Document and Entity Information - USD ($)	12 Months Ended
Document and Entity Information - USD ($)	Dec. 31, 2021	Mar. 28, 2022	Jun. 30, 2021
Cover [Abstract]
Entity Registrant Name	SIENTRA, INC.
Entity Central Index Key	0001551693
Document Type	10-K
Document Period End Date	Dec. 31, 2021
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Shell Company	false
ICFR Auditor Attestation Flag	false
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Public Float			$ 454,480,000
Entity Common Stock, Shares Outstanding		62,363,259
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	FY
Trading Symbol	SIEN
Title of 12(b) Security	Common Stock, par value $0.01 per share
Security Exchange Name	NASDAQ
Entity File Number	001-36709
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	20-5551000
Entity Address, Address Line One	420 South Fairview Avenue
Entity Address, Address Line Two	Suite 200
Entity Address, City or Town	Santa Barbara
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	93117
City Area Code	805
Local Phone Number	562-3500
Document Annual Report	true
Document Transition Report	false
Documents Incorporated by Reference	Portions of the registrant’s definitive Proxy Statement relating to its 2022 Annual Meeting of Stockholders are incorporated by reference into Part III of this Annual Report on Form 10-K where indicated. Such Proxy Statement will be filed with the U.S. Securities and Exchange Commission within 120 days after the end of the fiscal year to which this report relates.
Auditor Name	KPMG LLP
Auditor Firm ID	185
Auditor Location	Los Angeles, CA

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 51,772	$ 54,967
Accounts receivable, net of allowances of $2,278 and $1,047 at December 31, 2021 and December 31, 2020, respectively	33,105	19,771
Inventories, net	52,914	39,168
Prepaid expenses and other current assets	2,979	1,891
Current assets of discontinued operations	4	13,475
Total current assets	140,774	129,272
Property and equipment, net	13,998	12,301
Goodwill	9,202	9,202
Other intangible assets, net	28,765	9,387
Other assets	7,165	8,011
Non-current assets of discontinued operations		805
Total assets	199,904	168,978
Current liabilities:
Current portion of long-term debt	2,237	4,670
Accounts payable	7,402	5,799
Accrued and other current liabilities	21,298	28,408
Customer deposits	35,182	17,905
Sales return liability	13,399	9,192
Current liabilities of discontinued operations	500	4,686
Total current liabilities	80,018	70,660
Long-term debt	62,434	60,500
Derivative liability		26,570
Deferred and contingent consideration	5,872	2,350
Warranty reserve and other long-term liabilities	10,723	9,455
Total liabilities	159,047	169,535
Commitments and contingencies (Note 12)
Stockholders’ equity (deficit):
Preferred stock, $0.01 par value – Authorized 10,000,000 shares; none issued or outstanding
Common stock, $0.01 par value - Authorized 200,000,000 shares; issued 62,242,090 and 50,712,151 and outstanding 62,169,363 and 50,639,424 shares at December 31, 2021 and December 31, 2020, respectively	622	506
Additional paid-in capital	661,839	558,059
Treasury stock, at cost (72,727 shares at December 31, 2021 and December 31, 2020)	(260)	(260)
Accumulated deficit	(621,344)	(558,862)
Total stockholders’ equity (deficit)	40,857	(557)
Total liabilities and stockholders’ equity (deficit)	$ 199,904	$ 168,978

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Accounts receivable, allowances (in dollars)	$ 2,278	$ 1,047
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	62,242,090	50,712,151
Common stock, shares outstanding	62,169,363	50,639,424
Treasury stock, shares	72,727	72,727

Consolidated Statements of Operations - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Statement [Abstract]
Net sales	$ 80,683	$ 54,997	$ 46,363
Cost of goods sold	36,348	23,599	16,353
Gross profit	44,335	31,398	30,010
Operating expenses:
Sales and marketing	48,456	37,405	37,924
Research and development	10,456	8,704	10,107
General and administrative	31,773	32,310	36,369
Restructuring		390	499
Total operating expenses	90,685	78,809	84,899
Loss from operations	(46,350)	(47,411)	(54,889)
Other income (expense), net:
Interest income	4	205	1,405
Interest expense	(8,254)	(9,438)	(4,567)
Change in fair value of derivative liability	(14,460)	(10,470)
Other income (expense), net	6,562	35	(2)
Total other income (expense), net	(16,148)	(19,668)	(3,164)
Loss from continuing operations before income taxes	(62,498)	(67,079)	(58,053)
Income tax expense	21	33	34
Loss from continuing operations	(62,519)	(67,112)	(58,087)
Income (loss) from discontinued operations, net of income taxes	37	(22,835)	(48,731)
Net loss	$ (62,482)	$ (89,947)	$ (106,818)
Basic and diluted net loss per share attributable to common stock holders
Continuing operations	$ (1.10)	$ (1.34)	$ (1.43)
Discontinued operations	0.00	(0.45)	(1.20)
Basic and diluted net loss per share	$ (1.10)	$ (1.79)	$ (2.63)
Weighted average outstanding common shares used for net income (loss) per share attributable to common stockholders:
Basic and diluted	57,057,107	50,233,175	40,654,272

Consolidated Statements of Stockholders' Equity (Deficit) - USD ($) $ in Thousands	Total	Common stock	Treasury stock	Additional paid-in capital	Accumulated deficit
Balance, beginning of year at Dec. 31, 2018	$ 66,878	$ 286	$ (260)	$ 428,949	$ (362,097)
Balance, beginning of year (in shares) at Dec. 31, 2018		28,701,494	72,727
Proceeds from follow-on offering, net of costs	107,734	$ 200		107,534
Proceeds from follow-on offering, net of costs (in shares)		20,000,000
Employee stock-based compensation expense	12,655			12,655
Stock option exercises	125			125
Stock option exercises (in shares)		51,451
Employee stock purchase program (ESPP)	1,216	$ 1		1,215
Employee stock purchase program (ESPP) (in shares)		175,624
Vested restricted stock		$ 10		(10)
Vested restricted stock (in shares)		944,467
Shares withheld for tax obligations on vested RSUs	(3,064)	$ (2)		(3,062)
Shares withheld for tax obligations on vested RSUs, shares		(260,129)
Equity contingent consideration	3,156			3,156
Net loss	(106,818)				(106,818)
Balance, end of year at Dec. 31, 2019	81,882	$ 495	$ (260)	550,562	(468,915)
Balance, end of year (in shares) at Dec. 31, 2019		49,612,907	72,727
Proceeds from follow-on offering, net of costs	263			263
Proceeds from follow-on offering, net of costs (in shares)		37,000
Employee stock-based compensation expense	8,171			8,171
Stock option exercises	29			29
Stock option exercises (in shares)		9,817
Employee stock purchase program (ESPP)	836	$ 2		834
Employee stock purchase program (ESPP) (in shares)		203,728
Vested restricted stock		$ 12		(12)
Vested restricted stock (in shares)		1,150,707
Shares withheld for tax obligations on vested RSUs	(1,791)	$ (3)		(1,788)
Shares withheld for tax obligations on vested RSUs, shares		(302,008)
Net loss	(89,947)				(89,947)
Balance, end of year at Dec. 31, 2020	(557)	$ 506	$ (260)	558,059	(558,862)
Balance, end of year (in shares) at Dec. 31, 2020		50,712,151	72,727
Proceeds from follow-on offering, net of costs	39,226	$ 62		39,164
Proceeds from follow-on offering, net of costs (in shares)		6,222,222
Employee stock-based compensation expense	10,390			10,390
Stock option exercises	291			290
Stock option exercises (in shares)		72,726
Employee stock purchase program (ESPP)	674	$ 2		672
Employee stock purchase program (ESPP) (in shares)		199,071
Vested restricted stock	1,005	$ 15		990
Vested restricted stock (in shares)		1,452,893
Shares withheld for tax obligations on vested RSUs	(3,145)	$ (3)		(3,142)
Shares withheld for tax obligations on vested RSUs, shares		(347,628)
Shares issued for asset acquisition	14,425	$ 39		14,386
Shares issued for asset acquisition (in shares)		3,930,655
Reclassification of derivative liability to equity	41,030			41,030
Net loss	(62,482)				(62,482)
Balance, end of year at Dec. 31, 2021	$ 40,857	$ 622	$ (260)	$ 661,839	$ (621,344)
Balance, end of year (in shares) at Dec. 31, 2021		62,242,090	72,727

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Cash flows from operating activities:
Net loss	$ (62,482)	$ (89,947)	$ (106,818)
Income (loss) from discontinued operations, net of income taxes	37	(22,835)	(48,731)
Loss from continuing operations, net of income taxes	(62,519)	(67,112)	(58,087)
Adjustments to reconcile net loss to net cash used in operating activities
Depreciation and amortization	4,360	3,370	1,716
Provision for doubtful accounts	1,326	537	638
Provision for warranties	970	659	228
Provision for inventory	82	1,817	2,004
Fair value adjustments to derivative liability	14,460	10,470
Fair value adjustments of other liabilities held at fair value	441	96	970
Amortization of debt discount and issuance costs	3,587	4,347	359
Gain on extinguishment of debt	(6,652)
Stock-based compensation expense	10,390	8,221	12,595
Payments of contingent consideration liability in excess of acquisition-date fair value	(2,419)		(1,968)
Other non-cash adjustments	684	375	267
Changes in operating assets and liabilities:
Accounts receivable	(14,660)	(6,302)	(1,393)
Inventories	(13,775)	(9,342)	(8,752)
Prepaid expenses, other current assets and other assets	(1,501)	169	(8,243)
Accounts payable, accrueds, and other liabilities	(752)	1,431	6,414
Customer deposits	17,277	3,961	4,007
Sales return liability	4,207	1,077	2,068
Legal settlement payable			(410)
Net cash flow from operating activities - continuing operations	(44,494)	(46,226)	(47,587)
Net cash flow from operating activities - discontinued operations	1,994	(13,912)	(39,446)
Net cash used in operating activities	(42,500)	(60,138)	(87,033)
Cash flows from investing activities:
Purchase of property and equipment	(3,805)	(3,956)	(2,951)
Asset acquisitions	(1,000)
Business acquisitions, net of cash and restricted cash acquired			17,943
Net cash flow from investing activities - continuing operations	(4,805)	(3,956)	(20,894)
Net cash flow from investing activities - discontinued operations	8,134	(80)	(1,120)
Net cash provided by (used in) investing activities	3,329	(4,036)	(22,014)
Cash flows from financing activities:
Proceeds from issuance of common stock for employee stock-based plans	1,970	865	1,341
Net proceeds from issuance of common stock	39,226	263	107,734
Tax payments related to shares withheld for vested restricted stock units (RSUs)	(3,145)	(1,791)	(3,064)
Gross borrowings under the Term Loan	1,000		5,000
Repayments under the Term Loan		(25,000)
Repayment of the Revolving Loan		(6,508)	(15,788)
Net proceeds from issuance of the Convertible Note		60,000
Payments of contingent consideration up to acquisition-date fair value	(4,550)		(5,766)
Deferred financing costs	(800)	(2,958)	(1,997)
Net cash provided by financing activities	35,938	31,523	109,756
Net increase (decrease) in cash, cash equivalents and restricted cash	(3,233)	(32,651)	709
Cash, cash equivalents and restricted cash at:
Beginning of period	55,300	87,951	87,242
End of period	52,067	55,300	87,951
Reconciliation of cash, cash equivalents, and restricted cash to the consolidated balance sheets
Cash and cash equivalents	51,772	54,967	87,608
Restricted cash included in other assets	$ 295	$ 333	$ 343
Restricted Cash Noncurrent Asset Statement Of Financial Position Extensible List	us-gaap:OtherAssets	us-gaap:OtherAssets	us-gaap:OtherAssets
End of period	$ 52,067	$ 55,300	$ 87,951
Supplemental disclosure of cash flow information:
Interest paid	4,193	4,198	4,089
Supplemental disclosure of non-cash investing and financing activities:
Property and equipment in accounts payable and accrued liabilities	323	413	745
Reclassification of derivative liability to equity	41,030
Acquisition of business, deferred and contingent consideration obligations at fair value			9,063
Asset acquisition, deferred and contingent consideration obligations at fair value	5,015
Asset acquisition costs included in accounts payable and accrued liabilities	213
Paycheck Protection Program
Adjustments to reconcile net loss to net cash used in operating activities
Gain on extinguishment of debt	(6,700)
Cash flows from financing activities:
Gross borrowings		$ 6,652
Revolving Loan
Cash flows from financing activities:
Gross borrowings	$ 2,237		$ 22,296

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

(1) Summary of Significant Accounting Policies

(a)

Basis of Presentation and Use of Estimates

The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America, or GAAP, requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements, and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Assets and liabilities which are subject to significant judgment and use of estimates include the allowance for doubtful accounts, sales return liability, provision for warranties, valuation of inventories, recoverability of long-lived assets, valuation allowances with respect to deferred tax assets, useful lives associated with property and equipment and finite lived intangible assets, and the valuation and assumptions underlying stock-based compensation and other equity instruments. On an ongoing basis, the Company evaluates its estimates compared to historical experience and trends, which form the basis for making judgments about the carrying value of assets and liabilities. In addition, the Company engages the assistance of valuation specialists in concluding on fair value measurements in connection with stock-based compensation and other equity instruments.

As a result of the miraDry Sale discussed in Note 2, the miraDry business met the criteria to be reported as discontinued operations. Therefore, the Company is reporting the historical results of miraDry, including the results of operations, cash flows, and related assets and liabilities, as discontinued operations for all periods presented herein through the date of the Sale. Unless otherwise noted, the accompanying notes to the audited consolidated financial statements have all been revised to reflect continuing operations only. As discussed in Note 11, following the Sale the Company has one operating segment in continuing operations named Plastic Surgery, formerly known as Breast Products.

(b)

Liquidity

Since the Company’s inception, it has incurred significant net operating losses and the Company anticipates that losses will continue in the near term. The Company expects its operating expenses will remain consistent with the current year ended December 31, 2021, and will need to generate significant net sales to achieve profitability. To date, the Company has funded operations primarily with proceeds from the sales of preferred stock, borrowings under term loans and the convertible note, sales of products, and the proceeds from the sale of common stock in public offerings. To fund ongoing operating and capital needs, the Company may need to raise additional capital in the future through the sale of equity securities and incremental debt financing.

Sale of the miraDry business

Refer to Note 2 for details on the sale of the miraDry business.

Debt financing

See Note 7 to the consolidated financial statements for a full description of our long-term debt, revolving line of credit, convertible note, and PPP loan.

Equity financing

On June 7, 2019, the Company completed an underwritten follow-on public offering of 17,391,305 shares of common stock at $5.75 per share, as well as 2,608,695 additional shares of common stock pursuant to the full exercise of the over-allotment option granted to the underwriters. Net proceeds were approximately $107.7 million after deducting underwriting discounts and commissions of $6.9 million and offering expenses of approximately $0.4 million.

Further on February 8, 2021, the Company completed a follow-on public offering of 5,410,628 shares of common stock at $6.75 per share, as well as 811,594 additional shares of common stock pursuant to the full exercise of the over-allotment option granted to the underwriters. Net proceeds were approximately $39.2 million after deducting underwriting discounts and commissions of approximately $2.5 million and offering expenses of approximately $0.3 million.

At December 31, 2021, the Company had cash and cash equivalents of $51.8 million. The accompanying consolidated financial statements have been prepared on a going concern basis, which implies the Company will continue to realize its assets and discharge its liabilities in the normal course of business. The Company believes that its cash and cash equivalents will be sufficient to fund its operations for at least the next 12 months.

(c)

Cash and Cash Equivalents

The Company considers all highly liquid investments purchased with an original maturity of three months or less when purchased to be cash equivalents. Cash and cash equivalents consist primarily of cash in checking accounts and interest-bearing money market accounts.

(d)

Concentration of Credit and Supplier Risks

Financial instruments that potentially subject the Company to significant concentrations of credit risk consist primarily of cash and cash equivalents. The Company’s cash and cash equivalents are deposited in demand accounts at financial institutions that management believes are creditworthy. The Company is exposed to credit risk in the event of default by these financial institutions for cash and cash equivalents in excess of amounts insured by the Federal Deposit Insurance Corporation, or FDIC. Management believes that the Company’s investments in cash and cash equivalents are financially sound and have minimal credit risk and the Company has not experienced any losses on its deposits of cash and cash equivalents.

The Company relies on a limited number of third-party manufacturers for the manufacturing and supply of its products. This could result in the Company not being able to acquire the inventory needed to meet customer demand, which would result in possible loss of sales and affect operating results adversely.

(e)

Fair Value of Financial Instruments

The carrying amounts of cash and cash equivalents, accounts receivable, accounts payable, accrued liabilities, customer deposits and sales return liability are reasonable estimates of their fair value because of the short maturity of these items. The fair value of the contingent consideration and the convertible feature related to the convertible note are discussed in Note 4. The fair value of the debt is based on the amount of future cash flows associated with the instrument discounted using the Company’s market rate. As of December 31, 2021 and 2020, the carrying value of the long-term debt was not materially different from the fair value. As of December 31, 2021 and 2020, the carrying value and fair value of the convertible note were as follows (in thousands):


	December 31,		December 31,
	2021		2020
Carrying value	$	47,477	$	44,436
Fair value	$	42,029	$	37,580

The convertible note is carried on the consolidated balance sheets at amortized cost. The fair value is estimated using a discounted cash flow analysis with a yield derived from a calibrated binomial lattice model as of the convertible note issuance date and adjusted for market movements thereafter. The market for trading of the convertible note is not considered to be an active market and therefore the estimate of fair value is based on Level 2 inputs.

(f)

Fair Value Measurements

Certain assets and liabilities are carried at fair value under GAAP. Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value must maximize the use of observable inputs and minimize the use of unobservable inputs.

Financial assets and liabilities carried at fair value are to be classified and disclosed in one of the following three levels of the fair value hierarchy, of which the first two are considered observable and the last is considered unobservable:

•

Level 1 — Quoted prices in active markets for identical assets or liabilities.

•

Level 2 — Observable inputs (other than Level 1 quoted prices) such as quoted prices in active markets for similar assets or liabilities, quoted prices in markets that are not active for identical or similar assets or liabilities, or other inputs that are observable or can be corroborated by observable market data.

•

Level 3 — Unobservable inputs that are supported by little or no market activity and that are significant to determining the fair value of the assets or liabilities, including pricing models, discounted cash flow methodologies and similar techniques.

(g)

Property and Equipment

Property and equipment are stated at cost, net of accumulated depreciation. Depreciation is computed using the straight‑line method over the estimated useful life of the asset, generally three to fifteen years. Leasehold improvements are depreciated over the shorter of the lease term or the estimated useful life of the related asset. Upon retirement or sale of an asset, the cost and related accumulated depreciation or amortization are removed from the consolidated balance sheet and any resulting gain or loss is reflected in operations in the period realized. Maintenance and repairs are charged to operations as incurred.

(h)

Leases

The Company leases certain office space, warehouses, distribution facilities, manufacturing facilities and office equipment. The Company determines if an arrangement contains a lease at inception by evaluating whether the arrangement conveys the right to use an identified asset and whether the Company obtains substantially all of the economic benefits from and has the ability to direct the use of the asset.

Operating and finance lease right-of-use, or ROU, assets and lease liabilities are recognized based on the present value of the future lease payments over the lease term at the commencement date. The Company determines its incremental borrowing rate based on the information available at the commencement date in determining the lease liabilities as the Company’s leases generally do not provide an implicit rate. The ROU assets also include any initial direct costs incurred and any lease payments made at or before the lease commencement date, less lease incentives received. Lease terms may include options to extend or terminate when the Company is reasonably certain that the option will be exercised. The Company elected to apply the short-term lease measurement and recognition exemption in which ROU assets and lease liabilities are not recognized for short-term leases. The Company’s lease agreements generally do not contain material residual value guarantees or material restrictive covenants.

The Company’s leases of office space, warehouses, distribution facilities and manufacturing facilities are treated as operating leases and often contain lease and non-lease components. The Company has elected to account for these lease and non-lease components separately. Non-lease components for these assets are primarily comprised of common-area maintenance, utilities, and real estate taxes that are passed on from the lessor in proportion to the space leased by the Company, and are recognized in operating expenses in the period in which the obligation for those payments was incurred. Lease cost for these operating leases is recognized on a straight-line basis over the lease term in operating expenses.

The Company’s leases of office equipment are accounted for as finance leases as they meet one or more of the five finance lease classification criteria. Lease cost for these finance leases is comprised of amortization of the ROU asset and interest expense which are recognized in operating expenses and other income (expense), net.

