is for the second and third quarters to generally be seasonally weak, so perhaps they’ve set it up — as most companies try to do — so they have an impressive looking quarter their first time out.

The average cost of a single procedure is in the $600-700 range for a single hour of a single location (ie, one “love handle”), and apparently most folks would do a couple applications. Bigger applications, like a belly, would be perhaps twice as much per hour. Zeltiq is targeting both a group of about 20 million “veteran” aesthetic procedures customers (mostly wealthy, middle-aged women), and the much larger group of “novice” targets — healthy appearance-conscious people in their 30s-50s who might have stubborn “problem areas.”

So far the analysts all give ZLTQ a “buy” rating — but of course, those are also the analysts from the same investment banks who managed the IPO for Zeltiq just a few months ago (and, cynics will note, would like to manage any follow-on offerings). They do have a good slug of IPO cash that should support a pretty strong growth strategy — particularly the big ramp-up in sales force that they need right now, and the consumer marketing that will help drive demand, though they also have to ramp up manufacturing capacity if demand rises as they expect.

I have no idea if this marketing and buildout will work, or if other things like laser liposurgery or whatever will prove to be more popular as noninvasive or minimally invasive fat-fighting options — and likewise, I don’t know if the patients have generally been happy with results so far (the company says yes … of course). And likewise, I expect there’s plenty of risk if one of their doctors uses the system to do something outside the lines, or if there’s some accident or unforeseen problem with the system. They’re a very small company — about $350 million in market cap now, with the share price now down to about $10 — and their only real asset is this “cool technology.” They are investing more in R&D, including an expansion of their work with Mass General to fund more research into other aesthetic applications of this cold technology, and they probably won’t show a profit this year.

There is certainly potential for profit, and for that profit to scale very rapidly if the product takes off with consumers, since it’s inherently a high margin business (gross margin is already at almost 60% even with their low initial sales — it’s the building of their sales force, more R&D, and their corporate costs that suck up the cash, not the cost of producing the machine, and the recurring supplies revenue is at substantially higher margins than the systems sales). You can check out their marketing (coolsculpting.com[2]) and their investor presentations[3] and choose for yourself.

I’m personally kind of intrigued by this one, though I’d be much more comfortable if they had at least one publicly reported quarter under their belt after the IPO (and a quarter that they didn’t say was “seasonally weak”). I don’t know when their fourth quarter report will come out, but given the very early stage of their sales ramp-up it’s very possible that the numbers could cause a substantial move in the share price — of course, that could mean “down” as well as “up.” Clearly, investors are not enamored of this one right now (it’s down a bit this week, despite their presentation at a health care investing conference yesterday), which is a bit worrisome — but perhaps not a surprise for a new IPO that hasn’t yet proven itself.

For companies like this who have “lumpy” revenue that depends on bigger-ticket system sales, an earnings miss on a bad sales quarter can often present an opportunity if the adoption rate and usage rate of the installed base is good — but that’s a hard bet to make when they haven’t even really reported one quarter yet, and when the stock is just getting its first analyst coverage and the lockup period hasn’t even expired to give an idea of what insiders are doing. Intriguing, but still certainly a gamble on a product that’s just ramping up — if you know more about Zeltiq or have an opinion on CoolSculpting or the price of ZLTQ shares, let us know with a comment below.

  1. first 10-Q is here: http://investor.coolsculpting.com/secfiling.cfm?filingID=1193125-11-314261&CIK=1415336
  2. coolsculpting.com: http://www.coolsculpting.com/heres-the-skinny/
  3. investor presentations: http://investor.coolsculpting.com/events.cfm

Source URL: https://www.stockgumshoe.com/reviews/gamechangers-2/freeze-the-fat-away-quick-40-profit-hilary-kramer/

  1. Avatar
    Jan 10 2012, 03:14:04 pm

    I followed her picks last year. She picked a couple of winners, but many losers too. I wouldn’t invest a lot in her picks.

    • 12477 |
      Travis Johnson, Stock Gumshoe
      Travis Johnson, Stock Gumshoe
      Jan 10 2012, 03:42:03 pm

      Yes, the technicals are generally terrible. Some of the quantitative models might give it a so-so rating, since they do have revenue growth, but for the most part anything going off of reported numbers or stock charts is going to dislike this pick — it’s a “story” stock that requires you to think the business model will take off. Initial signs are pretty good with the fairly quick takeup in system sales so far, but definitely far from proven even as a “story”. Good business model, good market, beyond that it’s waiting for some proof that the product really gets traction enough to grow to profitability — and there’s not a huge margin of error if their initial target of 4,000 to 5,000 doctors is really the entire addressable market, since they’ve already installed systems with 15% of them if that’s the case, if they’re going to grow and justify that 80 million+ they’ve invested so far, it seems to me that they they would probably have to sell at least several thousands systems pretty quickly and keep per-system usage at a pretty high level. Still intrigued, though.