(i)

Goodwill and Other Intangible Assets

Goodwill

Goodwill represents the excess of the purchase price over the fair value of net assets of purchased businesses. Goodwill is not amortized, but instead is subject to impairment tests on at least an annual basis and whenever circumstances suggest that goodwill may be impaired. The Company’s annual test for impairment is performed as of October 1 of each fiscal year. The Company makes a qualitative assessment of whether it is more likely than not that a reporting unit’s fair value is less than its carrying amount. If the Company concludes that it is more likely than not that the fair value of a reporting unit is less than its carrying amount from the qualitative assessment, the Company performs a quantitative analysis to compare the fair value of the reporting unit to its carrying amount. The Company recognizes impairment charges for the amount by which the carrying amount exceeds the reporting unit’s fair value.

The Company’s fair value analysis of goodwill utilizes the income approach and market approach, which requires the use of estimates about a reporting unit’s future revenues and free cash flows, market multiples, enterprise value, control risk premiums, discount rates, terminal value and enterprise value to determine the estimated fair value. The Company’s future revenues and free cash flow assumptions are determined based upon actual results giving effect to management’s expected changes in operating results in future years. The market multiples, enterprise value, control risk premiums, discount rates and terminal value are based upon market participant assumptions using a defined peer group. Changes in these assumptions can materially affect these estimates. Thus, to the extent the market changes, discount rates increase significantly or the Company does not meet its projected performance, the Company could recognize impairments, and such impairments could be material. For the years ended December 31, 2021, 2020, and 2019, the Company did not record any goodwill impairment charges.

Indefinite-lived intangible assets

The Company tests indefinite-lived intangible assets for impairment at least on an annual basis as of October 1 of each fiscal year and whenever circumstances suggest the intangible assets may be impaired. The Company makes a qualitative assessment of whether it is more likely than not that the fair value of the intangible asset is less than its carrying amount. If the Company concludes that it is more likely than not that the fair value is less than its carrying amount from the qualitative assessment, the Company performs a quantitative analysis to compare the fair value of the intangible asset to its carrying amount. If the carrying value of the intangible asset exceeds its fair value, an impairment loss is recognized in an amount equal to the difference. The Company also evaluates the remaining useful life of an indefinite-lived intangible asset to determine whether events and circumstances continue to support an indefinite useful life. For the years ended December 31, 2021, 2020, and 2019, the Company did not record any indefinite-lived intangible assets impairment charges.

Finite-lived intangible assets

The intangible assets are amortized to the consolidated statement of operations based on estimated cash flows generated from the intangible asset over its estimated life. Each fiscal year the Company evaluates the estimated remaining useful lives of purchased intangible assets and whether events or changes in circumstance warrant a revision to the remaining periods of amortization. Judgments about the recoverability of purchased finite‑lived intangible assets are made whenever events or changes in circumstance indicate that impairment may exist. Recoverability of finite‑lived intangible assets is measured by comparison of the carrying amount of the asset group to the future undiscounted cash flows the asset group is expected to generate. If the sum of the future undiscounted cash flows is less than the carrying value, the Company will evaluate whether the fair value of each asset in the asset group exceeds its respective carrying value. If the fair value of any asset in the asset group is determined to be less than its carrying value, then the Company will recognize an impairment loss based on the excess of the carrying amount over the asset’s respective fair value.

The Company’s fair value analysis of intangible assets utilizes methods under various income approaches. The Company values its customer relationships using an excess earnings method, which assumes the value of the asset is the discounted future cash flows derived from existing customers and requires the use of customer attrition rates and discount rates to determine the estimated fair value. The future revenues and free cash flow from existing customers are determined based upon actual results giving effect to management’s expected changes in operating results in future

years. The attrition rate is based on average historical levels of customer attrition and the discount rate is based upon market participant assumptions using a defined peer group. Tradenames and developed technology are valued using a relief from royalty method, which assumes the value of the asset is the discounted cash flows of the amount that would be paid by a hypothetical market participant had they not owned the asset and instead licensed the asset from another company. This method requires the use of royalty rates which are determined based on comparable third-party license agreements involving similar assets and discount rates similar to the above to determine the estimated fair value.

(j)

Impairment of Tangible Long‑Lived Assets

The Company’s management routinely considers whether indicators of impairment of long‑lived assets are present. If such indicators are present, management determines whether the sum of the estimated undiscounted cash flows attributable to the asset group in question is less than their carrying value. If less, the Company will recognize an impairment loss based on the excess of the carrying amount of the assets over their respective fair values. Fair value is determined by discounted future cash flows, appraisals or other methods. If the assets determined to be impaired are to be held and used, the Company will recognize an impairment charge to the extent the present value of anticipated net cash flows attributable to the asset are less than the asset’s carrying value. The fair value of the asset will then become the asset’s new carrying value. There have been no impairments recorded for tangible long-lived assets during the years ended December 31, 2021, 2020, and 2019.

(k)

Acquisitions

The Company evaluates acquisitions of assets and other similar transactions to assess whether or not the transaction should be accounted for as a business combination or asset acquisition by first applying a screen test to determine if substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or group of similar identifiable assets. If the screen is met, the transaction is accounted for as an asset acquisition. If the screen is not met, further determination is required as to whether or not the Company has acquired inputs and processes that have the ability to create outputs which would meet the definition of a business.

Business combinations

Business combinations are accounted for using the acquisition method of accounting. Under the acquisition method, assets acquired and liabilities assumed are recorded at their respective fair values as of the acquisition date in the financial statements. The excess of the fair value of consideration transferred over the fair value of the net assets acquired is recorded as goodwill. Liability-classified contingent consideration obligations incurred in connection with a business combination are recorded at their fair values on the acquisition date and remeasured at their fair values each subsequent reporting period until the related contingencies are resolved. The resulting changes in fair values are recorded in earnings. Equity-classified contingent consideration obligations incurred in connection with a business combination are recorded at their fair values on the acquisition date and are not subsequently remeasured each reporting period unless the obligation becomes reclassified as a liability. The subsequent settlement of the obligation is accounted for within equity.

Asset acquisitions

In an asset acquisition, the fair value of the consideration transferred, including transaction costs, is allocated to the assets acquired and liabilities assumed based on their relative fair values. No goodwill is recognized in an asset acquisition. Subsequent changes are recorded as adjustments to the carrying amount of the assets acquired.

(l)

Segment Reporting

Reportable segments represent components for which separate financial information is available that is utilized on a regular basis by the Chief Executive Officer, who has been identified as the Chief Operating Decision Maker, or CODM, as defined by authoritative guidance on segment reporting, in determining how to allocate resources and evaluate performance. The segments are determined based on several factors, including client base, homogeneity of products, technology, delivery channels and similar economic characteristics. Following the sale of the miraDry business on June 10, 2021, the Company has one reportable segment named Plastic Surgery, formally known as Breast Products.

(m)

Revenue Recognition

The Company generates revenue primarily through the sale and delivery of promised goods or services to customers. Sales prices are documented in the executed sales contract, purchase order or order acknowledgement prior to the transfer of control to the customer. Typical payment terms are 30 days.

Revenue contracts may include multiple products or services, each of which is considered a separate performance obligation. Performance obligations typically include the delivery of promised products, such as breast implants, tissue expanders, and BIOCORNEUM, along with service-type warranties. Other deliverables are sometimes promised but are ancillary and insignificant in the context of the contract as a whole. Revenue is allocated to each performance obligation based on its relative standalone selling price. The Company determines standalone selling prices based on observable prices for all performance obligations with the exception of the service-type warranty under the Platinum20 Limited Warranty Program, or Platinum20.

The Company introduced Platinum20 in May 2018 on all OPUS breast implants implanted in the United States or Puerto Rico on or after May 1, 2018. Platinum20 provides for financial assistance for revision surgeries and no-charge contralateral replacement implants upon the occurrence of certain qualifying events. The Company considers Platinum20 to have an assurance warranty component and a service warranty component. The assurance component is recorded as a warranty liability at the time of sale (as discussed in Note 1(s)). The Company considers the service warranty component as an additional performance obligation and defers revenue at the time of sale using the expected cost plus margin approach for the performance obligation. Inputs into the expected cost plus margin approach include historical incidence rates, estimated replacement costs, estimated financial assistance payouts and an estimated margin.

The liability for unsatisfied performance obligations under the service warranty as of December 31, 2021 were as follows (in thousands):


	Year Ended December 31,
	2021
Balance as of December 31, 2020	$	1,945
Additions and adjustments		1,863
Revenue recognized		(571	)
Balance as of December 31, 2021	$	3,237

Revenue for service warranties are recognized ratably over the term of the agreements. Specifically for Platinum20, the performance obligation is satisfied at the time that the benefits are provided and are expected to be satisfied over the following 3 to 24 month period for financial assistance and 20 years for product replacement.

For delivery of promised products, control transfers and revenue is recognized upon shipment, unless the contractual arrangement requires transfer of control when products reach their destination, for which revenue is recognized once the product arrives at its destination. A portion of the Company’s revenue is generated from the sale of consigned inventory of breast implants and tissue expanders maintained at doctor, hospital, and clinic locations. For these products, revenue is recognized at the time the Company is notified by the customer that the product has been implanted, not when the consigned products are delivered to the customer’s location.

Sales Return Liability

With the exception of the Company’s BIOCORNEUM scar management products, the Company allows for the return of products from customers within six months after the original sale, which is accounted for as variable consideration. A sales return liability is established based on estimated returns using relevant historical experience taking into consideration recent gross sales and notifications of pending returns, as adjusted for changes in recent industry events and trends. The estimated sales returns are recorded as a reduction of revenue and as a sales return liability in the same period revenue is recognized. Actual sales returns in any future period are inherently uncertain and thus may differ from the estimates. If actual sales returns differ significantly from the estimates, an adjustment to revenue in the current or subsequent period would be recorded. The following table provides a rollforward of the sales return liability (in thousands):


	Year Ended December 31,
	2021			2020
Beginning balance	$	9,192		$	8,116
Addition to reserve for sales activity		158,245			118,508
Actual returns		(152,773	)		(117,407	)
Change in estimate of sales returns		(1,265	)		(25	)
Ending balance	$	13,399		$	9,192

Practical Expedients and Policy Election

The Company generally expenses sales commissions when incurred because the amortization period would have been one year or less. These costs are recorded within sales and marketing expenses.

The Company does not adjust accounts receivable for the effects of any significant financing components as customer payment terms are shorter than one year.

The Company has elected to account for shipping and handling activities performed after a customer obtains control of the products as activities to fulfill the promise to transfer the products to the customer. Shipping and handling activities are largely provided to customers free of charge. The associated costs were $5.5 million, $2.9 million and $1.9 million for the years ended December 31, 2021, 2020, and 2019, respectively. These costs are viewed as part of the Company’s marketing programs and are recorded as a component of sales and marketing expense in the consolidated statement of operations as an accounting policy election.

(n)

Accounts Receivable and Allowance for Doubtful Accounts

Accounts receivable are recorded at the invoiced amount and do not bear interest. The Company maintains allowances for doubtful accounts for estimated losses resulting from the inability to collect from some of its customers. The allowances for doubtful accounts are based on the analysis of historical bad debts, customer credit‑worthiness, past transaction history with the customer, and current economic trends. If the financial condition of the Company’s customers were to deteriorate, adversely affecting their ability to make payments, additional allowances may be required.

(o)

Inventories and Cost of Goods Sold

Inventories represent raw materials, work in process and finished goods that are recorded at the lower of cost or market on a first‑in, first‑out basis, or FIFO. The Company recognizes the cost of inventory transferred to the customer in cost of goods sold when revenue is recognized. Further, the Company periodically assesses the recoverability of all inventories to determine whether adjustments for impairment or obsolescence are required. The Company evaluates the remaining shelf life and other general obsolescence and impairment criteria in assessing the recoverability of the Company’s inventory.

(p)

Income Taxes

The Company accounts for income taxes under the asset and liability method. Under this method, deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to affect taxable income. Valuation allowances are established when necessary to reduce deferred tax assets to the amounts expected to be realized.

The Company operates in several tax jurisdictions and is subject to taxes in each jurisdiction in which it conducts business. To date, the Company has incurred cumulative net losses and maintains a full valuation allowance on its net deferred tax assets due to the uncertainty surrounding realization of such assets. However, the Company has deferred tax liabilities that cannot be considered sources of income to support the realization of the deferred tax assets, and has provided for tax expense (or benefit) and a corresponding deferred tax liability.

The Company accounts for uncertain tax positions in accordance with Account Standards Codification, or ASC, 740‑10, Accounting for Uncertainty in Income Taxes. The Company assesses all material positions taken in any income tax return, including all significant uncertain positions, in all tax years that are still subject to assessment or challenge by relevant taxing authorities. Assessing an uncertain tax position begins with the initial determination of the position’s sustainability and is measured at the largest amount of benefit that is greater than fifty percent likely of being realized upon ultimate settlement. As of each balance sheet date, unresolved uncertain tax positions must be reassessed, and the Company will determine whether (i) the factors underlying the sustainability assertion have changed and (ii) the amount of the recognized tax benefit is still appropriate. The recognition and measurement of tax benefits requires significant judgment. Judgments concerning the recognition and measurement of tax benefit might change as new information becomes available.

(q)

Research and Development Expenditures

Research and development costs are charged to operating expenses as incurred. Research and development, or R&D, primarily consist of clinical expenses, regulatory expenses, product development, consulting services, outside research activities, quality control and other costs associated with the development of the Company’s products and compliance with Good Clinical Practices, or GCP, requirements. R&D expenses also include related personnel and consultant compensation and stock-based compensation expense.

(r)

Stock‑Based Compensation

The Company applies the fair value provisions of ASC 718, Compensation — Stock Compensation, or ASC 718. ASC 718 requires the recognition of compensation expense, using a fair‑value based method, for costs related to all employee share‑based payments, including stock options, restricted stock units, and the employee stock purchase plan. In the absence of an observable market price for an award, ASC 718 requires companies to estimate the fair value of share‑based payment awards on the date of grant using an option‑pricing model. We estimate the fair value of our stock‑based awards to employees and directors using the Black‑Scholes option pricing model. The grant date fair value of a stock‑based award is recognized as an expense over the requisite service period of the award on a straight‑line basis. In addition, we use the Monte-Carlo simulation option-pricing model to determine the fair value of market-based awards. The Monte-Carlo simulation option-pricing model uses the same input assumptions as the Black-Scholes model; however, it also further incorporates into the fair-value determination the possibility that the market condition may not be satisfied. Compensation costs related to these awards are recognized regardless of whether the market condition is satisfied, provided that the requisite service has been provided.

The option-pricing models require the input of subjective assumptions, including the risk‑free interest rate, expected dividend yield, expected volatility and expected term, among other inputs. These estimates involve inherent uncertainties and the application of management’s judgment. If factors change and different assumptions are used, our stock‑based compensation expense could be materially different in the future. These assumptions are estimated as follows:

•

Risk‑free interest rate—The risk‑free interest rate is based on the yields of U.S. Treasury securities with maturities similar to the expected term of the options for each option group.

•

Dividend yield—The Company has never declared or paid any cash dividends and do not presently plan to pay cash dividends in the foreseeable future. Consequently, the Company utilized an expected dividend yield of zero.

•

Expected volatility—In the prior years, the Company utilized median historic price volatilities and implied volatilities of comparable public companies due to a lack of significant trading history for the Company’s own common stock. In the current year, the Company estimated its expected stock volatility based on company-specific historical and implied volatility information of its stock as sufficient historical information has become available.

•

Expected term—The expected term represents the period that our stock‑based awards are expected to be outstanding. The Company utilizes the simplified method to estimate the expected term.

(s)

Product Warranties

The Company offers a product replacement and limited warranty program for the Company’s silicone gel breast implants. For silicone gel breast implant surgeries occurring prior to May 1, 2018, the Company provides lifetime replacement implants and up to $3,600 in financial assistance for revision surgeries, for covered rupture events that occur within ten years of the surgery date. The Company introduced its Platinum20 Limited Warranty Program in May 2018, covering OPUS silicone gel breast implants implanted in the United States or Puerto Rico on or after May 1, 2018. The Company considers the program to have an assurance warranty component and a service warranty component. The service warranty component is discussed in Note 1(m) above. The assurance component is related to the lifetime no-charge contralateral replacement implants and up to $5,000 in financial assistance for revision surgeries, for covered rupture events that occur within twenty years of the surgery date.

(t)

Net Loss Per Share


	December 31,
	2021			2020			2019
Loss from continuing operations	$	(62,519	)	$	(67,112	)	$	(58,087	)
Income (loss) from discontinued operations, net of income taxes		37			(22,835	)		(48,731	)
Net loss	$	(62,482	)	$	(89,947	)	$	(106,818	)
Weighted average common shares outstanding, basic and diluted		57,057,107			50,233,175			40,654,272
Basic and diluted net loss per share attributable to common stockholders
Continuing operations	$	(1.10	)	$	(1.34	)	$	(1.43	)
Discontinued operations		0.00			(0.45	)		(1.20	)
Basic and diluted net loss per share	$	(1.10	)	$	(1.79	)	$	(2.63	)

The Company excluded the following potentially dilutive securities, outstanding as of December 31, 2021, 2020 and 2019 from the computation of diluted net loss per share attributable to common stockholders for the years ended December 31, 2021, 2020 and 2019 because they had an anti-dilutive impact due to the net loss attributable to common stockholders incurred for the periods.


	December 31,
	2021		2020		2019
Stock issuable upon conversion of convertible note		14,634,146		11,991,870		—
Stock options to purchase common stock		1,616,891		1,008,598		1,390,115
Unvested RSUs		1,789,603		1,135,454		1,174,431
		18,040,640		14,135,922		2,564,546

The Company uses the if-converted method for calculating any potential dilutive effects of the convertible note. The Company did not adjust the net loss for the year ended December 31, 2021 to eliminate any interest expense or gain/loss for the derivative liability related to the note in the computation of diluted loss per share, as the effects would be anti-dilutive.

(u)

Recent Accounting Pronouncements

Recently Adopted Accounting Standards

In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes. The amendment removes certain exceptions for recognizing deferred taxes for investments, performing intraperiod allocation, and calculating income taxes in interim periods. The amendment also adds guidance to reduce complexity in certain areas, including recognizing deferred taxes for tax goodwill and allocating taxes to members of a consolidated group. The ASU is effective for annual and interim periods in fiscal years beginning after December 15, 2020. Early adoption was permitted. The Company adopted the applicable amendments within ASU 2019-12 in the first quarter of 2021 and there was no material impact on its condensed consolidated financial statements from the adoption.

Recently Issued Accounting Standards

In August 2020, the FASB issued ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity. The amendment eliminates certain accounting models and simplifies the accounting for convertible instruments and enhances disclosures for convertible instruments and earnings per share. The amendments are effective for public entities excluding smaller reporting companies for fiscal years beginning after December 15, 2021, including interim periods within those fiscal years. For all other entities, the amendments are effective for fiscal years beginning after December 15, 2023 including interim periods within those fiscal years and early adoption is permitted. The Company is currently evaluating the impact that adoption of the standard will have on the consolidated financial statements.

In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848)-Facilitation of the Effects of Reference Rate Reform on Financial Reporting. The amendment provides optional expedients and exceptions for contract modifications that replace a reference rate affected by reference rate reform. The amendments are effective for all entities as of March 12, 2020 through December 31, 2022, and entities may elect to apply by Topic as of any date from the beginning of an interim period that includes or is subsequent to March 12, 2020, or prospectively from a date within an interim period that includes or is subsequent to March 12, 2020, up to the date that the financial statements are available to be issued. The Company is currently evaluating the impact the election of the optional expedient will have on the consolidated financial statements.

(v)

Risks and Uncertainties

As an aesthetics company, surgical procedures involving the Company’s breast products are susceptible to local and national government restrictions, such as social distancing, vaccination requirements, “shelter in place” orders and business closures. The inability or limited ability to perform such non-emergency procedures significantly harmed the Company’s revenues since the second quarter of 2020 and continued to harm the Company’s revenues during the year ended December 31, 2021. While many states have lifted certain restrictions on non-emergency procedures, the Company will likely continue to experience future harm to its revenues while existing or new restrictions remain in place. It is not possible to accurately predict the length or severity of the COVID-19 pandemic, including the spread of any variants, or the timing for a broad and sustained ability to perform non-emergency procedures involving the Company’s products. The Company continues to monitor and assess new information related to the COVID-19 pandemic, the actions taken to contain or treat COVID-19, as well as the economic impact on local, regional, national and international customers and markets.

Further, the spread of COVID-19 has caused the Company to modify workforce practices, and the Company may take further actions determined to be in the best interests of the Company’s employees or as required by governments. The continued spread of COVID-19, or another infectious disease, could also result in delays or disruptions in the Company’s supply chain or adversely affect the Company’s manufacturing facilities and personnel. Further, trade and/or national security protection policies may be adjusted as a result of the COVID-19 pandemic, such as actions by governments that limit, restrict or prevent the movement of certain goods into a country and/or region.

The estimates used for, but not limited to, determining the collectability of accounts receivable, fair value of long-lived assets and goodwill, and sales returns liability required could be impacted by the pandemic. While the full impact of COVID-19 is unknown at this time, the Company has made appropriate estimates based on the facts and circumstances available as of the reporting date. These estimates may change as new events occur and additional information is obtained.

(w)

Reclassifications

Certain reclassifications have been made to prior year amounts to conform to the current year presentation, including those related to discontinued operations following the sale of the miraDry business.

Discontinued Operations

12 Months Ended

Dec. 31, 2021

Discontinued Operations and Disposal Groups [Abstract]

Discontinued Operations

(2) Discontinued Operations

On June 10, 2021, the Company completed the sale of its miraDry business (the “Sale”) to miraDry Acquisition Company, Inc., a Delaware corporation (“Buyer”), an entity affiliated with 1315 Capital II, LP, as a result of the Company’s strategic decision to focus investment on its core Plastic Surgery segment. The Sale was made pursuant to the terms and conditions of the Asset Purchase Agreement (the “Purchase Agreement”), dated May 11, 2021, among the Company and certain of its subsidiaries, Buyer, and, solely for purposes of Section 8.14 of the Purchase Agreement, 1315 Capital II, LP. The aggregate purchase price was $10.0 million, which after certain adjustments for agreed upon changes in the estimated net asset value amount of purchased assets and assumed liabilities resulted in net cash proceeds of $11.3 million to the Company on the date of close. In October 2021, the Company finalized the transaction and paid $3.2 million to the Buyer in accordance with the agreed upon post close changes in the net asset value and recognized a loss on sale of $2.5 million.

In accordance with the Purchase Agreement, assumed liabilities did not include product liabilities, environmental, and employee claims arising prior to the closing date. The Purchase Agreement also included customary representations and warranties, as well as certain covenants, including, among other things, that: (i) the Company will abide by certain non-solicitation, exclusivity, and non-competition covenants, and (ii) the Company would enter into a transition services agreement (“TSA”) to provide certain transition services related to the business.

Under the TSA, the Company provided certain post-closing services to the Buyer related to the miraDry business for a period of six months, including accounting, accounts receivable support, customer service, IT, regulatory, quality assurance, and clinical support. As consideration for these services, the Buyer reimbursed the Company for direct and certain indirect costs, as well as certain overhead or administrative expenses related to operating the business. The Company recognized $0.2 million of TSA fees and cost reimbursements in operating expenses from continuing operations in the consolidated statement of operations for the year ended December 31, 2021. As of December 31, 2021, the Company has received $0.3 million relating to the TSA services and has recorded a receivable of $0.1 million within other current assets in the consolidated balance sheets. In connection with the accounts receivable support under the TSA, the Company received $2.3 million in customer payments and remitted $2.3 million to the Buyer during the period from June 10, 2021 through December 31, 2021. As of December 31, 2021, the Company does not have a payable to the Buyer on the consolidated balance sheets.

Additionally, the Company and the Buyer entered into a sublease agreement whereby the Buyer subleased the miraDry office space in Santa Clara, CA. The sublease term was for an initial period of six months, with subsequent option periods for up to a total of twenty four months. Following the initial period, the Buyer exercised an additional period of six months. During year ended December 31, 2021, the Company recognized $0.5 million of sublease income in general and administrative expenses in the consolidated statements of operations.

The Sale met the discontinued operations criteria given that the business is a component and represented a strategic shift. The following table presents the aggregate carrying amounts of major classes of assets and liabilities of discontinued operations (in thousands):


	December 31,		December 31,
	2021		2020
Assets of discontinued operations:
Accounts receivable, net	$	—	$	3,732
Inventories, net		—		9,480
Prepaid expenses and other current assets		4		263
Current assets of discontinued operations		4		13,475
Property and equipment, net		—		805
Total assets of discontinued operations	$	4	$	14,280
Liabilities of discontinued operations:
Accounts payable	$	6	$	704
Accrued and other current liabilities		494		3,982
Total liabilities of discontinued operations	$	500	$	4,686

The results of operations for the miraDry business were included in income (loss) from discontinued operations on the accompanying consolidated statements of operations. The following table provides information regarding the results of discontinued operations (in thousands):


	Year Ended
	December 31,
	2021			2020			2019
Net sales	$	9,347		$	16,244		$	37,337
Cost of goods sold		4,805			8,703			16,659
Gross profit		4,542			7,541			20,678
Operating expenses		1,940			30,440			69,355
Income (loss) from operations of discontinued operations		2,602			(22,899	)		(48,677	)
Other income (expense), net		(77	)		64			(54	)
Income (loss) from discontinued operations before income taxes		2,525			(22,835	)		(48,731	)
Loss on sale of discontinued operations before income taxes		(2,488	)		—			—
Total income (loss) from discontinued operations before income taxes		37			(22,835	)		(48,731	)
Income tax expense (benefit)		—			—			—
Income (loss) from discontinued operations, net of income taxes	$	37		$	(22,835	)	$	(48,731	)

The results of the miraDry business, including the results of operations, cashflows, and related assets and liabilities are reported as discontinued operations for all periods presented herein.

Acquisitions

12 Months Ended

Dec. 31, 2021

Business Combinations [Abstract]

Acquisitions

(3) Acquisitions

Acquisition of certain assets from AuraGen Aesthetics, LLC

On December 31, 2021, the Company entered into an Asset Purchase Agreement with AuraGen Aesthetics LLC (“AuraGen”) pursuant to which the Company purchased substantially all of the assets of AuraGen relating to its fat grafting technology, including the AuraGen 1-2-3 with AuraClens system. The total consideration paid by the Company to AuraGen (the “Closing Consideration”) consists of (i) $1,000,000 in cash at the closing, (ii) deferred consideration of $3,000,000 due in cash on the first annual anniversary of the Asset Purchase Agreement, and (iii) an aggregate total of 3,930,655 shares of the Company's common stock issued at closing. As of December 31, 2021, the Company recognized a liability of $2.4 million for the deferred consideration, which represents the fair value of the cash to be paid on the first anniversary of the acquisition date based on time to settlement of one year discounted at 20%.

In addition to the Closing Consideration, the Company shall pay additional contingent consideration of up to $8.5 million (the “Milestone Payments” and “Earnout Shares” and, together with the Closing Consideration, the “Asset Purchase Consideration”) to AuraGen based on the achievement of certain clinical endpoints following the completion of the Study (as defined in the Asset Purchase Agreement). The Milestone Payments may be payable in cash, stock or a combination of both at the election of the Company, with the Earnout Shares payable in stock or cash at the election of AuraGen. As of December 31, 2021, the Company recognized a liability of $2.6 million, which represents the fair value of the obligation as of the acquisition date. Refer to Note 4 for additional information on the measurement of the contingent consideration.

The acquisition did not meet the definition of a business combination and was accounted for as an asset acquisition. The acquisition date fair value of the consideration transferred consisted of the following (in thousands):


	Fair Value as of December 31, 2021
Cash payment made on closing date	$	1,000
Direct transaction costs		213
Equity issued on closing date		14,426
Fair value of deferred cash consideration		2,400
Fair value of contingent consideration		2,615
Total purchase consideration	$	20,654

The allocation of the total purchase price is as follows (in thousands):


	December 31,
	2021
Inventories	$	54
Developed technology		20,600
Net assets acquired	$	20,654

The intangible asset acquired, estimated useful life and amortization method is as follows (in thousands):


			Estimated useful	Amortization
	Amount		life	method
Developed technology	$	20,600	8 years	Straight line

Balance Sheet Components

12 Months Ended

Dec. 31, 2021

Balance Sheet Related Disclosures [Abstract]

Balance Sheet Components

(4) Balance Sheet Components

Inventories, net consist of the following (in thousands):


	December 31,		December 31,
	2021		2020
Raw materials	$	2,109	$	3,788
Work in progress		4,796		10,710
Finished goods		41,982		21,254
Finished goods - right of return		4,027		3,416
	$	52,914	$	39,168

At December 31, 2021 and 2020, approximately $8.0 million and $5.7 million, respectively, of inventory was held on consignment at doctors’ offices, clinics, and hospitals. The value and quantity at any one location is not significant.

Property and equipment, net consist of the following (in thousands):


	December 31,			December 31,
	2021			2020
Leasehold improvements	$	2,734		$	2,523
Manufacturing equipment and tooling		9,922			8,529
Computer equipment		1,672			2,522
Software		6,379			3,010
Furniture and fixtures		1,542			1,040
		22,249			17,624
Less accumulated depreciation		(8,251	)		(5,323	)
	$	13,998		$	12,301

Depreciation expense for the years ended December 31, 2021, 2020 and 2019 was $3.1 million, $2.0 million and $0.8 million, respectively. There have been no impairments recorded during the years ended December 31, 2021, 2020 and 2019.

Accrued and other current liabilities consist of the following:


	December 31,		December 31,
	2021		2020
Payroll and related expenses	$	5,188	$	3,003
Accrued severance		248		2,900
Accrued commissions		4,329		4,734
Accrued manufacturing		121		225
Deferred and contingent consideration, current portion		2,431		10,146
Audit, consulting and legal fees		185		48
Accrued sales and marketing expenses		159		300
Lease liabilities		1,666		1,588
Other		6,971		5,464
	$	21,298	$	28,408

The following table provides a rollforward of the accrued warranties (in thousands):


	Year Ended December 31,
	2021			2020
Balance as of January 1	$	1,934		$	1,397
Warranty costs incurred during the period		(399	)		(122	)
Changes in accrual related to warranties issued during the period		933			589
Changes in accrual related to pre-existing warranties		37			70
Balance as of December 31	$	2,505		$	1,934

As of December 31, 2021, and 2020, both balances are included in “Warranty reserve and other long-term liabilities”.

Liabilities measured at fair value

Contingent consideration

The contingent consideration balance consists of milestone payments related to the acquisition of AuraGen and future royalty payments related to the acquisition of BIOCORNEUM.

The Company assessed the fair value of all contingent consideration using a Monte-Carlo simulation model. The contingent consideration related to AuraGen is based on the achievement of certain clinical endpoints following the completion of a study measuring retention rates using the fat grafting products. The significant assumptions utilized in the fair value measurement was the probable retention rate based on historical data and the Company's equity volatility of 95%. Any subsequent changes to the fair value of contingent consideration will be recorded as an adjustment to the carrying value of the assets acquired.

The contingent consideration related to the acquisition of BIOCORNEUM consists of royalty obligations based on future net sales for a defined term, beginning in 2024. The significant assumption utilized in the fair value measurement was the discount rate, which was 21.0%.

As these inputs are not observable, the overall fair value measurement of the contingent consideration is classified as Level 3.

Derivative liability

Prior to the amendment in September 2021 discussed in Note 7, the Company assessed on a quarterly basis the fair value of the derivative liability associated with the conversion feature in the convertible note due in 2025. The conversion feature was initially bifurcated and recorded as a derivative liability on the condensed consolidated balance sheets with a corresponding discount at the date of issuance that netted against the principal amount of the note. The Company utilized a binomial lattice method to determine the fair value of the conversion feature, which utilized inputs including the common stock price, volatility of common stock, the risk-free interest rate and the probability of conversion to common shares at the Base Conversion Rate in the event of a major transaction (e.g. a change in control). As the probability of conversion is a significant unobservable input, the overall fair value measurement of the conversion feature was classified as Level 3. As a result of the amendment, the conversion feature met the criteria for equity classification and has been reclassified to “Additional paid in capital” on the consolidated balance sheet.

The following tables present information about the Company’s liabilities that are measured at fair value on a recurring basis as of December 31, 2021 and 2020 and indicate the level of the fair value hierarchy utilized to determine such fair value (in thousands):


	Fair Value Measurements as of
	December 31, 2021 Using:
	Level 1		Level 2		Level 3		Total
Liabilities:
Liability for contingent consideration	$	—	$	—	$	3,114	$	3,114
	$	—	$	—	$	3,114	$	3,114


	Fair Value Measurements as of
	December 31, 2020 Using:
	Level 1		Level 2		Level 3		Total
Liabilities:
Liability for contingent consideration	$	—	$	—	$	7,026	$	7,026
Liability for derivative		—		—		26,570		26,570
	$	—	$	—	$	33,596	$	33,596

The following table provides a rollforward of the aggregate fair values of the Company’s liabilities for which fair value is determined by Level 3 inputs (in thousands):


	Contingent consideration liability			Derivative liability
Balance, December 31, 2020	$	7,026		$	26,570
Additions		2,615			—
Change in fair value		442			14,460
Settlements		(6,969	)		—
Reclassification to equity		—			(41,030	)
Balance, December 31, 2021	$	3,114		$	—

The liability for the current portion of contingent consideration is included in “Accrued and other current liabilities” and the long-term portion is included in “deferred and contingent consideration” in the consolidated balance sheets.

The Company recognizes changes in the fair value of the derivative liability in “Change in fair value of derivative liability” in the consolidated statement of operations and changes in the contingent consideration are recognized in “General and administrative” expense in the consolidated statement of operations.

Goodwill and Other Intangible Assets, net

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Other Intangible Assets, net

(5) Goodwill and Other Intangible Assets, net

(a)

Goodwill

Following the sale of the miraDry business, the Company has one reporting unit, Plastic Surgery, formerly known as Breast Products. The Company evaluates goodwill for impairment at least annually on October 1st and whenever circumstances suggest that goodwill may be impaired.

In the current year, the Company performed a qualitative analysis for goodwill on the annual impairment testing date of October 1, 2021. The Company determined the fair value of the reporting unit was more likely than not greater than its carrying value and did not record any goodwill impairment charges.

The changes in the carrying amount of goodwill during the years ended December 31, 2021 and 2020 were as follows (in thousands):


	Plastic Surgery
Balances as of December 31, 2019	$	23,480
Accumulated impairment losses		(14,278	)
Goodwill acquired		—
Balances as of December 31, 2020	$	9,202
Goodwill acquired		—
Balances as of December 31, 2021	$	9,202

(b)

Other Intangible Assets

In the current year, the Company performed a qualitative analysis on the annual impairment testing date of October 1, 2021. The Company determined the fair value of the intangible assets was more likely than not greater than its carrying value and did not record any impairment charges.

The components of the Company’s other intangible assets consist of the following definite-lived and indefinite-lived assets (in thousands):


	Average
	Amortization		December 31, 2021
	Period		Gross Carrying		Accumulated			Intangible
	(in years)		Amount		Amortization			Assets, net
Intangibles with definite lives
Customer relationships		10	$	4,940	$	(4,224	)	$	716
Trade names - finite life		12		800		(389	)		411
Manufacturing know-how		19		8,240		(1,652	)		6,588
Developed technology		8		20,600		—			20,600
Total definite-lived intangible assets			$	37,043	$	(8,728	)	$	28,315

Intangibles with indefinite lives
Trade names - indefinite life	—			450		—			450
Total indefinite-lived intangible assets			$	450	$	—		$	450


	Average
	Amortization		December 31, 2020
	Period		Gross Carrying		Accumulated			Intangible
	(in years)		Amount		Amortization			Assets, net
Intangibles with definite lives
Customer relationships		10	$	4,940	$	(3,856	)	$	1,084
Trade names - finite life		12		800		(322	)		478
Manufacturing know-how		19		8,240		(865	)		7,375
Total definite-lived intangible assets			$	16,443	$	(7,506	)	$	8,937

Intangibles with indefinite lives
Trade names - indefinite life	—			450		—			450
Total indefinite-lived intangible assets			$	450	$	—		$	450

Amortization expense for the year ended December 31, 2021, 2020 and 2019 was $1.2 million, $1.3 million and $0.9 million, respectively. The following table summarizes the estimated amortization expense relating to the Company's intangible assets as of December 31, 2021 (in thousands):


	Amortization
Period	Expense
2022	$	3,738
2023		3,667
2024		3,523
2025		3,380
2026		3,206
Thereafter		10,801
	$	28,315

Leases

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Leases

(6) Leases

Components of lease expense were as follows:


		Year Ended December 31,
Lease Cost	Classification	2021			2020		2019
Operating lease cost	Operating expenses	$	1,644		$	1,698	$	1,550
Operating lease cost	Inventory		276			488		4,206
Sublease income	Operating expenses		(520	)		—		—
Total operating lease cost		$	1,400		$	2,186	$	5,756
Finance lease cost
Amortization of right-of-use assets	Operating expenses		35			41		41
Amortization of right-of-use assets	Inventory		19			36		—
Interest on lease liabilities	Other income (expense), net		8			10		4
Total finance lease cost		$	62		$	87	$	45
Variable lease cost	Inventory		—			—		10,568
Total lease cost		$	1,462		$	2,273	$	16,369

Short-term lease expense for the years ended December 31, 2021, 2020, and 2019 were immaterial.

Supplemental cash flow information related to operating and finance leases was as follows (in thousands):


	Year Ended December 31,
	2021		2020		2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases	$	1,716	$	1,758	$	5,419
Operating cash outflows from finance leases		69		85		44
Finance cash flows from finance leases	$	—	$	—	$	—
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	965	$	1,242	$	8,667
Finance leases		—		157		117

Supplemental balance sheet information related to operating and finance leases was as follows (in thousands, except lease term and discount rate):


	December 31,			December 31,
	2021			2020
Reported as:
Other assets
Operating lease right-of-use assets	$	6,488		$	7,176
Finance lease right-of-use assets		77			158
Total right-of use assets	$	6,565		$	7,334
Accrued and other current liabilities
Operating lease liabilities	$	1,595		$	1,504
Finance lease liabilities		71			84
Warranty reserve and other long-term liabilities
Operating lease liabilities		5,576			5,946
Finance lease liabilities		28			77
Total lease liabilities	$	7,270		$	7,611
Weighted average remaining lease term (years)
Operating leases		4			5
Finance leases		2			2
Weighted average discount rate
Operating leases		8.16	%		7.75	%
Finance leases		6.90	%		6.15	%

As of December 31, 2021, maturities of the Company’s operating and finance lease liabilities are as follows (in thousands):


Period	Operating leases		Finance leases		Total
2022	$	2,184	$	63	$	2,247
2023		2,269		38		2,307
2024		1,818		3		1,821
2025		898		—		898
2026		852		—		852
2027		586		—		586
Total lease payments	$	8,607	$	104	$	8,711
Less imputed interest		1,436		5		1,441
Total lease liabilities	$	7,171	$	99	$	7,270

Debt

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Debt

(7) Debt

Term Loan and Revolving Loan

On July 25, 2017, the Company entered into a Term Loan Credit and Security Agreement and a Revolving Loan Credit and Security Agreement with MidCap Financial Trust (“MidCap”), which replaced the Company’s prior Silicon Valley Bank Loan Agreement. Both agreements were amended and restated on July 1, 2019 and further amended on November 7, 2019 (as so amended, the “Restated Term Loan Agreement” and the “Restated Revolving Credit Agreement” and, together, the “Credit Agreements”).

The Restated Term Loan Agreement provided for the following tranches: (i) a $35 million term loan facility drawn at signing, (ii) a $5 million term loan facility drawn at signing, (iii) at any time after September 30, 2020 to December 31, 2020, a $10.0 million term loan facility (subject to the satisfaction of certain conditions, including evidence that the Company’s net revenue for the past 12 months was greater than or equal to $100.0 million), and (iv) until December 31, 2020 and upon the consent of the agent and the lenders following a request from the Company, an additional $15.0 million term loan facility. The loan matures on July 1, 2024 and carries an interest rate of LIBOR plus 7.50%. Under this amendment. the Company would have made monthly payments of accrued interest from the funding date until July 31, 2021, to be followed by monthly installments of principal and interest through the maturity date. The Company may prepay some or all of the principal prior to its maturity date provided the Company pays MidCap a prepayment fee. The loan provided that the Company shall pay an exit fee equal to 5.0% of the aggregate amount of all term loans funded to the Company.