  2. Avatar
    Jan 10 2012, 04:12:23 pm

    this technology was discussed and demonstrated on the TV show—“The Doctors” —and received a fairly welcome reception without supporting comments from the doctors. Depending on the actual cost, I can see a lot of interest in this procedure.

  3. Avatar
    Jan 10 2012, 04:33:15 pm

    I’m a dermatologist, recently employed in a multi-office derm group that has at least one of these CoolSculpting devices (not in the office where I practice). Patient satisfaction will likely reflect proper selection, as you are absolutely correct about the limitations. Cost-wise (to the patient, assuming two sessions), it’s a bit better than the fees I charge for laser-assisted liposuction, but I’ll still be busy with lipo for the even moderately larger cases. I think CoolSculpting is viable and here to stay for 5 years or so. Competition will come from the ultrasonic (Liposonix, I think) device and from bile salt (deoxycholate) injections (if it gets approval from the FDA) which target the same type of patient needing only modest fat removal. The ultrasound device is quite painful, I’m told, and the injections aren’t approved, despite the rise (and fall) of “mesotherapy clinics offering “LipoDissolve”.

  4. Avatar
    Stephan Franck
    Jan 10 2012, 04:59:42 pm

    In looking at the stock price performance of ZLTQ there seems to be a strong downward trend. Also, the spread between ask and bid price is quite large. It seems like a pretty risky investment to me!

  5. Avatar
    Jan 10 2012, 05:47:30 pm

    As Skin says above, the product “ain;t all that” (paraphrasing). My old lady works in a plastic surgeon’s office and she said, “It doesn’t work. We get people all the time who had it and weren’t happy.” Pass

    • Avatar
      Jan 11 2012, 08:42:03 pm

      It works, but there are unhappy patients because they were too large to be good candidates. There is something called selection bias – I could say that Proactive doesn’t work for acne because I see patients nearly every day who haven’t responded to it. Naturally I don’t see acne patients for whom it works, so if I formed an opinion based on what my patients told me without considering that, it is likely to be erroneous.

  6. Avatar
    Jan 11 2012, 09:20:00 am

    Whoa, maybe TMI about the thinkolator’s lipid deposits. Sacrificing it’s body for others stock picking clarity? Is this something to take advantage of or does it reflect a systematic error, I.e. Not “making the connection” between body and mind, habitually running calorically over budget, borrowing today from the organisms’ future ability to withstand stress ( and to continue to have the intellectual clarity to make good picks). Or maybe intellectual clarity is overrated and what an investor should follow is rippling baboon dominance regardless of whether the message holds together logically ( or bears the hallmarks of human weakness and thus credibility). Thanks for sacrificing your health presumably for our reading pleasure, Travis.
    Thanks for the interesting reading, Travis.

      • Avatar
        Jan 11 2012, 01:57:13 pm

        Sorry. Was joking, riffing and free associating. See recent article from print WSJ: “Is Your Personality Making You Fat?” More syllogistically:
        1) I was unpleasantly surprised to hear of Travis’ 20 lb. fat belly;
        2) Does that mean he’s sacrificing his body for the site;
        3) If so, does that apparent systematic error in caloric budgeting and/or health judgment implicate his judgment in other areas;
        4) Maybe investors should not or do not care and should merely seek to find advantage;
        5) Or follow the advice of a more dominant primate without belly fat regardless of how logically cool and educational Travis’ site is, or seems to be.

  7. Avatar
    Jan 11 2012, 04:21:56 pm

    Travis perhaps you could volunteer to shed a few pounds , and go for the Cool Light Treatment. That would definitely give new meaning to the phrase , Taking One For The Team? LOL

    • 12477 |
      Travis Johnson, Stock Gumshoe
      Travis Johnson, Stock Gumshoe
      Jan 11 2012, 04:36:34 pm

      Ha! I’m afraid I’ve 20 pounds to go before I get to the point that it’s just the “stubborn love handles” that are making my body imperfectly sculpted.

  8. Avatar
    Daniel Victor
    Jan 11 2012, 07:25:54 pm

    I used to have shares in Chromogenex,before its intellectual assets were shifted to another ‘Chromogenex’ and the original company liquidated.Does its i-lipo fat removal system have any merit ?

  9. Avatar
    Jan 11 2012, 08:06:11 pm

    Did they prove that the weight stays off? It is not self-evident that removing fat in this way will cause it to disappear permanently. Our bodies are weird biological systems and how they behave is not similar to sculpting wood. As consumers–and investors–we should believe that until proven otherwise the fat will reappear. Perhaps it will reappear somewhere else, so that instead of love handles you will have a fat face. The unhealthy aspects of obesity remain, e.g., obese people are walking heart attacks and strokes, even if they are sculpted. They will take their sculpted bodies to the same early grave.