On May 11, 2020, the Company entered into the Second Amendment to Amended and Restated Credit and Security Agreement (Term Loan), by and among the Company, certain of the Company’s subsidiaries, the lenders party thereto and MidCap Financial Trust as agent (the “Term Amendment”). The Term Amendment provided for, among other things, the prepayment by the Company of $25.0 million of outstanding principal, $0.1 million of accrued interest, and $1.25 million in prepaid exit fees with the parties agreeing to waive the prepayment fee with respect to these amounts. The Term Amendment increased the tranche 3 commitment amount from $10.0 million to $15.0 million, extended the tranche 3 termination date from December 31, 2020 to June 30, 2021, and amended certain conditions upon which the tranche 3 commitment can be withdrawn, including evidence that the Company’s net revenue for the past six months was greater than or equal to $30.0 million. In addition, the Term Amendment amended certain financial requirements including reducing the Company’s minimum unrestricted cash amount from $20.0 million to $5.0 million and amended certain minimum net revenue requirements. Further, the monthly minimum net revenue requirements were revised to be calculated on a trailing three-month basis.

On February 5, 2021, the Company entered into a Second Amended and Restated Credit and Security Agreement (Term Loan), by and among the Company, certain of the Company’s subsidiaries, the lenders party thereto from time to time and MidCap Financial Trust, as administrative agent and collateral agent (“Agent”) (the “Restated Term Loan Agreement”). The Restated Term Loan Agreement amends and restates the Company’s existing Amended and Restated Credit and Security Agreement, dated as of July 1, 2019. Pursuant to the Restated Term Loan Agreement, tranche 3 commitments were reduced from $15 million to $1 million and were advanced on the effective date of the Restated Term Loan Agreement and the remaining unfunded tranche of $15 million was revised to two $5 million tranche commitments, with tranche 4 availability commencing on July 1, 2021 and tranche 5 availability commencing July 1, 2022. The parties agreed to extend the last day of the interest only period for all tranches from July 31, 2021 in the Existing Term Loan Agreement to December 31, 2022 in the Restated Term Loan Agreement. The Restated Term Loan Agreement contains certain minimum net revenue requirements based on the Company’s 12-month trailing net revenue, as well as certain minimum unrestricted cash requirements that increase upon the funding of the tranche 4 and tranche 5 loans. The exit fee was modified to apply to only the amount of any tranche 4 and 5 loans advanced. Finally, in connection with the Restated Term Loan Agreement, the Company agreed to pay an amendment fee of $750,000.

On December 31, 2021, in connection with the AuraGen Asset Purchase, the Company entered into Limited Consent and Second Amendment to Second Amended and Restated Credit and Security Agreement (Term Loan) (as amended, the “Term Loan Agreement”), dated February 5, 2021, with certain of the Company's wholly owned subsidiaries, the lenders party thereto and MidCap Financial Trust, as agent, in order to permit the Company to enter into the Purchase Agreement and consummate the Asset Purchase under the Term Loan Agreement.

As of December 31, 2021, there was $16.0 million of outstanding principal related to the term loans and $1.0 million of unamortized debt issuance costs which are included in “Long-term debt” on the consolidated balance sheets.

The Restated Revolving Credit Agreement provides for, among other things, a revolving loan of up to $10.0 million. The amount of loans available to be drawn under the Revolving Credit Agreement is based on a borrowing base equal to 85% of the net collectible value of eligible accounts receivable plus 40% of eligible finished goods inventory, or the Borrowing Base, provided that availability from eligible finished goods inventory does not exceed 20% of the Borrowing Base. The revolving loan carries an interest rate of LIBOR plus 4.50%. The Company may make (subject to the applicable borrowing base at the time) and repay borrowings from time to time until the maturity of the facility on July 1, 2024.

On May 11, 2020, the Company entered into the Second Amendment to Amended and Restated Credit and Security Agreement (Revolving Loan), by and among the Company, certain of the Company’s subsidiaries, the lenders party thereto and MidCap Financial Trust as agent (the “Revolving Amendment”). The Revolving Amendment includes conforming changes to reflect the changes in the Term Amendment. In addition, the Revolving Amendment reduces the borrowing base by the portion of the eligible inventory previously included in the calculation.

Also on February 5, 2021, Sientra entered into a Third Amendment to Amended and Restated Credit and Security Agreement (Revolving Loan), by and among the Company, the lenders party thereto from time to time, and the Agent (the “Revolving Loan Amendment”). The Revolving Loan Amendment modified the Net Revenue requirement in a manner consistent with the modification under the Restated Term Loan Agreement. In addition, the Revolving Loan Amendment made other conforming changes to the Restated Term Loan Agreement.

Further on December 31, 2021, the Company entered into Limited Consent and Fifth Amendment to Amended and Restated Credit and Security Agreement (Revolving Loan) (as amended, the “Revolving Loan Agreement”), dated July 1, 2019, with certain of the Company's wholly owned subsidiaries, the lenders
party thereto and MidCap Financial Trust, as agent, in order to permit the Company to enter into the Purchase Agreement and consummate the AuraGen Asset Purchase under the Revolving Loan Agreement.

As of December 31, 2021, there were $2.2 million borrowings outstanding under the Revolving Loan and no amounts available. As of December 31, 2021, the unamortized debt issuance costs related to the Revolving Loan was approximately $46,000 and was included in “Other assets” on the consolidated balance sheets.

The amortization of debt issuance costs on the Term Loan and Revolving Loan for the years ended December 31, 2021, 2020, and 2019 was $0.5 million, $0.9 million, and $0.4 million, respectively, and was included in interest expense in the consolidated statements of operations.

The Credit Agreements include customary affirmative and restrictive covenants and representations and warranties, including a financial covenant for minimum revenues, a financial covenant for minimum cash requirements, a covenant against the occurrence of a “change in control,” financial reporting obligations, and certain limitations on indebtedness, liens, investments, distributions, collateral, mergers or acquisitions, taxes, and deposit accounts. Upon the occurrence of an event of default, a default interest rate of an additional 5.0% may be applied to any outstanding principal balances, and Midcap may declare all outstanding obligations immediately due and payable and take such other actions as set forth in the Credit Agreements. The Company’s obligations under the Credit Agreements are secured by a security interest in substantially all of the Company’s assets.

Convertible Note

On March 11, 2020, the Company issued $60.0 million of unsecured and subordinated convertible notes with an interest rate of 4.00% (“Note”) to Deerfield Partners, L.P.(“Holder”) in order to fund ongoing operations. The Note matures on March 11, 2025, subject to earlier conversion by the option of the Holder at any time in whole or in part into common shares of the Company, for a period up to five years. Upon conversion by the Holder, the Company shall deliver, shares of the Company’s common stock at a conversion rate of 14,634 per $1,000 principal amount of the Note (which represents an initial conversion rate price of $4.10), or the Base Conversion Rate, in each case subject to customary anti-dilution adjustments. In addition to the typical anti-dilution adjustment, the Note also provides the

Holder with additional consideration (“Make-Whole Provision”) beyond the settlement of the conversion obligation, in the event of a major transaction prior to maturity (e.g. a change in control). Upon conversion by the Holder in the event of a major transaction, the Company shall deliver, either cash, shares of the Company’s common stock or a combination of cash and common stock at the Base Conversion rate plus the additional consideration from the Make-Whole Provision. The $60.0 million principal amount of the Note is not payable until the maturity date of March 11, 2025, unless converted to equity earlier. The Company has paid interest in cash on the Note at 4.00% per annum, quarterly from July 1, 2020.

The Convertible Note is convertible at any time at the option of Deerfield, provided that Deerfield is prohibited from converting the Convertible Note into shares of Common Stock if, as a result of such conversion, the Holder (together with certain affiliates and “group” members) would beneficially own more than 4.985% of the total number of shares of Common Stock then issued and outstanding. Pursuant to the Convertible Note, Deerfield has the option to demand repayment of all outstanding principal, and any unpaid interest accrued thereon, in connection with a Major Transaction (as defined in the Convertible Note), which shall include, among others, any acquisition or other change of control of the Company; the sale or transfer of assets of the Company equal to more than 50% of the Enterprise Value (as defined in the Convertible Note) of the Company; a liquidation, bankruptcy or other dissolution of the Company; or if at any time shares of the Company’s common stock are not listed on an Eligible Market (as defined in the Convertible Note). The Convertible Note is subject to specified events of default, the occurrence of which would entitle Deerfield to immediately demand repayment of all outstanding principal and accrued interest on the Convertible Note. Such events of default include, among others, failure to make any payment under the Convertible Note when due, failure to observe or perform any covenant under the Deerfield Facility Agreement or the other transaction documents related thereto (subject to a standard cure period), the failure of the Company to be able to pay debts as they come due, the commencement of bankruptcy or insolvency proceedings against the Company, a material judgement levied against the Company and a material default by the Company under the Convertible Note.

On September 28, 2021, the Company entered into a First Amendment (the “Amendment”) to Facility Agreement (the “Agreement”) with Deerfield Partners, L.P., as agent and lender (“Deerfield”). The Amendment provides for, among other things, the permissibility to issue unregistered shares of the Company’s common stock upon the conversion of the Convertible Note (as defined in the Agreement). In addition, the Amendment provides that, in the event of a Major Transaction (as defined in the Convertible Note), cap the number of additional shares of the Company’s common stock to be issued if the Share Price Result (as defined in the Convertible Note) is greater than $30.00 per share or less than $1.50 per share.

Prior to the amendment, the conversion features in the outstanding convertible debt instrument were accounted for as a free-standing embedded derivative bifurcated from the principal balance of the Note, as (1) the conversion features were not clearly and closely related to the debt instrument and were not considered to be indexed to the Company’s equity, (2) the conversion features standing alone meet the definition of a derivative, and (3) the Note is not remeasured at fair value each reporting period with changes in fair value recorded in the consolidated statement of operations.

As a result of the amendment, the conversion feature no longer needed to be accounted for as a free-standing embedded derivative as it met the criteria for equity classification. As of the amendment date, the derivative liability was adjusted to a fair value of $41.0 million and has been reclassified to “Additional paid in capital” on the consolidated balance sheet.

On December 31, 2021, in connection with the AuraGen Asset Purchase, the Company entered into Amendment No. 3 (the “Facility Amendment”) to the Facility Agreement, dated March 11, 2020, with Deerfield Partners, L.P. in order to permit the Company to enter into the Purchase Agreement and consummate the Asset Purchase.

As of December 31, 2021, the unamortized debt discount and issuance costs were $12.5 million and were included in "Long-term debt" on the consolidated balance sheets. The Company will amortize the debt discount and debt issuance costs to interest expense under the effective interest method over the term of the Note, at a resulting effective interest rate of approximately 12%. For the years ended December 31, 2021 and 2020, the amortization of the convertible debt discount and issuance costs were $3.0 million and $2.2 million, respectively, and were included in interest expense in the consolidated statements of operations.

Registration Rights Agreement

In connection with the Deerfield Facility Agreement, on March 11, 2020, the Company and Deerfield entered into a Registration Rights Agreement (the “Registration Rights Agreement”). Pursuant to the Registration Rights Agreement, the Company filed with the SEC a Registration Statement on Form S-3 as required to effect a registration of the Common Stock issued or issuable upon conversion of or pursuant to the Convertible Note (the “Registrable Securities”), covering the resale of the Registrable Securities and such indeterminate number of additional shares of Common Stock as may become issuable upon conversion of or otherwise pursuant to the Convertible Note to prevent dilution resulting from certain corporate actions.

CARES Act

On April 20, 2020, the Company was granted a loan of $6.7 million under the Paycheck Protection Program of the CARES Act, or the PPP Loan, from Silicon Valley Bank, or the Lender. The PPP Loan was scheduled to mature on April 20, 2022, or the Maturity Date, and bore interest at a rate of 1.0% per annum. Under the terms of the PPP Loan, the Company made no payments until the date which forgiveness of the PPP Loan is determined, which can be up to 10 months following the end of the covered period (which is defined as 24 weeks from the date of the loan), or the Deferral Period. Commencing one month after the expiration of the Deferral Period, and continuing on the same day of each month until the Maturity Date, the Company would have paid to Lender monthly payments of principal and interest, in an amount required to fully amortize the principal amount outstanding on the PPP Loan on the last day of the Deferral Period by the Maturity Date.

On July 30, 2021, the Company was notified by Silicon Valley Bank that they received payment in full from the Small Business Administration for the amount of the Company's PPP Loan and the Company's PPP Loan had been fully forgiven. For the year ended December 31, 2021, the Company recorded a gain on extinguishment of the PPP Loan of $6.7 million in “Other income (expense), net” within the consolidated statement of operations.

Future Principal Payments of Debt

The future schedule of principal and exit fee payments for all outstanding debt as of December 31, 2021 was as follows (in thousands):


Fiscal Year
2022	$	—
2023		10,667
2024		5,333
2025		60,000
Total	$	76,000

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-URI http://asc.fasb.org/topic&trid=2208564

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (h)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(c))
-URI http://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (g)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1C
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495334-112611

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1E
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495348-112611

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1I
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495371-112611

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 470
-SubTopic 20
-Section 50
-Paragraph 1B
-Subparagraph (i)
-URI http://asc.fasb.org/extlink&oid=123466505&loc=SL123495323-112611

+ Details

Income Taxes

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Income Taxes

(8) Income Taxes

The provision for income tax consists of the following:


	Year Ended December 31,
	2021		2020		2019
Federal	$	11	$	12	$	9
State		10		10		9
Foreign		—		11		16
Total income tax (benefit) expense	$	21	$	33	$	34

Actual income tax expense differs from that obtained by applying the statutory federal income tax rate of 21% in 2021, 2020, and 2019, respectively, to income before income taxes as follows: (in thousands):


	Year Ended December 31,
	2021			2020			2019
Tax at federal statutory rate	$	(13,124	)	$	(18,882	)	$	(22,424	)
State, net of federal benefit		(770	)		(2,372	)		(2,109	)
PPP loan forgiveness		(1,397	)		—			—
Permanent items		606			2,282			857
Benefit state rate change		(184	)		20			337
Other		8,499			2,984			368
Goodwill impairment		—			—			1,602
Change in valuation allowance		6,391			16,001			21,403
	$	21		$	33		$	34

The tax effects of temporary differences and carryforwards that give rise to significant portions of the deferred tax assets and liabilities are as follows (in thousands):


	December 31,
	2021			2020
Net operating loss carryforwards	$	122,570		$	113,374
Research and development credits		2,121			2,121
Lease liabilities		1,798			1,861
Derivative liability		—			6,495
Accruals and reserves		14,961			10,175
Intangibles		1,732			3,053
		143,182			137,079
Less valuation allowance		(137,700	)		(131,309	)
Total deferred tax assets	$	5,482		$	5,770

Depreciation	$	(717	)	$	(276	)
Convertible debt discount		(2,800	)		(3,440	)
Right-of-use assets		(1,624	)		(1,793	)
Intangibles - deferred tax liability		(434	)		(333	)
Total deferred tax liabilities		(5,575	)		(5,842	)
Net deferred taxes	$	(93	)	$	(72	)

In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. Generally, the ultimate realization of deferred tax assets is dependent on the generation of future taxable income during the periods in which those temporary differences become deductible. Based on all the relevant factors, a valuation allowance of $137.7 million has been established against deferred tax assets as of December 31, 2021 as management determined that it is more likely than not that sufficient taxable income will not be generated to realize these temporary differences.

As of December 31, 2021, the Company had net operating loss carryforwards of approximately $483.1 million and $330.1 million available to reduce future taxable income, if any, for federal and state income tax purposes, respectively. Federal net operating loss carryforwards of $9.8 million begins expiring in 2027, and state net operating loss carryforwards of $8.3 million began expiring in 2017. It is possible that the Company will not generate taxable income in time to use these NOLs before their expiration. In addition, under Section 382 of the Internal Revenue Code of 1986, as amended, or the Code, if a corporation undergoes an “ownership change ”, the corporation's ability to use its pre-change NOL carryforwards and other pre-change tax attributes to offset its post-change income may be limited. In general, an “ownership change” occurs if there is a cumulative change in a loss corporation’s ownership by 5% shareholders that exceeds 50 percentage points over a rolling three-year period.

As of December 31, 2021, the Company had research and development credit carryforwards of approximately $30,000 and $2.7 million available to reduce future taxable income, income, if any, for federal and California state income tax purposes, respectively. The federal credit carryforwards begin expiring in 2029 and the state credits carryforward indefinitely.

At December 31, 2021, the Company had unrecognized tax benefits of approximately $0.6 million associated with the research and development credits. The Company does not anticipate that total unrecognized net tax benefits will significantly change over the next twelve months.

A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows (in thousands):


Ending balance at December 31, 2019	$	1,116
Additions based on tax positions taken in the current year		10
Decreases based on tax positions taken in a prior year		(507	)
Ending balance at December 31, 2020		619
Additions based on tax positions taken in the current year		—
Ending balance at December 31, 2021	$	619

It is the Company’s policy to include penalties and interest expense related to income taxes as a component of other (income) expense and interest expense, respectively, as necessary. There was no interest expense or penalties related to unrecognized tax benefits recorded through December 31, 2021.

The Company files U.S. federal and state income tax returns in jurisdictions with varying statute of limitations. In general, the Company’s federal tax returns for 2018 to 2020 and state tax returns for 2017 to 2020 remain open for examination by the federal and state tax authorities, including net operating loss carryforwards to those years.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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-Topic 740
-SubTopic 10
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-Paragraph 2
-Subparagraph (SAB Topic 11.C)
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-Topic 235
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-Paragraph 1
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-URI http://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

+ Details

Employee Benefit Plans

12 Months Ended

Dec. 31, 2021

Retirement Benefits [Abstract]

Employee Benefit Plans

(9) Employee Benefit Plans

In September 2016, the Company adopted a Section 401(k) Retirement Savings Plan for the benefit of eligible employees. All employees become eligible to participate in the plan the first of the month following their hire date and may contribute their pretax or after–tax salary, up to the Internal Revenue Service annual contribution limit. The Company makes contributions to the 401(k) plan under a safe harbor provision, whereby the Company contributes 3% of each participating employee’s annual compensation. The Company contributions vest immediately. The Company contributed and included in operating expense $0.6 million, $0.5 million, and $0.7 million for each of the years ended December 31, 2021, 2020, and 2019, respectively.

- Definition

The entire disclosure for retirement benefits.

+ References

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+ Details

Stockholders' Equity

12 Months Ended

Dec. 31, 2021

Share-based Payment Arrangement [Abstract]

Stockholders' Equity

(10) Stockholders’ Equity

(a)

Authorized Stock

The Company’s Amended and Restated Certificate of Incorporation authorizes the Company to issue 210,000,000 shares of common and preferred stock, consisting of 200,000,000 shares of common stock with $0.01 par value and 10,000,000 shares of preferred stock with $0.01 par value. As of December 31, 2021, the Company had no preferred stock issued or outstanding.

(b)

Stock Option Plans

In April 2007, the Company adopted the 2007 Equity Incentive Plan, or 2007 Plan. The 2007 Plan provides for the granting of stock options to employees, directors and consultants of the Company. Options granted under the 2007 Plan may either be incentive stock options or nonstatutory stock options. Incentive stock options, or ISOs, may be granted only to Company employees. Nonstatutory stock options, or NSOs, may be granted to all eligible recipients. A total of 1,690,448 shares of the Company’s common stock were reserved for issuance under the 2007 Plan.

As of December 31, 2021, pursuant to the 2007 Plan, there were 114,120 options outstanding and no shares of common stock available for future grants.

The Company’s board of directors adopted the 2014 Equity Incentive Plan, or 2014 Plan, in July 2014, and the stockholders approved the 2014 Plan in October 2014. The 2014 Plan became effective upon completion of the IPO on November 3, 2014, at which time the Company ceased granting awards under the 2007 Plan. Under the 2014 Plan, the Company may issue ISOs, NSOs, stock appreciation rights, restricted stock awards, restricted stock unit awards and other forms of stock awards, or collectively, stock awards, all of which may be granted to employees, including officers, non-employee directors and consultants of the Company and their affiliates. ISOs may be granted only to employees. A total of 1,027,500 shares of common stock were initially reserved for issuance under the 2014 Plan, subject to certain annual increases.

As of December 31, 2021, pursuant to the 2014 Plan, there were 8,717,856 shares of common stock reserved and 2,190,272 shares of common stock available for future grants.

Pursuant to a board-approved Inducement Plan, the Company may issue NSOs and restricted stock unit awards which may only be granted to new employees of the Company and their affiliates in accordance with NASDAQ Stock Market Rule 5635(c)(4) as an inducement material to such individuals entering into employment with the Company. As of December 31, 2021, inducement grants for 1,983,411 shares of common stock have been awarded, and 606,112 shares of common stock were reserved for future issuance under the Inducement Plan.

Options under the 2007 Plan and the 2014 Plan may be granted for periods of up to ten years as determined by the Company’s board of directors, provided, however, that (i) the exercise price of an ISO shall not be less than 100% of the estimated fair value of the shares on the date of grant, and (ii) the exercise price of an ISO granted to a more than 10% shareholder shall not be less than 110% of the estimated fair value of the shares on the date of grant. An NSO has no such exercise price limitations. NSOs under the Inducement Plan may be granted for periods of up to ten years as determined by the board of directors, provided, the exercise price will be not less than 100% of the estimated fair value of the shares on the date of grant. Options generally vest with 25% of the grant vesting on the first anniversary and the balance vesting monthly on a straight-lined basis over the requisite service period of three additional years for the award. Additionally, options have been granted to certain key executives that vest upon achievement of performance conditions based on performance targets as defined by the board of directors, which have included net sales targets and defined corporate objectives over the performance period with possible payout ranging from 0% to 100% of the target award. Compensation expense is recognized on a straight-lined basis over the vesting term of one year based upon the probable performance target that will be met. The vesting provisions of individual options may vary but provide for vesting of at least 25% per year.

The following summarizes all option activity under the 2007 Plan, 2014 Plan and Inducement Plan:


				Weighted		Weighted average
				average		remaining
	Option			exercise		contractual
	Shares			price		term (year)
Balances at December 31, 2019		1,880,846		$	7.42		5.48
Granted		600,000			3.58
Exercised		(9,817	)		2.89
Forfeited		(511,528	)		8.87
Balances at December 31, 2020		1,959,501		$	4.79		5.92
Exercised		(72,726	)		3.99
Forfeited		(182,812	)		5.49
Balances at December 31, 2021		1,703,963		$	4.75		5.41
Vested and expected to vest at December 31, 2021		1,703,963
Vested and exercisable at December 31, 2021		1,266,428					7.27

There were no stock options granted during the years ended December 31, 2021 and 2019. The weighted average grant date fair value of stock options granted to employees and directors during the year ended December 31, 2020 was $3.58 per share. Stock-based compensation expense for stock options for the years ended December 31, 2021, 2020 and 2019 was $0.5 million, $0.1 million and $0.6 million, respectively. Tax benefits arising from the disposition of certain shares issued upon exercise of stock options within two years of the date of grant or within one year of the date of exercise by the option holder, or Disqualifying Dispositions, provide the Company with a tax deduction equal to the difference between the exercise price and the fair market value of the stock on the date of exercise. As of December 31, 2021 there was $1.5 million of unrecognized compensation cost related to stock options granted under the plans. The expense is recorded within the operating expense components in the consolidated statement of operations based on the employees receiving the awards.

The aggregate intrinsic value of stock options is calculated as the difference between the exercise price of the stock options and the fair value of the Company’s common stock for those stock options that had exercise prices lower than the fair value of the Company’s common stock. The aggregate intrinsic value of stock options exercised was $208,000, $14,000, and $0.6 million during the years ended December 31, 2021, 2020 and 2019, respectively.

The following table presents the weighted‑average assumptions used to estimate the fair value of options granted during the periods presented:


	Year Ended December 31,
Stock Options	2021	2020	2019
Expected term (in years)	—	6.50	—
Expected volatility	—	82.65%	—
Risk-free interest rate	—	0.27%	—
Dividend yield	—	—	—

The expected term of employee stock options, risk‑free interest rate and volatility represents the weighted average, based on grant date period which the stock options are expected to remain outstanding. The Company utilizes the simplified method to estimate the expected term of the options pursuant to ASC Subtopic 718‑10 for all option grants to employees. The Company estimates its expected stock volatility based on company-specific historical and implied volatility information of its stock. The risk‑free interest rate is based on the U.S. Treasury yield curve in effect at the time of the grant for periods corresponding with the expected term of the option. The dividend yield assumption is based on the Company’s history and expectation of dividend payouts. The Company has never declared or paid any cash dividends on its common stock, and the Company does not anticipate paying any cash dividends in the foreseeable future. The Company records forfeitures when they occur.

For purposes of financial accounting for stock‑based compensation, the Company has determined the fair values of its options based in part on the work of a third‑party valuation specialist. The determination of stock‑based compensation is inherently uncertain and subjective and involves the application of valuation models and assumptions requiring the use of judgment. If the Company had made different assumptions, its stock‑based compensation expense, and its net loss could have been significantly different.

(c)

Restricted Stock Units

The Company has issued restricted stock unit awards, or RSUs, to employees and non-employees under the 2014 Plan and Inducement Plan. The RSUs issued to employees generally vest on a straight-line basis annually over a 3-year requisite service period. The RSUs issued to non-employees are generally for consulting services and generally vest either monthly or annually over the service term.

Activity related to RSUs is set forth below:


				Weighted average
	Number			grant date
	of shares			fair value
Balances at December 31, 2019		2,232,956		$	11.99
Granted		3,070,430			4.77
Vested		(1,150,707	)		10.06
Forfeited		(1,058,889	)		7.82
Balances at December 31, 2020		3,093,790		$	6.97
Granted		1,636,969			7.06
Vested		(1,452,893	)		6.42
Forfeited		(478,314	)		2.31
Balances at December 31, 2021		2,799,552		$	8.11

The weighted average grant date fair value of RSUs granted to employees and directors during the years ended December 31, 2021, 2020 and 2019 was $7.06, $4.77, and $8.02 per share, respectively. Stock-based compensation expense for RSUs for the years ended December 31, 2021, 2020 and 2019 was $9.3 million, $7.5 million and $11.2 million, respectively. As of December 31, 2021, there was $9.8 million total unrecognized compensation cost related to non-vested RSU awards. The cost is expected to be recognized over a weighted average period of 2.03 years.

(d)

Employee Stock Purchase Plan

The Company’s board of directors adopted the 2014 Employee Stock Purchase Plan, or ESPP, in July 2014, and the stockholders approved the ESPP in October 2014. The ESPP allows eligible employees to purchase shares of the Company’s common stock at a discount through payroll deductions of up to 15% of their eligible compensation, subject to any plan limitations. The ESPP provides offering periods not to exceed 27 months, and each offering period will include purchase periods, which will be the approximately six-month period commencing with one exercise date and ending with the next exercise date, except that the first offering period commenced on the first trading day following the effective date of the Company’s registration statement. Employees are able to purchase shares at 85% of the lower of the fair market value of the Company’s common stock on the first trading day of the offering period or on the exercise date. A total of 255,500 shares of common stock were initially reserved for issuance under the ESPP. The number of shares available for sale under the ESPP will be increased annually on the first day of each fiscal year, equal to the lesser of i) 1% of the total outstanding shares of the Company’s common stock as of the last day of the immediately preceding fiscal year; ii) 3,000,000 shares of common stock, or iii) such lesser amount as determined by the board of directors.

As of December 31, 2021, the number of shares of common stock reserved for issuance under the ESPP was 2,252,652. During the year ended December 31, 2021, employees purchased 199,071 shares under the ESPP at a weighted average exercise price of $3.38 per share. During the year ended December 31, 2020, employees purchased 203,728 shares under the ESPP at a weighted average exercise price of $4.11 per share. As of December 31, 2021, the number of shares of common stock available for future issuance under the ESPP was 1,253,615. Stock-based compensation related to the ESPP for the years ended December 31, 2021, 2020 and 2019 was $0.6 million, $0.6 million, and $0.8 million, respectively.

The following table presents the weighted-average assumptions used to estimate the fair value of the stock purchase rights granted under the employee stock purchase plan:


	Year Ended December 31,
ESPP	2021					2020					2019
Expected term (in years)	0.50		to	2.00		0.50		to	2.00		0.50		to	2.00
Expected volatility	64	%	to	101	%	68	%	to	139	%	69	%	to	77	%
Risk-free interest rate	0.06	%	to	0.20	%	0.14	%	to	1.57	%	1.87	%	to	2.06	%
Dividend yield	—					—					—

(e)

Significant modifications

There were no material modifications of equity awards during the years ended December 31, 2021, 2020, and 2019.

Segment Reporting and Geographic Information

12 Months Ended

Dec. 31, 2021

Segment Reporting [Abstract]

Segment Reporting and Geographic Information

(11) Segment Reporting and Geographic Information

(a)

Reportable Segments

Following the sale of the miraDry business on June 10, 2021, the Company has one reportable segment named Plastic Surgery, formally known as Breast Products. The Plastic Surgery segment focuses on sales of silicone gel breast implants, tissue expanders and scar management products under the brands Sientra Round, Sientra Teardrop, AlloX2, Dermaspan, Softspan and BIOCORNEUM.

The net sales, net operating loss and net assets for the Plastic Surgery segment are presented in the consolidated statement of operations and consolidated balance sheets as continuing operations.

(b)

Geographic Information

Net sales are attributed to geographic areas based on where the Company’s products are shipped. The following table presents the net sales by geographical region for the periods presented (in thousands):


	December 31,
	2021		2020		2019
United States	$	79,037	$	53,284	$	46,295
International		1,646		1,713		68
Total net sales	$	80,683	$	54,997	$	46,363

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

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-Paragraph 21
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8721-108599

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-URI http://asc.fasb.org/topic&trid=2134510

+ Details

Commitments and Contingencies

12 Months Ended

Dec. 31, 2021

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

(12) Commitments and Contingencies

The Company is subject to claims and assessments from time to time in the ordinary course of business. The Company accrues a liability for such matters when it is probable that future expenditures will be made and such expenditures can be reasonably estimated.

Product Liability Litigation

On October 7, 2019, a lawsuit was filed in the Superior Court of the State of California against the Company and Silimed Industria de Implantes Ltda. (the Company’s former contract manufacturer). The lawsuit alleges that the Company’s textured breast implants caused certain of the plaintiffs to develop a condition known as breast implant associated anaplastic large cell lymphoma (“BIA-ALCL”), and that the Company is liable to the plaintiffs based on claims for strict liability (failure to warn), strict liability (defective manufacture), negligence and loss of consortium. On January 21, 2020, the Company filed a demurrer to the plaintiff’s complaint, which demurrer the Court granted in a tentative ruling dated March 9, 2021 with leave to replead. The Plaintiffs filed an amended complaint on April 6, 2021 and the Company filed a demurrer to that complaint on May 6, 2021. On October 25, 2021, the Court issued a ruling granting the Company’s demurrer in-part and denying it in-part, and gave plaintiffs twenty days to file an amendment complaint. The Company intends to vigorously defend itself in this lawsuit. Given the nature of this case, the Company is unable to estimate the reasonably possible loss or range of loss, if any, arising from this matter.

On September 23, 2020, a lawsuit was filed in the Eastern District of Tennessee against the Company. The lawsuit alleges that the Company’s textured breast implants caused certain of the plaintiffs to develop a condition known as breast implant associated anaplastic large cell lymphoma (“BIA-ALCL”), and that the Company is liable to the plaintiffs based on claims for negligence, strict liability (manufacturing defects), strict liability (failure to warn), breach of express and implied warranties, and punitive damages. The Company filed a motion to dismiss the complaint on December 7, 2020. On February 28, 2022 the Court granted the Company’s motion, and dismissed the plaintiff’s complaint with prejudice.

Subsequent Events

12 Months Ended

Dec. 31, 2021

Subsequent Events [Abstract]

Subsequent Events

(13) Subsequent Events

Health Canada Approval

On March 23, 2022, the Company received approval from Health Canada to begin commercialization of its smooth round HSC and HSC+ silicone gel breast implants in Canada. Following this approval, the Company intends to begin commercialization in Canada with its distribution partner, Kai Aesthetics, Inc.

Amendment to Credit Agreements

On March 30, 2022 (the “Effective Date”), the Company entered into a Third Amendment (the “Third Amendment”) to the Term Loan Agreement, with certain of the Company’s wholly owned subsidiaries, the lenders party thereto and MidCap, in order to provide the Company an additional tranche of funding and allow the Company to draw the fourth tranche. The Third Amendment provides that the fourth tranche of $5,000,000 will be drawn on March 31, 2022. Additionally, the Third Amendment provides the Company with a sixth tranche pursuant to which the Company may draw $9,000,000 any time after January 1, 2023 until March 31, 2023. The Third Amendment also eliminated the minimum unrestricted cash requirement and reset the minimum Net Revenue (as defined therein) requirements based on the Company’s 12-month trailing Net Revenue. Finally, the Third Amendment increased the prepayment fee by 0.5% until following the third anniversary of the Effective Date, at which point no prepayment fee shall apply.

Also on March 30, 2022, the Company entered into Sixth Amendment (the “Sixth Amendment”) to the Revolving Loan Agreement, with certain of the Company’s wholly owned subsidiaries, the lenders party thereto and MidCap. The Sixth Amendment modified the Net Revenue (as defined therein) requirement in a manner consistent with the modification under the Restated Term Loan Agreement. In addition, the Sixth Amendment made other conforming changes to the Restated Term Loan Agreement.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Basis of Presentation and Use of Estimates

(a)

Basis of Presentation and Use of Estimates

The preparation of financial statements in conformity with accounting principles generally accepted in the United States of America, or GAAP, requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and the disclosure of contingent assets and liabilities at the dates of the financial statements, and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Assets and liabilities which are subject to significant judgment and use of estimates include the allowance for doubtful accounts, sales return liability, provision for warranties, valuation of inventories, recoverability of long-lived assets, valuation allowances with respect to deferred tax assets, useful lives associated with property and equipment and finite lived intangible assets, and the valuation and assumptions underlying stock-based compensation and other equity instruments. On an ongoing basis, the Company evaluates its estimates compared to historical experience and trends, which form the basis for making judgments about the carrying value of assets and liabilities. In addition, the Company engages the assistance of valuation specialists in concluding on fair value measurements in connection with stock-based compensation and other equity instruments.

As a result of the miraDry Sale discussed in Note 2, the miraDry business met the criteria to be reported as discontinued operations. Therefore, the Company is reporting the historical results of miraDry, including the results of operations, cash flows, and related assets and liabilities, as discontinued operations for all periods presented herein through the date of the Sale. Unless otherwise noted, the accompanying notes to the audited consolidated financial statements have all been revised to reflect continuing operations only. As discussed in Note 11, following the Sale the Company has one operating segment in continuing operations named Plastic Surgery, formerly known as Breast Products.

Liquidity

(b)

Liquidity

Since the Company’s inception, it has incurred significant net operating losses and the Company anticipates that losses will continue in the near term. The Company expects its operating expenses will remain consistent with the current year ended December 31, 2021, and will need to generate significant net sales to achieve profitability. To date, the Company has funded operations primarily with proceeds from the sales of preferred stock, borrowings under term loans and the convertible note, sales of products, and the proceeds from the sale of common stock in public offerings. To fund ongoing operating and capital needs, the Company may need to raise additional capital in the future through the sale of equity securities and incremental debt financing.

Sale of the miraDry business

Refer to Note 2 for details on the sale of the miraDry business.

Debt financing

See Note 7 to the consolidated financial statements for a full description of our long-term debt, revolving line of credit, convertible note, and PPP loan.

Equity financing

On June 7, 2019, the Company completed an underwritten follow-on public offering of 17,391,305 shares of common stock at $5.75 per share, as well as 2,608,695 additional shares of common stock pursuant to the full exercise of the over-allotment option granted to the underwriters. Net proceeds were approximately $107.7 million after deducting underwriting discounts and commissions of $6.9 million and offering expenses of approximately $0.4 million.

Further on February 8, 2021, the Company completed a follow-on public offering of 5,410,628 shares of common stock at $6.75 per share, as well as 811,594 additional shares of common stock pursuant to the full exercise of the over-allotment option granted to the underwriters. Net proceeds were approximately $39.2 million after deducting underwriting discounts and commissions of approximately $2.5 million and offering expenses of approximately $0.3 million.

At December 31, 2021, the Company had cash and cash equivalents of $51.8 million. The accompanying consolidated financial statements have been prepared on a going concern basis, which implies the Company will continue to realize its assets and discharge its liabilities in the normal course of business. The Company believes that its cash and cash equivalents will be sufficient to fund its operations for at least the next 12 months.

Cash and Cash Equivalents

(c)

Cash and Cash Equivalents

The Company considers all highly liquid investments purchased with an original maturity of three months or less when purchased to be cash equivalents. Cash and cash equivalents consist primarily of cash in checking accounts and interest-bearing money market accounts.

Concentration of Credit and Supplier Risks

(d)

Concentration of Credit and Supplier Risks

Financial instruments that potentially subject the Company to significant concentrations of credit risk consist primarily of cash and cash equivalents. The Company’s cash and cash equivalents are deposited in demand accounts at financial institutions that management believes are creditworthy. The Company is exposed to credit risk in the event of default by these financial institutions for cash and cash equivalents in excess of amounts insured by the Federal Deposit Insurance Corporation, or FDIC. Management believes that the Company’s investments in cash and cash equivalents are financially sound and have minimal credit risk and the Company has not experienced any losses on its deposits of cash and cash equivalents.

The Company relies on a limited number of third-party manufacturers for the manufacturing and supply of its products. This could result in the Company not being able to acquire the inventory needed to meet customer demand, which would result in possible loss of sales and affect operating results adversely.

Fair Value of Financial Instruments

(e)

Fair Value of Financial Instruments

The carrying amounts of cash and cash equivalents, accounts receivable, accounts payable, accrued liabilities, customer deposits and sales return liability are reasonable estimates of their fair value because of the short maturity of these items. The fair value of the contingent consideration and the convertible feature related to the convertible note are discussed in Note 4. The fair value of the debt is based on the amount of future cash flows associated with the instrument discounted using the Company’s market rate. As of December 31, 2021 and 2020, the carrying value of the long-term debt was not materially different from the fair value. As of December 31, 2021 and 2020, the carrying value and fair value of the convertible note were as follows (in thousands):


	December 31,		December 31,
	2021		2020
Carrying value	$	47,477	$	44,436
Fair value	$	42,029	$	37,580

The convertible note is carried on the consolidated balance sheets at amortized cost. The fair value is estimated using a discounted cash flow analysis with a yield derived from a calibrated binomial lattice model as of the convertible note issuance date and adjusted for market movements thereafter. The market for trading of the convertible note is not considered to be an active market and therefore the estimate of fair value is based on Level 2 inputs.

Fair Value Measurements

(f)

Fair Value Measurements

Certain assets and liabilities are carried at fair value under GAAP. Fair value is defined as the exchange price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value must maximize the use of observable inputs and minimize the use of unobservable inputs.

Financial assets and liabilities carried at fair value are to be classified and disclosed in one of the following three levels of the fair value hierarchy, of which the first two are considered observable and the last is considered unobservable:

•

Level 1 — Quoted prices in active markets for identical assets or liabilities.

•

Level 2 — Observable inputs (other than Level 1 quoted prices) such as quoted prices in active markets for similar assets or liabilities, quoted prices in markets that are not active for identical or similar assets or liabilities, or other inputs that are observable or can be corroborated by observable market data.

•

Level 3 — Unobservable inputs that are supported by little or no market activity and that are significant to determining the fair value of the assets or liabilities, including pricing models, discounted cash flow methodologies and similar techniques.

Property and Equipment

(g)

Property and Equipment

Property and equipment are stated at cost, net of accumulated depreciation. Depreciation is computed using the straight‑line method over the estimated useful life of the asset, generally three to fifteen years. Leasehold improvements are depreciated over the shorter of the lease term or the estimated useful life of the related asset. Upon retirement or sale of an asset, the cost and related accumulated depreciation or amortization are removed from the consolidated balance sheet and any resulting gain or loss is reflected in operations in the period realized. Maintenance and repairs are charged to operations as incurred.

Leases

(h)

Leases

The Company leases certain office space, warehouses, distribution facilities, manufacturing facilities and office equipment. The Company determines if an arrangement contains a lease at inception by evaluating whether the arrangement conveys the right to use an identified asset and whether the Company obtains substantially all of the economic benefits from and has the ability to direct the use of the asset.

Operating and finance lease right-of-use, or ROU, assets and lease liabilities are recognized based on the present value of the future lease payments over the lease term at the commencement date. The Company determines its incremental borrowing rate based on the information available at the commencement date in determining the lease liabilities as the Company’s leases generally do not provide an implicit rate. The ROU assets also include any initial direct costs incurred and any lease payments made at or before the lease commencement date, less lease incentives received. Lease terms may include options to extend or terminate when the Company is reasonably certain that the option will be exercised. The Company elected to apply the short-term lease measurement and recognition exemption in which ROU assets and lease liabilities are not recognized for short-term leases. The Company’s lease agreements generally do not contain material residual value guarantees or material restrictive covenants.