    • 12477 |
      Travis Johnson, Stock Gumshoe
      Travis Johnson, Stock Gumshoe
      Jan 12 2012, 10:46:41 am

      I expect that for them it’s an expectations game — they can apparently get rid of tough layers of fat in specific areas, and the body disposes those dead cells gradually, I gather. But they’re about getting rid of pesky patches of fat in healthy people, not big weight loss for the obese.

    • Avatar
      Jan 28 2012, 12:53:00 pm

      Yes indeed, even if the fat CELLS die, their CONTENTS (FAT, fer cryin’ out loud!) cannot simply disappear as if by magic. This is really a hare-brained scheme. Where do they think the fat is going to go once it is released from fat cells (assuming for the moment that it actually is released)? Fat does not just *disappear* once you have damaged the cells that stored it. It HAS to be burned or stored elsewhere, which was the problem in the first place (too little burning of energy relative to the amount eaten). It cannot be excreted–bodies have no physiologic mechanism for that. If the intact fat (triglyceride) is released directly into the bloodstream, it can cause serious tissue damage by glomming into fat globules and blocking blood flow. [http://en.wikipedia.org/wiki/Fat_embolism]

      But assuming a friendlier (less catastrophic) process, that the fat is released in a more orderly and physiologically normal way by first breaking up the triglyceride molecules and releasing the fatty acids for transport on blood proteins (albumins), those fatty acids STLL HAVE TO GO SOMEWHERE, like to the liver or other fat depots around the body. Trust me on this: we do NOT want POUNDS OF BODY FAT DUMPED INTO THE BLOODSTREAM in either of these ways. Not only would blood fatty acid fat levels go sky-high, but you’d end up with a fatty (and likely seriously damaged) liver. Elevated liver fat is now considered a strong contender for the cause of metabolic syndrome. None of this is good if survival is in your plans.

      This scheme has, IMO, an extremely low probability of accomplishing what it says it accomplishes in the way that is claimed. I am guessing that it is flat-out health-fraud.

  10. Avatar
    Tom K.
    Jan 15 2012, 10:23:04 am

    The remnants of these dissolved fat cells would have to be filtered out of the blood stream by the kidneys. What are the chances of long term kidney damage?

    • Avatar
      Jan 16 2012, 01:23:13 pm

      Essentially, nil. Lipocytes have relatively little other than fat as cytoplasm. It is difficult to even show a transient elevation of triglycerides after a treatment.

      • Avatar
        Jan 28 2012, 12:58:10 pm

        Which says to me that it isn’t working, and thank goodness. Or, if it is working, it is only re-distributing the fat very slowly.

      • Avatar
        Jan 28 2012, 01:30:15 pm

        Skin, I’m a little stunned by your reference to “bile salt (deoxycholate) injections”. This is, in effect, injection of a detergent to dissolve adipose fat. Is there formation of micelles which can be transported in the blood (or lymphatics), or is there some sort of merging with normal blood lipoproteins? Seems it would either end up in the liver or in other adipose tissue. Has to go somewhere. Thanks.

  11. Avatar
    Sharon Logue
    Jan 16 2012, 03:09:24 pm

    it’s not hard to find a lot of information on this technique, and yes they have competition from Zerona, defined as a non invasive cool laser. Reading what patients have said, the Zerona technique appears painless compared to the zeltiq technique, where patients complain of “grabbing pain on their abdomen”. Both techniques reduce fat as reported by the reviewers. Zeltiq gets best bang for the buck ratings on the body contouring website, and smart lipo gets best overall satisfaction. Zerona has other novel uses for their lasers.
    You have to wonder if two ice gel paks compressing a fat site would do the same thing, or if people suffering from hypothermia loose a lot of weight real fast. I think Hillary throws out ideas without a lot of analysis. Her Metabolix recommendation sounded great too, until Archer Daniels Midland dropped the joint venture.

    • Avatar
      Ben Treen
      Jan 17 2012, 09:24:54 am

      The laws of physics don’t support the claims made about Zerona. That wavelength and fluence cannot possibly penetrate into the subcutis and interact with fat in any meaningful way. Any circumferential loss “associated” with Zerona comes from diet and exercise, not the device. I didn’t mention Zerona in my original comment because, in my opinion, it’s a fraud. You don’t understand that the Cool Sculpt device protects the skin from frostbite while freezing the fat. Hypothermia, as medically defined as a drop in core temperature, has nothing to do with it, nor does hypothermia necessarily or even frequently result in freezing of subcuticular fat in adults.
      Please note that I neither use the Cool Sculpt, nor have any stock in the company (which I consider too risky for me).

  12. Avatar
    Jan 18 2012, 03:59:05 pm

    I would keep an eye on this stock, simply because of the short interest. Around 37.5%..that could be one hell of a short squeeze if she can actually move money into this stock.

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