The Company’s leases of office space, warehouses, distribution facilities and manufacturing facilities are treated as operating leases and often contain lease and non-lease components. The Company has elected to account for these lease and non-lease components separately. Non-lease components for these assets are primarily comprised of common-area maintenance, utilities, and real estate taxes that are passed on from the lessor in proportion to the space leased by the Company, and are recognized in operating expenses in the period in which the obligation for those payments was incurred. Lease cost for these operating leases is recognized on a straight-line basis over the lease term in operating expenses.

The Company’s leases of office equipment are accounted for as finance leases as they meet one or more of the five finance lease classification criteria. Lease cost for these finance leases is comprised of amortization of the ROU asset and interest expense which are recognized in operating expenses and other income (expense), net.

Goodwill and Other Intangible Assets

(i)

Goodwill and Other Intangible Assets

Goodwill

Goodwill represents the excess of the purchase price over the fair value of net assets of purchased businesses. Goodwill is not amortized, but instead is subject to impairment tests on at least an annual basis and whenever circumstances suggest that goodwill may be impaired. The Company’s annual test for impairment is performed as of October 1 of each fiscal year. The Company makes a qualitative assessment of whether it is more likely than not that a reporting unit’s fair value is less than its carrying amount. If the Company concludes that it is more likely than not that the fair value of a reporting unit is less than its carrying amount from the qualitative assessment, the Company performs a quantitative analysis to compare the fair value of the reporting unit to its carrying amount. The Company recognizes impairment charges for the amount by which the carrying amount exceeds the reporting unit’s fair value.

The Company’s fair value analysis of goodwill utilizes the income approach and market approach, which requires the use of estimates about a reporting unit’s future revenues and free cash flows, market multiples, enterprise value, control risk premiums, discount rates, terminal value and enterprise value to determine the estimated fair value. The Company’s future revenues and free cash flow assumptions are determined based upon actual results giving effect to management’s expected changes in operating results in future years. The market multiples, enterprise value, control risk premiums, discount rates and terminal value are based upon market participant assumptions using a defined peer group. Changes in these assumptions can materially affect these estimates. Thus, to the extent the market changes, discount rates increase significantly or the Company does not meet its projected performance, the Company could recognize impairments, and such impairments could be material. For the years ended December 31, 2021, 2020, and 2019, the Company did not record any goodwill impairment charges.

Indefinite-lived intangible assets

The Company tests indefinite-lived intangible assets for impairment at least on an annual basis as of October 1 of each fiscal year and whenever circumstances suggest the intangible assets may be impaired. The Company makes a qualitative assessment of whether it is more likely than not that the fair value of the intangible asset is less than its carrying amount. If the Company concludes that it is more likely than not that the fair value is less than its carrying amount from the qualitative assessment, the Company performs a quantitative analysis to compare the fair value of the intangible asset to its carrying amount. If the carrying value of the intangible asset exceeds its fair value, an impairment loss is recognized in an amount equal to the difference. The Company also evaluates the remaining useful life of an indefinite-lived intangible asset to determine whether events and circumstances continue to support an indefinite useful life. For the years ended December 31, 2021, 2020, and 2019, the Company did not record any indefinite-lived intangible assets impairment charges.

Finite-lived intangible assets

The intangible assets are amortized to the consolidated statement of operations based on estimated cash flows generated from the intangible asset over its estimated life. Each fiscal year the Company evaluates the estimated remaining useful lives of purchased intangible assets and whether events or changes in circumstance warrant a revision to the remaining periods of amortization. Judgments about the recoverability of purchased finite‑lived intangible assets are made whenever events or changes in circumstance indicate that impairment may exist. Recoverability of finite‑lived intangible assets is measured by comparison of the carrying amount of the asset group to the future undiscounted cash flows the asset group is expected to generate. If the sum of the future undiscounted cash flows is less than the carrying value, the Company will evaluate whether the fair value of each asset in the asset group exceeds its respective carrying value. If the fair value of any asset in the asset group is determined to be less than its carrying value, then the Company will recognize an impairment loss based on the excess of the carrying amount over the asset’s respective fair value.

The Company’s fair value analysis of intangible assets utilizes methods under various income approaches. The Company values its customer relationships using an excess earnings method, which assumes the value of the asset is the discounted future cash flows derived from existing customers and requires the use of customer attrition rates and discount rates to determine the estimated fair value. The future revenues and free cash flow from existing customers are determined based upon actual results giving effect to management’s expected changes in operating results in future

years. The attrition rate is based on average historical levels of customer attrition and the discount rate is based upon market participant assumptions using a defined peer group. Tradenames and developed technology are valued using a relief from royalty method, which assumes the value of the asset is the discounted cash flows of the amount that would be paid by a hypothetical market participant had they not owned the asset and instead licensed the asset from another company. This method requires the use of royalty rates which are determined based on comparable third-party license agreements involving similar assets and discount rates similar to the above to determine the estimated fair value.

Impairment of Tangible Long Lived Assets

(j)

Impairment of Tangible Long‑Lived Assets

The Company’s management routinely considers whether indicators of impairment of long‑lived assets are present. If such indicators are present, management determines whether the sum of the estimated undiscounted cash flows attributable to the asset group in question is less than their carrying value. If less, the Company will recognize an impairment loss based on the excess of the carrying amount of the assets over their respective fair values. Fair value is determined by discounted future cash flows, appraisals or other methods. If the assets determined to be impaired are to be held and used, the Company will recognize an impairment charge to the extent the present value of anticipated net cash flows attributable to the asset are less than the asset’s carrying value. The fair value of the asset will then become the asset’s new carrying value. There have been no impairments recorded for tangible long-lived assets during the years ended December 31, 2021, 2020, and 2019.

Acquisitions

(k)

Acquisitions

The Company evaluates acquisitions of assets and other similar transactions to assess whether or not the transaction should be accounted for as a business combination or asset acquisition by first applying a screen test to determine if substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or group of similar identifiable assets. If the screen is met, the transaction is accounted for as an asset acquisition. If the screen is not met, further determination is required as to whether or not the Company has acquired inputs and processes that have the ability to create outputs which would meet the definition of a business.

Business combinations

Business combinations are accounted for using the acquisition method of accounting. Under the acquisition method, assets acquired and liabilities assumed are recorded at their respective fair values as of the acquisition date in the financial statements. The excess of the fair value of consideration transferred over the fair value of the net assets acquired is recorded as goodwill. Liability-classified contingent consideration obligations incurred in connection with a business combination are recorded at their fair values on the acquisition date and remeasured at their fair values each subsequent reporting period until the related contingencies are resolved. The resulting changes in fair values are recorded in earnings. Equity-classified contingent consideration obligations incurred in connection with a business combination are recorded at their fair values on the acquisition date and are not subsequently remeasured each reporting period unless the obligation becomes reclassified as a liability. The subsequent settlement of the obligation is accounted for within equity.

Asset acquisitions

In an asset acquisition, the fair value of the consideration transferred, including transaction costs, is allocated to the assets acquired and liabilities assumed based on their relative fair values. No goodwill is recognized in an asset acquisition. Subsequent changes are recorded as adjustments to the carrying amount of the assets acquired.

Segment Reporting

(l)

Segment Reporting

Reportable segments represent components for which separate financial information is available that is utilized on a regular basis by the Chief Executive Officer, who has been identified as the Chief Operating Decision Maker, or CODM, as defined by authoritative guidance on segment reporting, in determining how to allocate resources and evaluate performance. The segments are determined based on several factors, including client base, homogeneity of products, technology, delivery channels and similar economic characteristics. Following the sale of the miraDry business on June 10, 2021, the Company has one reportable segment named Plastic Surgery, formally known as Breast Products.

Revenue Recognition

(m)

Revenue Recognition

The Company generates revenue primarily through the sale and delivery of promised goods or services to customers. Sales prices are documented in the executed sales contract, purchase order or order acknowledgement prior to the transfer of control to the customer. Typical payment terms are 30 days.

Revenue contracts may include multiple products or services, each of which is considered a separate performance obligation. Performance obligations typically include the delivery of promised products, such as breast implants, tissue expanders, and BIOCORNEUM, along with service-type warranties. Other deliverables are sometimes promised but are ancillary and insignificant in the context of the contract as a whole. Revenue is allocated to each performance obligation based on its relative standalone selling price. The Company determines standalone selling prices based on observable prices for all performance obligations with the exception of the service-type warranty under the Platinum20 Limited Warranty Program, or Platinum20.

The Company introduced Platinum20 in May 2018 on all OPUS breast implants implanted in the United States or Puerto Rico on or after May 1, 2018. Platinum20 provides for financial assistance for revision surgeries and no-charge contralateral replacement implants upon the occurrence of certain qualifying events. The Company considers Platinum20 to have an assurance warranty component and a service warranty component. The assurance component is recorded as a warranty liability at the time of sale (as discussed in Note 1(s)). The Company considers the service warranty component as an additional performance obligation and defers revenue at the time of sale using the expected cost plus margin approach for the performance obligation. Inputs into the expected cost plus margin approach include historical incidence rates, estimated replacement costs, estimated financial assistance payouts and an estimated margin.

The liability for unsatisfied performance obligations under the service warranty as of December 31, 2021 were as follows (in thousands):


	Year Ended December 31,
	2021
Balance as of December 31, 2020	$	1,945
Additions and adjustments		1,863
Revenue recognized		(571	)
Balance as of December 31, 2021	$	3,237

Revenue for service warranties are recognized ratably over the term of the agreements. Specifically for Platinum20, the performance obligation is satisfied at the time that the benefits are provided and are expected to be satisfied over the following 3 to 24 month period for financial assistance and 20 years for product replacement.

For delivery of promised products, control transfers and revenue is recognized upon shipment, unless the contractual arrangement requires transfer of control when products reach their destination, for which revenue is recognized once the product arrives at its destination. A portion of the Company’s revenue is generated from the sale of consigned inventory of breast implants and tissue expanders maintained at doctor, hospital, and clinic locations. For these products, revenue is recognized at the time the Company is notified by the customer that the product has been implanted, not when the consigned products are delivered to the customer’s location.

Sales Return Liability

With the exception of the Company’s BIOCORNEUM scar management products, the Company allows for the return of products from customers within six months after the original sale, which is accounted for as variable consideration. A sales return liability is established based on estimated returns using relevant historical experience taking into consideration recent gross sales and notifications of pending returns, as adjusted for changes in recent industry events and trends. The estimated sales returns are recorded as a reduction of revenue and as a sales return liability in the same period revenue is recognized. Actual sales returns in any future period are inherently uncertain and thus may differ from the estimates. If actual sales returns differ significantly from the estimates, an adjustment to revenue in the current or subsequent period would be recorded. The following table provides a rollforward of the sales return liability (in thousands):


	Year Ended December 31,
	2021			2020
Beginning balance	$	9,192		$	8,116
Addition to reserve for sales activity		158,245			118,508
Actual returns		(152,773	)		(117,407	)
Change in estimate of sales returns		(1,265	)		(25	)
Ending balance	$	13,399		$	9,192

Practical Expedients and Policy Election

The Company generally expenses sales commissions when incurred because the amortization period would have been one year or less. These costs are recorded within sales and marketing expenses.

The Company does not adjust accounts receivable for the effects of any significant financing components as customer payment terms are shorter than one year.

The Company has elected to account for shipping and handling activities performed after a customer obtains control of the products as activities to fulfill the promise to transfer the products to the customer. Shipping and handling activities are largely provided to customers free of charge. The associated costs were $5.5 million, $2.9 million and $1.9 million for the years ended December 31, 2021, 2020, and 2019, respectively. These costs are viewed as part of the Company’s marketing programs and are recorded as a component of sales and marketing expense in the consolidated statement of operations as an accounting policy election.

Accounts Receivable and Allowance for Doubtful Accounts

(n)

Accounts Receivable and Allowance for Doubtful Accounts

Accounts receivable are recorded at the invoiced amount and do not bear interest. The Company maintains allowances for doubtful accounts for estimated losses resulting from the inability to collect from some of its customers. The allowances for doubtful accounts are based on the analysis of historical bad debts, customer credit‑worthiness, past transaction history with the customer, and current economic trends. If the financial condition of the Company’s customers were to deteriorate, adversely affecting their ability to make payments, additional allowances may be required.

Inventories and Cost of Goods Sold

(o)

Inventories and Cost of Goods Sold

Inventories represent raw materials, work in process and finished goods that are recorded at the lower of cost or market on a first‑in, first‑out basis, or FIFO. The Company recognizes the cost of inventory transferred to the customer in cost of goods sold when revenue is recognized. Further, the Company periodically assesses the recoverability of all inventories to determine whether adjustments for impairment or obsolescence are required. The Company evaluates the remaining shelf life and other general obsolescence and impairment criteria in assessing the recoverability of the Company’s inventory.

Income Taxes

(p)

Income Taxes

The Company accounts for income taxes under the asset and liability method. Under this method, deferred tax assets and liabilities are determined based on the difference between the financial statement and tax bases of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to affect taxable income. Valuation allowances are established when necessary to reduce deferred tax assets to the amounts expected to be realized.

The Company operates in several tax jurisdictions and is subject to taxes in each jurisdiction in which it conducts business. To date, the Company has incurred cumulative net losses and maintains a full valuation allowance on its net deferred tax assets due to the uncertainty surrounding realization of such assets. However, the Company has deferred tax liabilities that cannot be considered sources of income to support the realization of the deferred tax assets, and has provided for tax expense (or benefit) and a corresponding deferred tax liability.

The Company accounts for uncertain tax positions in accordance with Account Standards Codification, or ASC, 740‑10, Accounting for Uncertainty in Income Taxes. The Company assesses all material positions taken in any income tax return, including all significant uncertain positions, in all tax years that are still subject to assessment or challenge by relevant taxing authorities. Assessing an uncertain tax position begins with the initial determination of the position’s sustainability and is measured at the largest amount of benefit that is greater than fifty percent likely of being realized upon ultimate settlement. As of each balance sheet date, unresolved uncertain tax positions must be reassessed, and the Company will determine whether (i) the factors underlying the sustainability assertion have changed and (ii) the amount of the recognized tax benefit is still appropriate. The recognition and measurement of tax benefits requires significant judgment. Judgments concerning the recognition and measurement of tax benefit might change as new information becomes available.

Research and Development Expenditures

(q)

Research and Development Expenditures

Research and development costs are charged to operating expenses as incurred. Research and development, or R&D, primarily consist of clinical expenses, regulatory expenses, product development, consulting services, outside research activities, quality control and other costs associated with the development of the Company’s products and compliance with Good Clinical Practices, or GCP, requirements. R&D expenses also include related personnel and consultant compensation and stock-based compensation expense.

Stock-Based Compensation

(r)

Stock‑Based Compensation

The Company applies the fair value provisions of ASC 718, Compensation — Stock Compensation, or ASC 718. ASC 718 requires the recognition of compensation expense, using a fair‑value based method, for costs related to all employee share‑based payments, including stock options, restricted stock units, and the employee stock purchase plan. In the absence of an observable market price for an award, ASC 718 requires companies to estimate the fair value of share‑based payment awards on the date of grant using an option‑pricing model. We estimate the fair value of our stock‑based awards to employees and directors using the Black‑Scholes option pricing model. The grant date fair value of a stock‑based award is recognized as an expense over the requisite service period of the award on a straight‑line basis. In addition, we use the Monte-Carlo simulation option-pricing model to determine the fair value of market-based awards. The Monte-Carlo simulation option-pricing model uses the same input assumptions as the Black-Scholes model; however, it also further incorporates into the fair-value determination the possibility that the market condition may not be satisfied. Compensation costs related to these awards are recognized regardless of whether the market condition is satisfied, provided that the requisite service has been provided.

The option-pricing models require the input of subjective assumptions, including the risk‑free interest rate, expected dividend yield, expected volatility and expected term, among other inputs. These estimates involve inherent uncertainties and the application of management’s judgment. If factors change and different assumptions are used, our stock‑based compensation expense could be materially different in the future. These assumptions are estimated as follows:

•

Risk‑free interest rate—The risk‑free interest rate is based on the yields of U.S. Treasury securities with maturities similar to the expected term of the options for each option group.

•

Dividend yield—The Company has never declared or paid any cash dividends and do not presently plan to pay cash dividends in the foreseeable future. Consequently, the Company utilized an expected dividend yield of zero.

•

Expected volatility—In the prior years, the Company utilized median historic price volatilities and implied volatilities of comparable public companies due to a lack of significant trading history for the Company’s own common stock. In the current year, the Company estimated its expected stock volatility based on company-specific historical and implied volatility information of its stock as sufficient historical information has become available.

•

Expected term—The expected term represents the period that our stock‑based awards are expected to be outstanding. The Company utilizes the simplified method to estimate the expected term.

Product Warranties

(s)

Product Warranties

The Company offers a product replacement and limited warranty program for the Company’s silicone gel breast implants. For silicone gel breast implant surgeries occurring prior to May 1, 2018, the Company provides lifetime replacement implants and up to $3,600 in financial assistance for revision surgeries, for covered rupture events that occur within ten years of the surgery date. The Company introduced its Platinum20 Limited Warranty Program in May 2018, covering OPUS silicone gel breast implants implanted in the United States or Puerto Rico on or after May 1, 2018. The Company considers the program to have an assurance warranty component and a service warranty component. The service warranty component is discussed in Note 1(m) above. The assurance component is related to the lifetime no-charge contralateral replacement implants and up to $5,000 in financial assistance for revision surgeries, for covered rupture events that occur within twenty years of the surgery date.

Net Loss Per Share

(t)

Net Loss Per Share


	December 31,
	2021			2020			2019
Loss from continuing operations	$	(62,519	)	$	(67,112	)	$	(58,087	)
Income (loss) from discontinued operations, net of income taxes		37			(22,835	)		(48,731	)
Net loss	$	(62,482	)	$	(89,947	)	$	(106,818	)
Weighted average common shares outstanding, basic and diluted		57,057,107			50,233,175			40,654,272
Basic and diluted net loss per share attributable to common stockholders
Continuing operations	$	(1.10	)	$	(1.34	)	$	(1.43	)
Discontinued operations		0.00			(0.45	)		(1.20	)
Basic and diluted net loss per share	$	(1.10	)	$	(1.79	)	$	(2.63	)

The Company excluded the following potentially dilutive securities, outstanding as of December 31, 2021, 2020 and 2019 from the computation of diluted net loss per share attributable to common stockholders for the years ended December 31, 2021, 2020 and 2019 because they had an anti-dilutive impact due to the net loss attributable to common stockholders incurred for the periods.


	December 31,
	2021		2020		2019
Stock issuable upon conversion of convertible note		14,634,146		11,991,870		—
Stock options to purchase common stock		1,616,891		1,008,598		1,390,115
Unvested RSUs		1,789,603		1,135,454		1,174,431
		18,040,640		14,135,922		2,564,546

The Company uses the if-converted method for calculating any potential dilutive effects of the convertible note. The Company did not adjust the net loss for the year ended December 31, 2021 to eliminate any interest expense or gain/loss for the derivative liability related to the note in the computation of diluted loss per share, as the effects would be anti-dilutive.

Recent Accounting Pronouncements

(u)

Recent Accounting Pronouncements

Recently Adopted Accounting Standards

In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes. The amendment removes certain exceptions for recognizing deferred taxes for investments, performing intraperiod allocation, and calculating income taxes in interim periods. The amendment also adds guidance to reduce complexity in certain areas, including recognizing deferred taxes for tax goodwill and allocating taxes to members of a consolidated group. The ASU is effective for annual and interim periods in fiscal years beginning after December 15, 2020. Early adoption was permitted. The Company adopted the applicable amendments within ASU 2019-12 in the first quarter of 2021 and there was no material impact on its condensed consolidated financial statements from the adoption.

Recently Issued Accounting Standards

In August 2020, the FASB issued ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity. The amendment eliminates certain accounting models and simplifies the accounting for convertible instruments and enhances disclosures for convertible instruments and earnings per share. The amendments are effective for public entities excluding smaller reporting companies for fiscal years beginning after December 15, 2021, including interim periods within those fiscal years. For all other entities, the amendments are effective for fiscal years beginning after December 15, 2023 including interim periods within those fiscal years and early adoption is permitted. The Company is currently evaluating the impact that adoption of the standard will have on the consolidated financial statements.

In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848)-Facilitation of the Effects of Reference Rate Reform on Financial Reporting. The amendment provides optional expedients and exceptions for contract modifications that replace a reference rate affected by reference rate reform. The amendments are effective for all entities as of March 12, 2020 through December 31, 2022, and entities may elect to apply by Topic as of any date from the beginning of an interim period that includes or is subsequent to March 12, 2020, or prospectively from a date within an interim period that includes or is subsequent to March 12, 2020, up to the date that the financial statements are available to be issued. The Company is currently evaluating the impact the election of the optional expedient will have on the consolidated financial statements.

Risks and Uncertainties

(v)

Risks and Uncertainties

As an aesthetics company, surgical procedures involving the Company’s breast products are susceptible to local and national government restrictions, such as social distancing, vaccination requirements, “shelter in place” orders and business closures. The inability or limited ability to perform such non-emergency procedures significantly harmed the Company’s revenues since the second quarter of 2020 and continued to harm the Company’s revenues during the year ended December 31, 2021. While many states have lifted certain restrictions on non-emergency procedures, the Company will likely continue to experience future harm to its revenues while existing or new restrictions remain in place. It is not possible to accurately predict the length or severity of the COVID-19 pandemic, including the spread of any variants, or the timing for a broad and sustained ability to perform non-emergency procedures involving the Company’s products. The Company continues to monitor and assess new information related to the COVID-19 pandemic, the actions taken to contain or treat COVID-19, as well as the economic impact on local, regional, national and international customers and markets.

Further, the spread of COVID-19 has caused the Company to modify workforce practices, and the Company may take further actions determined to be in the best interests of the Company’s employees or as required by governments. The continued spread of COVID-19, or another infectious disease, could also result in delays or disruptions in the Company’s supply chain or adversely affect the Company’s manufacturing facilities and personnel. Further, trade and/or national security protection policies may be adjusted as a result of the COVID-19 pandemic, such as actions by governments that limit, restrict or prevent the movement of certain goods into a country and/or region.

The estimates used for, but not limited to, determining the collectability of accounts receivable, fair value of long-lived assets and goodwill, and sales returns liability required could be impacted by the pandemic. While the full impact of COVID-19 is unknown at this time, the Company has made appropriate estimates based on the facts and circumstances available as of the reporting date. These estimates may change as new events occur and additional information is obtained.

Reclassifications

(w)

Reclassifications

Certain reclassifications have been made to prior year amounts to conform to the current year presentation, including those related to discontinued operations following the sale of the miraDry business.

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2021

Accounting Policies [Abstract]

Schedule of Carrying Value and Fair Value of Convertible Note

As of December 31, 2021 and 2020, the carrying value and fair value of the convertible note were as follows (in thousands):


	December 31,		December 31,
	2021		2020
Carrying value	$	47,477	$	44,436
Fair value	$	42,029	$	37,580

Schedule of Liability for Unsatisfied Performance Obligations Under Service Warranty

The liability for unsatisfied performance obligations under the service warranty as of December 31, 2021 were as follows (in thousands):


	Year Ended December 31,
	2021
Balance as of December 31, 2020	$	1,945
Additions and adjustments		1,863
Revenue recognized		(571	)
Balance as of December 31, 2021	$	3,237

Schedule of Rollforward of Sales Return Liability

The following table provides a rollforward of the sales return liability (in thousands):


	Year Ended December 31,
	2021			2020
Beginning balance	$	9,192		$	8,116
Addition to reserve for sales activity		158,245			118,508
Actual returns		(152,773	)		(117,407	)
Change in estimate of sales returns		(1,265	)		(25	)
Ending balance	$	13,399		$	9,192

Schedule of net loss per share, basic and diluted


	December 31,
	2021			2020			2019
Loss from continuing operations	$	(62,519	)	$	(67,112	)	$	(58,087	)
Income (loss) from discontinued operations, net of income taxes		37			(22,835	)		(48,731	)
Net loss	$	(62,482	)	$	(89,947	)	$	(106,818	)
Weighted average common shares outstanding, basic and diluted		57,057,107			50,233,175			40,654,272
Basic and diluted net loss per share attributable to common stockholders
Continuing operations	$	(1.10	)	$	(1.34	)	$	(1.43	)
Discontinued operations		0.00			(0.45	)		(1.20	)
Basic and diluted net loss per share	$	(1.10	)	$	(1.79	)	$	(2.63	)

Schedule of potentially dilutive securities excluded from the computation of diluted net loss per share attributable to common stockholders

The Company excluded the following potentially dilutive securities, outstanding as of December 31, 2021, 2020 and 2019 from the computation of diluted net loss per share attributable to common stockholders for the years ended December 31, 2021, 2020 and 2019 because they had an anti-dilutive impact due to the net loss attributable to common stockholders incurred for the periods.


	December 31,
	2021		2020		2019
Stock issuable upon conversion of convertible note		14,634,146		11,991,870		—
Stock options to purchase common stock		1,616,891		1,008,598		1,390,115
Unvested RSUs		1,789,603		1,135,454		1,174,431
		18,040,640		14,135,922		2,564,546

Discontinued Operations (Tables)

12 Months Ended

Dec. 31, 2021

Discontinued Operations and Disposal Groups [Abstract]

Schedule of Disposal Groups Including Discontinued Operations Balance Sheet and Income Statement

The following table presents the aggregate carrying amounts of major classes of assets and liabilities of discontinued operations (in thousands):


	December 31,		December 31,
	2021		2020
Assets of discontinued operations:
Accounts receivable, net	$	—	$	3,732
Inventories, net		—		9,480
Prepaid expenses and other current assets		4		263
Current assets of discontinued operations		4		13,475
Property and equipment, net		—		805
Total assets of discontinued operations	$	4	$	14,280
Liabilities of discontinued operations:
Accounts payable	$	6	$	704
Accrued and other current liabilities		494		3,982
Total liabilities of discontinued operations	$	500	$	4,686

The following table provides information regarding the results of discontinued operations (in thousands):


	Year Ended
	December 31,
	2021			2020			2019
Net sales	$	9,347		$	16,244		$	37,337
Cost of goods sold		4,805			8,703			16,659
Gross profit		4,542			7,541			20,678
Operating expenses		1,940			30,440			69,355
Income (loss) from operations of discontinued operations		2,602			(22,899	)		(48,677	)
Other income (expense), net		(77	)		64			(54	)
Income (loss) from discontinued operations before income taxes		2,525			(22,835	)		(48,731	)
Loss on sale of discontinued operations before income taxes		(2,488	)		—			—
Total income (loss) from discontinued operations before income taxes		37			(22,835	)		(48,731	)
Income tax expense (benefit)		—			—			—
Income (loss) from discontinued operations, net of income taxes	$	37		$	(22,835	)	$	(48,731	)

- Definition

Tabular disclosure of information related to a disposal group. Includes, but is not limited to, a discontinued operation, disposal classified as held-for-sale or disposed of by means other than sale or disposal of an individually significant component.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 360
-SubTopic 10
-Section 50
-Paragraph 3A
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Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Topic 205
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-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109222650&loc=d3e1474-107760

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 5D
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721677-107760

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
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-Section 45
-Paragraph 11
-URI http://asc.fasb.org/extlink&oid=109222160&loc=SL51721533-107759

Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
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-Section 50
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-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721659-107760

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
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-Section 50
-Paragraph 4B
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721665-107760

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 360
-SubTopic 10
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109226691&loc=d3e2941-110230

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 5C
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721675-107760

Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 7
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721683-107760

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 1
-URI http://asc.fasb.org/extlink&oid=109222650&loc=d3e1361-107760

Reference 11: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 5A
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721671-107760

Reference 12: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 5B
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721673-107760

Reference 13: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 205
-SubTopic 20
-Section 50
-Paragraph 4A
-URI http://asc.fasb.org/extlink&oid=109222650&loc=SL51721663-107760

+ Details

Acquisitions (Tables)

12 Months Ended

Dec. 31, 2021

Asset Acquisition [Line Items]

Schedule of Aggregate Preliminary Acquisition Date Fair Value of Consideration Transferred

The acquisition did not meet the definition of a business combination and was accounted for as an asset acquisition. The acquisition date fair value of the consideration transferred consisted of the following (in thousands):


	Fair Value as of December 31, 2021
Cash payment made on closing date	$	1,000
Direct transaction costs		213
Equity issued on closing date		14,426
Fair value of deferred cash consideration		2,400
Fair value of contingent consideration		2,615
Total purchase consideration	$	20,654

Schedule of Allocation of the Fair Value of the Consideration Transferred by Major Class

The allocation of the total purchase price is as follows (in thousands):


	December 31,
	2021
Inventories	$	54
Developed technology		20,600
Net assets acquired	$	20,654

Schedule of Intangible Asset Acquired, Estimated Useful Life and Amortization Method

The intangible asset acquired, estimated useful life and amortization method is as follows (in thousands):


			Estimated useful	Amortization
	Amount		life	method
Developed technology	$	20,600	8 years	Straight line

Balance Sheet Components (Tables)

12 Months Ended

Dec. 31, 2021

Balance Sheet Related Disclosures [Abstract]

Schedule of inventories, net

Inventories, net consist of the following (in thousands):


	December 31,		December 31,
	2021		2020
Raw materials	$	2,109	$	3,788
Work in progress		4,796		10,710
Finished goods		41,982		21,254
Finished goods - right of return		4,027		3,416
	$	52,914	$	39,168

Schedule of property and equipment, net

Property and equipment, net consist of the following (in thousands):


	December 31,			December 31,
	2021			2020
Leasehold improvements	$	2,734		$	2,523
Manufacturing equipment and tooling		9,922			8,529
Computer equipment		1,672			2,522
Software		6,379			3,010
Furniture and fixtures		1,542			1,040
		22,249			17,624
Less accumulated depreciation		(8,251	)		(5,323	)
	$	13,998		$	12,301

Schedule of accrued and other current liabilities

Accrued and other current liabilities consist of the following:


	December 31,		December 31,
	2021		2020
Payroll and related expenses	$	5,188	$	3,003
Accrued severance		248		2,900
Accrued commissions		4,329		4,734
Accrued manufacturing		121		225
Deferred and contingent consideration, current portion		2,431		10,146
Audit, consulting and legal fees		185		48
Accrued sales and marketing expenses		159		300
Lease liabilities		1,666		1,588
Other		6,971		5,464
	$	21,298	$	28,408

Schedule of rollforward of the accrued warranties

The following table provides a rollforward of the accrued warranties (in thousands):


	Year Ended December 31,
	2021			2020
Balance as of January 1	$	1,934		$	1,397
Warranty costs incurred during the period		(399	)		(122	)
Changes in accrual related to warranties issued during the period		933			589
Changes in accrual related to pre-existing warranties		37			70
Balance as of December 31	$	2,505		$	1,934

Schedule of Company's Liabilities that are Measured at Fair Value on a Recurring Basis

The following tables present information about the Company’s liabilities that are measured at fair value on a recurring basis as of December 31, 2021 and 2020 and indicate the level of the fair value hierarchy utilized to determine such fair value (in thousands):


	Fair Value Measurements as of
	December 31, 2021 Using:
	Level 1		Level 2		Level 3		Total
Liabilities:
Liability for contingent consideration	$	—	$	—	$	3,114	$	3,114
	$	—	$	—	$	3,114	$	3,114


	Fair Value Measurements as of
	December 31, 2020 Using:
	Level 1		Level 2		Level 3		Total
Liabilities:
Liability for contingent consideration	$	—	$	—	$	7,026	$	7,026
Liability for derivative		—		—		26,570		26,570
	$	—	$	—	$	33,596	$	33,596

Schedule of Aggregate Fair Values of Company's Liabilities for which Fair Value is Determined by Level 3 Inputs

The following table provides a rollforward of the aggregate fair values of the Company’s liabilities for which fair value is determined by Level 3 inputs (in thousands):


	Contingent consideration liability			Derivative liability
Balance, December 31, 2020	$	7,026		$	26,570
Additions		2,615			—
Change in fair value		442			14,460
Settlements		(6,969	)		—
Reclassification to equity		—			(41,030	)
Balance, December 31, 2021	$	3,114		$	—

Goodwill and Other Intangible Assets, net (Tables)

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Changes in Carrying Amount of Goodwill

The changes in the carrying amount of goodwill during the years ended December 31, 2021 and 2020 were as follows (in thousands):


	Plastic Surgery
Balances as of December 31, 2019	$	23,480
Accumulated impairment losses		(14,278	)
Goodwill acquired		—
Balances as of December 31, 2020	$	9,202
Goodwill acquired		—
Balances as of December 31, 2021	$	9,202

Schedule of Other Intangible assets

The components of the Company’s other intangible assets consist of the following definite-lived and indefinite-lived assets (in thousands):


	Average
	Amortization		December 31, 2021
	Period		Gross Carrying		Accumulated			Intangible
	(in years)		Amount		Amortization			Assets, net
Intangibles with definite lives
Customer relationships		10	$	4,940	$	(4,224	)	$	716
Trade names - finite life		12		800		(389	)		411
Manufacturing know-how		19		8,240		(1,652	)		6,588
Developed technology		8		20,600		—			20,600
Total definite-lived intangible assets			$	37,043	$	(8,728	)	$	28,315

Intangibles with indefinite lives
Trade names - indefinite life	—			450		—			450
Total indefinite-lived intangible assets			$	450	$	—		$	450


	Average
	Amortization		December 31, 2020
	Period		Gross Carrying		Accumulated			Intangible
	(in years)		Amount		Amortization			Assets, net
Intangibles with definite lives
Customer relationships		10	$	4,940	$	(3,856	)	$	1,084
Trade names - finite life		12		800		(322	)		478
Manufacturing know-how		19		8,240		(865	)		7,375
Total definite-lived intangible assets			$	16,443	$	(7,506	)	$	8,937

Intangibles with indefinite lives
Trade names - indefinite life	—			450		—			450
Total indefinite-lived intangible assets			$	450	$	—		$	450

Schedule of Estimated Amortization Expense

The following table summarizes the estimated amortization expense relating to the Company's intangible assets as of December 31, 2021 (in thousands):


	Amortization
Period	Expense
2022	$	3,738
2023		3,667
2024		3,523
2025		3,380
2026		3,206
Thereafter		10,801
	$	28,315

Leases (Tables)

12 Months Ended

Dec. 31, 2021

Leases [Abstract]

Components of Lease Expense

Components of lease expense were as follows:


		Year Ended December 31,
Lease Cost	Classification	2021			2020		2019
Operating lease cost	Operating expenses	$	1,644		$	1,698	$	1,550
Operating lease cost	Inventory		276			488		4,206
Sublease income	Operating expenses		(520	)		—		—
Total operating lease cost		$	1,400		$	2,186	$	5,756
Finance lease cost
Amortization of right-of-use assets	Operating expenses		35			41		41
Amortization of right-of-use assets	Inventory		19			36		—
Interest on lease liabilities	Other income (expense), net		8			10		4
Total finance lease cost		$	62		$	87	$	45
Variable lease cost	Inventory		—			—		10,568
Total lease cost		$	1,462		$	2,273	$	16,369

Supplemental Cash Flow Information Related to Operating and Finance Leases

Supplemental cash flow information related to operating and finance leases was as follows (in thousands):


	Year Ended December 31,
	2021		2020		2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases	$	1,716	$	1,758	$	5,419
Operating cash outflows from finance leases		69		85		44
Finance cash flows from finance leases	$	—	$	—	$	—
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	965	$	1,242	$	8,667
Finance leases		—		157		117

Supplemental Balance Sheet Information Related to Operating and Finance Leases

Supplemental balance sheet information related to operating and finance leases was as follows (in thousands, except lease term and discount rate):


	December 31,			December 31,
	2021			2020
Reported as:
Other assets
Operating lease right-of-use assets	$	6,488		$	7,176
Finance lease right-of-use assets		77			158
Total right-of use assets	$	6,565		$	7,334
Accrued and other current liabilities
Operating lease liabilities	$	1,595		$	1,504
Finance lease liabilities		71			84
Warranty reserve and other long-term liabilities
Operating lease liabilities		5,576			5,946
Finance lease liabilities		28			77
Total lease liabilities	$	7,270		$	7,611
Weighted average remaining lease term (years)
Operating leases		4			5
Finance leases		2			2
Weighted average discount rate
Operating leases		8.16	%		7.75	%
Finance leases		6.90	%		6.15	%

Maturities of Operating and Finance Lease Liabilities

As of December 31, 2021, maturities of the Company’s operating and finance lease liabilities are as follows (in thousands):


Period	Operating leases		Finance leases		Total
2022	$	2,184	$	63	$	2,247
2023		2,269		38		2,307
2024		1,818		3		1,821
2025		898		—		898
2026		852		—		852
2027		586		—		586
Total lease payments	$	8,607	$	104	$	8,711
Less imputed interest		1,436		5		1,441
Total lease liabilities	$	7,171	$	99	$	7,270

Debt (Tables)

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Schedule of Future Principal and Exit Fee Payments for Outstanding Debt

The future schedule of principal and exit fee payments for all outstanding debt as of December 31, 2021 was as follows (in thousands):


Fiscal Year
2022	$	—
2023		10,667
2024		5,333
2025		60,000
Total	$	76,000

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Schedule of Provision for Income Tax

The provision for income tax consists of the following:


	Year Ended December 31,
	2021		2020		2019
Federal	$	11	$	12	$	9
State		10		10		9
Foreign		—		11		16
Total income tax (benefit) expense	$	21	$	33	$	34

Schedule of Reconciliation of Actual Income Tax Expense Obtained by Applying Statutory Federal Income Tax Rate

Actual income tax expense differs from that obtained by applying the statutory federal income tax rate of 21% in 2021, 2020, and 2019, respectively, to income before income taxes as follows: (in thousands):


	Year Ended December 31,
	2021			2020			2019
Tax at federal statutory rate	$	(13,124	)	$	(18,882	)	$	(22,424	)
State, net of federal benefit		(770	)		(2,372	)		(2,109	)
PPP loan forgiveness		(1,397	)		—			—
Permanent items		606			2,282			857
Benefit state rate change		(184	)		20			337
Other		8,499			2,984			368
Goodwill impairment		—			—			1,602
Change in valuation allowance		6,391			16,001			21,403
	$	21		$	33		$	34

Schedule of Tax Effects of Temporary Differences and Carryforwards that Give Rise to Significant Portions of Deferred Tax Assets and Liabilities

The tax effects of temporary differences and carryforwards that give rise to significant portions of the deferred tax assets and liabilities are as follows (in thousands):


	December 31,
	2021			2020
Net operating loss carryforwards	$	122,570		$	113,374
Research and development credits		2,121			2,121
Lease liabilities		1,798			1,861
Derivative liability		—			6,495
Accruals and reserves		14,961			10,175
Intangibles		1,732			3,053
		143,182			137,079
Less valuation allowance		(137,700	)		(131,309	)
Total deferred tax assets	$	5,482		$	5,770

Depreciation	$	(717	)	$	(276	)
Convertible debt discount		(2,800	)		(3,440	)
Right-of-use assets		(1,624	)		(1,793	)
Intangibles - deferred tax liability		(434	)		(333	)
Total deferred tax liabilities		(5,575	)		(5,842	)
Net deferred taxes	$	(93	)	$	(72	)

Schedule of Reconciliation of Beginning and Ending Amount of Unrecognized Tax Benefits

A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows (in thousands):


Ending balance at December 31, 2019	$	1,116
Additions based on tax positions taken in the current year		10
Decreases based on tax positions taken in a prior year		(507	)
Ending balance at December 31, 2020		619
Additions based on tax positions taken in the current year		—
Ending balance at December 31, 2021	$	619

Stockholders' Equity (Tables)

12 Months Ended

Dec. 31, 2021

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Summary of option activity

The following summarizes all option activity under the 2007 Plan, 2014 Plan and Inducement Plan:


				Weighted		Weighted average
				average		remaining
	Option			exercise		contractual
	Shares			price		term (year)
Balances at December 31, 2019		1,880,846		$	7.42		5.48
Granted		600,000			3.58
Exercised		(9,817	)		2.89
Forfeited		(511,528	)		8.87
Balances at December 31, 2020		1,959,501		$	4.79		5.92
Exercised		(72,726	)		3.99
Forfeited		(182,812	)		5.49
Balances at December 31, 2021		1,703,963		$	4.75		5.41
Vested and expected to vest at December 31, 2021		1,703,963
Vested and exercisable at December 31, 2021		1,266,428					7.27

Summary of RSUs activity

Activity related to RSUs is set forth below:


				Weighted average
	Number			grant date
	of shares			fair value
Balances at December 31, 2019		2,232,956		$	11.99
Granted		3,070,430			4.77
Vested		(1,150,707	)		10.06
Forfeited		(1,058,889	)		7.82
Balances at December 31, 2020		3,093,790		$	6.97
Granted		1,636,969			7.06
Vested		(1,452,893	)		6.42
Forfeited		(478,314	)		2.31
Balances at December 31, 2021		2,799,552		$	8.11

Stock Option

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Schedule of Fair Value of Employee Stock Options Estimated Using Black-Scholes Option Valuation Model

The following table presents the weighted‑average assumptions used to estimate the fair value of options granted during the periods presented:


	Year Ended December 31,
Stock Options	2021	2020	2019
Expected term (in years)	—	6.50	—
Expected volatility	—	82.65%	—
Risk-free interest rate	—	0.27%	—
Dividend yield	—	—	—

Employee Stock Purchase Plan

Share Based Compensation Arrangement By Share Based Payment Award [Line Items]

Schedule of Fair Value of Employee Stock Options Estimated Using Black-Scholes Option Valuation Model

The following table presents the weighted-average assumptions used to estimate the fair value of the stock purchase rights granted under the employee stock purchase plan:


	Year Ended December 31,
ESPP	2021					2020					2019
Expected term (in years)	0.50		to	2.00		0.50		to	2.00		0.50		to	2.00
Expected volatility	64	%	to	101	%	68	%	to	139	%	69	%	to	77	%
Risk-free interest rate	0.06	%	to	0.20	%	0.14	%	to	1.57	%	1.87	%	to	2.06	%
Dividend yield	—					—					—

Segment Reporting and Geographic Information (Tables)

12 Months Ended

Dec. 31, 2021

Segment Reporting [Abstract]

Summary of Net Sales by Geographical Regions

The following table presents the net sales by geographical region for the periods presented (in thousands):


	December 31,
	2021		2020		2019
United States	$	79,037	$	53,284	$	46,295
International		1,646		1,713		68
Total net sales	$	80,683	$	54,997	$	46,363

Summary of Significant Accounting Policies (Details)			12 Months Ended
Summary of Significant Accounting Policies (Details)	Feb. 08, 2021 USD ($) $ / shares shares	Jun. 07, 2019 USD ($) $ / shares shares	Dec. 31, 2021 USD ($) Segment shares	Dec. 31, 2020 USD ($) shares	Dec. 31, 2019 USD ($) shares	Sep. 28, 2021 $ / shares
Summary Of Significant Accounting Policies [Line Items]
Impairment of tangible long-lived assets			$ 0	$ 0	$ 0
Cash and cash equivalents			$ 51,772,000	54,967,000	87,608,000
Number of reportable segments \| Segment			1
Goodwill impairment charge			$ 0	0	0
Goodwill recognized in asset acquisition			9,202,000	9,202,000
Indefinite-lived intangible assets impairment charges			0	0	0
Replacement implants and revision surgery financial assistance under limited warranty program			2,505,000	$ 1,934,000	$ 1,397,000
Series of Individually Immaterial Asset Acquisitions
Summary Of Significant Accounting Policies [Line Items]
Goodwill recognized in asset acquisition			$ 0
Silicone Gel Breast Implant Surgeries Occurring Prior to May 1, 2018
Summary Of Significant Accounting Policies [Line Items]
Period to claim financial assistance under limited warranty program			10 years
Silicone Gel Breast Implants Occurring on or after May 1, 2018
Summary Of Significant Accounting Policies [Line Items]
Period to claim financial assistance under limited warranty program			20 years
Common stock
Summary Of Significant Accounting Policies [Line Items]
Proceeds from follow-on offering, net of costs (in shares) \| shares			6,222,222	37,000	20,000,000
Underwritten Follow-On Offering \| Common stock
Summary Of Significant Accounting Policies [Line Items]
Proceeds from follow-on offering, net of costs (in shares) \| shares	5,410,628	17,391,305
Public offering price (in dollars per share) \| $ / shares	$ 6.75	$ 5.75
Additional shares granted to underwriters \| shares	811,594	2,608,695
Proceeds from the issuance of common stock, net of underwriting discounts, commissions and offering expenses	$ 39,200,000	$ 107,700,000
Payment of underwriting discounts and commissions and offering expenses	2,500,000	6,900,000
Offering expenses	$ 300,000	$ 400,000
Maximum \| Silicone Gel Breast Implant Surgeries Occurring Prior to May 1, 2018
Summary Of Significant Accounting Policies [Line Items]
Replacement implants and revision surgery financial assistance under limited warranty program			$ 3,600
Maximum \| Silicone Gel Breast Implants Occurring on or after May 1, 2018
Summary Of Significant Accounting Policies [Line Items]
Replacement implants and revision surgery financial assistance under limited warranty program			$ 5,000
Deerfield Facility Agreement \| Maximum
Summary Of Significant Accounting Policies [Line Items]
Public offering price (in dollars per share) \| $ / shares						$ 1.50
Deerfield Facility Agreement \| Minimum [Member]
Summary Of Significant Accounting Policies [Line Items]
Public offering price (in dollars per share) \| $ / shares						$ 30.00

Summary of Significant Accounting Policies - Schedule of Carrying Value and Fair Value of Convertible Note (Details) - Convertible Note - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Carrying Value	$ 47,477	$ 44,436
Fair Value	$ 42,029	$ 37,580

Summary of Significant Accounting Policies (PPE and Revenue) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment
Period for sales return	6 months
Revenue, practical expedient, incremental cost of obtaining contract	true
Revenue, practical expedient, significant financing component	true
Shipping and handling costs	$ 36,348	$ 23,599	$ 16,353
Breast Products \| Sales and marketing expense
Property, Plant and Equipment
Shipping and handling costs	$ 5,500	$ 2,900	$ 1,900
Type of Cost, Good or Service [Extensible List]	us-gaap:ShippingAndHandlingMember	us-gaap:ShippingAndHandlingMember	us-gaap:ShippingAndHandlingMember
Minimum
Property, Plant and Equipment
Estimated useful life of asset	3 years
Percentage of largest amount of tax benefit of settled uncertain tax position	50.00%
Maximum
Property, Plant and Equipment
Estimated useful life of asset	15 years

Summary of Significant Accounting Policies (PPE and Revenue) (Details 1) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date: 2022-01-01	Dec. 31, 2021
Summary Of Significant Accounting Policies [Line Items]
Performance obligation satisfying period	30 days
Product Replacement
Summary Of Significant Accounting Policies [Line Items]
Performance obligation satisfying period	20 years
Maximum \| Financial Service
Summary Of Significant Accounting Policies [Line Items]
Performance obligation satisfying period	24 months
Minimum \| Financial Service
Summary Of Significant Accounting Policies [Line Items]
Performance obligation satisfying period	3 months

Summary of Significant Accounting Policies - Schedule of Liability for Unsatisfied Performance Obligations Under Service Warranty (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($)
Change in Contract with Customer, Liability [Abstract]
Balance as of December 31, 2020	$ 1,945
Additions and adjustments	1,863
Revenue recognized	(571)
Balance as of December 31, 2021	$ 3,237

Summary of Significant Accounting Policies - Schedule of Rollforward of Sales Return Liability (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Revenue Recognition [Abstract]
Beginning balance	$ 9,192	$ 8,116
Addition to reserve for sales activity	158,245	118,508
Actual returns	(152,773)	(117,407)
Change in estimate of sales returns	(1,265)	(25)
Ending balance	$ 13,399	$ 9,192

Summary of Significant Accounting Policies - Schedule of Net Loss Per Share, Basic and Diluted (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Accounting Policies [Abstract]
Loss from continuing operations	$ (62,519)	$ (67,112)	$ (58,087)
Income (loss) from discontinued operations, net of income taxes	37	(22,835)	(48,731)
Net loss	$ (62,482)	$ (89,947)	$ (106,818)
Weighted Average Number of Shares Outstanding, Basic and Diluted	57,057,107	50,233,175	40,654,272
Earnings Per Share, Basic and Diluted [Abstract]
Continuing operations	$ (1.10)	$ (1.34)	$ (1.43)
Discontinued operations	0.00	(0.45)	(1.20)
Basic and diluted net loss per share	$ (1.10)	$ (1.79)	$ (2.63)

- Definition

Amount after tax of income (loss) from continuing operations attributable to the parent.

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- Definition

Amount after tax of income (loss) from a discontinued operation attributable to the parent. Includes, but is not limited to, the income (loss) from operations during the phase-out period, gain (loss) on disposal, gain (loss) for reversal of write-down (write-down) to fair value, less cost to sell, and adjustments to a prior period gain (loss) on disposal.

+ References + Details

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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+ Details

Summary of Significant Accounting Policies - Schedule of Potentially Dilutive Securities Excluded from Computation of Diluted Net Loss Per Share Attributable to Common Stockholders (Details) - shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Potentially dilutive securities
Potentially dilutive securities	18,040,640	14,135,922	2,564,546
Stock issuable upon conversion of convertible note
Potentially dilutive securities
Potentially dilutive securities	14,634,146	11,991,870
Stock options to purchase common stock
Potentially dilutive securities
Potentially dilutive securities	1,616,891	1,008,598	1,390,115
Unvested RSUs
Potentially dilutive securities
Potentially dilutive securities	1,789,603	1,135,454	1,174,431

Discontinued Operations (Details) - USD ($)		1 Months Ended	7 Months Ended	12 Months Ended
Discontinued Operations (Details) - USD ($)	Jun. 10, 2021	Oct. 31, 2021	Dec. 31, 2021	Dec. 31, 2021	Dec. 31, 2020
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Receivable			$ 33,105,000	$ 33,105,000	$ 19,771,000
Accounts payable			7,402,000	$ 7,402,000	$ 5,799,000
Transition Services Agreement
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Post-closing services period				6 months
TSA fees and cost reimbursements in operating expenses from continuing operations				$ 200,000
Payments relating to the TSA services				300,000
Receivable relating to TSA services			2,300,000
Remittance relating to TSA services			2,300,000
Accounts payable			0	$ 0
Sublease Agreement
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sublease term initial period				6 months
Additional sublease term				6 months
First option period				24 months
Subsequent option period				24 months
Sublease Agreement \| General and Administrative Expenses
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Sublease income				$ 500,000
Other Current Assets \| Transition Services Agreement
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Receivable			$ 100,000	$ 100,000
miraDry
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sale of assets	$ 10,000,000.0
Net upfront cash proceeds	$ 11,300,000
Loss on sale of businesses		$ 2,500,000
Payment for post close changes in net asset value		$ 3,200,000

Discontinued Operations - Summary of Aggregate Carrying Amounts of Major Classes of Assets and Liabilities of Discontinued Operations (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Assets of discontinued operations:
Accounts receivable, net		$ 3,732
Inventories, net		9,480
Prepaid expenses and other current assets	$ 4	263
Current assets of discontinued operations	4	13,475
Property and equipment, net		805
Total assets of discontinued operations	4	14,280
Liabilities of discontinued operations:
Accounts payable	6	704
Accrued and other current liabilities	494	3,982
Total liabilities of discontinued operations	$ 500	$ 4,686

Discontinued Operations - Summary of Information Regarding the Results of Discontinued Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Discontinued Operation, Income (Loss) from Discontinued Operation Disclosures [Abstract]
Net sales	$ 9,347	$ 16,244	$ 37,337
Cost of goods sold	4,805	8,703	16,659
Gross profit	4,542	7,541	20,678
Operating expenses	1,940	30,440	69,355
Income (loss) from operations of discontinued operations	2,602	(22,899)	(48,677)
Other income (expense), net	(77)	64	(54)
Income (loss) from discontinued operations before income taxes	2,525	(22,835)	(48,731)
Loss on sale of discontinued operations before income taxes	(2,488)
Total income (loss) from discontinued operations before income taxes	37	(22,835)	(48,731)
Income (loss) from discontinued operations, net of income taxes	$ 37	$ (22,835)	$ (48,731)

Acquisitions (Details) - USD ($)	Nov. 07, 2023	Dec. 31, 2021	Dec. 31, 2022
Vesta Intermediate Funding, Inc \| Scenario Forecast \| First Milestone Price Target
Business Acquisition [Line Items]
Number of days within which additional shares will be issued	5 days
Vesta Intermediate Funding, Inc \| Scenario Forecast \| Second Milestone Price Target
Business Acquisition [Line Items]
Number of days within which additional shares will be issued	5 days
AuraGen Aesthetics LLC
Business Acquisition [Line Items]
Asset purchase agreement date		Dec. 31, 2021
Payment to acquire business		$ 1,000,000
Fair value of deferred cash consideration		2,400,000
Fair value of contingent consideration		$ 2,600,000
Fair value measurement discount rate		20.00%
Stock issued during period, shares		3,930,655
AuraGen Aesthetics LLC \| Maximum
Business Acquisition [Line Items]
Contingent consideration liability		$ 8,500,000
AuraGen Aesthetics LLC \| Scenario Forecast
Business Acquisition [Line Items]
Contingent consideration liability			$ 3,000,000

Acquisitions - Schedule of Aggregate Preliminary Acquisition Date Fair Value of Consideration Transferred (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($)
Asset Acquisition [Line Items]
Cash payment made on closing date	$ 1,000
AuraGen Aesthetics LLC
Asset Acquisition [Line Items]
Cash payment made on closing date	1,000
Direct transaction costs	213
Equity issued on closing date	14,426
Fair value of deferred cash consideration	2,400
Fair value of contingent consideration	2,615
Total purchase consideration	$ 20,654

Acquisitions - Schedule of Allocation of the Fair Value of the Consideration Transferred by Major Class (Details) - AuraGen Aesthetics LLC $ in Thousands	Dec. 31, 2021 USD ($)
Asset Acquisition [Line Items]
Inventories	$ 54
Developed technology	20,600
Net assets acquired	$ 20,654

Acquisitions - Schedule of Intangible Asset Acquired Estimated Useful Life and Amortization Method (Details) - Developed technology $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($)
Asset Acquisition [Line Items]
Amount	$ 20,600
Estimated useful life	8 years
Amortization method	Straight line

Balance Sheet Components (Inventories) (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Inventory [Line Items]
Raw materials	$ 2,109	$ 3,788
Work in progress	4,796	10,710
Finished goods	41,982	21,254
Finished goods - right of return	4,027	3,416
Inventory, net	52,914	39,168
Inventory held on consignment at doctors' offices, clinics, and hospitals	$ 8,000	$ 5,700

Balance Sheet Components (PPE) (Details) - USD ($)	12 Months Ended
Balance Sheet Components (PPE) (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Property Plant And Equipment [Line Items]
Property and equipment, gross	$ 22,249,000	$ 17,624,000
Less accumulated depreciation	(8,251,000)	(5,323,000)
Property and equipment, net	13,998,000	12,301,000
Depreciation expense	3,100,000	2,000,000.0	$ 800,000
Impairments	0	0	$ 0
Leasehold improvements
Property Plant And Equipment [Line Items]
Property and equipment, gross	2,734,000	2,523,000
Manufacturing equipment and tooling
Property Plant And Equipment [Line Items]
Property and equipment, gross	9,922,000	8,529,000
Computer equipment
Property Plant And Equipment [Line Items]
Property and equipment, gross	1,672,000	2,522,000
Software
Property Plant And Equipment [Line Items]
Property and equipment, gross	6,379,000	3,010,000
Furniture and fixtures
Property Plant And Equipment [Line Items]
Property and equipment, gross	$ 1,542,000	$ 1,040,000

Balance Sheet Components (Accrued liabilities) (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Accrued and other current liabilities
Payroll and related expenses	$ 5,188	$ 3,003
Accrued severance	248	2,900
Accrued commissions	4,329	4,734
Accrued manufacturing	121	225
Deferred and contingent consideration, current portion	2,431	10,146
Audit, consulting and legal fees	185	48
Accrued sales and marketing expenses	159	300
Lease liabilities	$ 1,666	$ 1,588
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Accrued and Other Current Liabilities	Accrued and Other Current Liabilities
Finance Lease, Liability, Current, Statement of Financial Position [Extensible List]	Accrued and Other Current Liabilities	Accrued and Other Current Liabilities
Other	$ 6,971	$ 5,464
Total	$ 21,298	$ 28,408

Balance Sheet Components - Schedule of rollforward of the accrued warranties (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Balance Sheet Related Disclosures [Abstract]
Beginning Balance	$ 1,934	$ 1,397
Warranty costs incurred during the period	(399)	(122)
Changes in accrual related to warranties issued during the period	933	589
Changes in accrual related to pre-existing warranties	37	70
Ending Balance	$ 2,505	$ 1,934

Balance Sheet Components (Accrued Warranties) (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Product Warranty Liability [Line Items]
Replacement implants and revision surgery financial assistance under limited warranty program	$ 2,505	$ 1,934	$ 1,397

Balance Sheet Components (Liabilities measured at fair value) (Details)	12 Months Ended
	Dec. 31, 2021
Measurement Input, Discount Rate \| BIOCORNEUM \| Future Royalty Payments
Fair Value Measurements
Fair value measurement discount rate	21.00%
Monte-Carlo Simulation Model \| Measurement Input, Volatility Rate
Fair Value Measurements
Fair value measurement, volatility rate	95.00%

Balance Sheet Components - Schedule of Company's Liabilities that are Measured at Fair Value on a Recurring Basis (Details) - Recurring - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Fair Value Measurements
Fair value liability	$ 3,114	$ 33,596
Contingent Consideration Liability
Fair Value Measurements
Fair value liability	3,114	7,026
Derivative Liability
Fair Value Measurements
Fair value liability		26,570
Level 3
Fair Value Measurements
Fair value liability	3,114	33,596
Level 3 \| Contingent Consideration Liability
Fair Value Measurements
Fair value liability	$ 3,114	7,026
Level 3 \| Derivative Liability
Fair Value Measurements
Fair value liability		$ 26,570

Balance Sheet Components - Schedule of Aggregate Fair Values of Company's Liabilities for which Fair Value is Determined by Level 3 Inputs (Details) - Level 3 - Fair Value, Recurring $ in Thousands	12 Months Ended
	Dec. 31, 2021 USD ($)
Contingent Consideration Liability
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Balance at beginning of the period	$ 7,026
Additions	2,615
Change in fair value	442
Settlements	6,969
Balance at the end of the period	3,114
Derivative Liability
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Balance at beginning of the period	26,570
Change in fair value	14,460
Reclassification to equity	$ 41,030

Goodwill and Other Intangible Assets, net (Details)	12 Months Ended
Goodwill and Other Intangible Assets, net (Details)	Dec. 31, 2021 USD ($) ReportingUnit	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Finite Lived Intangible Assets [Line Items]
Number of reporting units \| ReportingUnit	1
Goodwill impairment charge	$ 0	$ 0	$ 0
Other intangible assets
Amortization expense	1,200,000	$ 1,300,000	$ 900,000
Plastic Surgery
Finite Lived Intangible Assets [Line Items]
Goodwill impairment charge	0
Non-cash impairment charges	$ 0

Goodwill and Other Intangible Assets, net - Schedule of Changes in Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Goodwill and intangible assets
Goodwill	$ 9,202	$ 9,202
Plastic Surgery
Goodwill and intangible assets
Goodwill	$ 9,202	9,202	$ 23,480
Accumulated impairment losses		$ (14,278)

Goodwill and Other Intangible Assets, net - Components of Other Intangible Assets (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Other intangible assets
Gross Carrying Amount	$ 37,043	$ 16,443
Accumulated Amortization	(8,728)	(7,506)
Intangible Assets, net	28,315	8,937
Indefinite-lived intangible assets	450	450
Trade name
Other intangible assets
Indefinite-lived intangible assets	$ 450	$ 450
Customer relationships
Other intangible assets
Average Amortization Period	10 years	10 years
Gross Carrying Amount	$ 4,940	$ 4,940
Accumulated Amortization	(4,224)	(3,856)
Intangible Assets, net	$ 716	$ 1,084
Trade Names - Finite Life
Other intangible assets
Average Amortization Period	12 years	12 years
Gross Carrying Amount	$ 800	$ 800
Accumulated Amortization	(389)	(322)
Intangible Assets, net	$ 411	$ 478
Manufacturing know-how
Other intangible assets
Average Amortization Period	19 years	19 years
Gross Carrying Amount	$ 8,240	$ 8,240
Accumulated Amortization	(1,652)	(865)
Intangible Assets, net	$ 6,588	$ 7,375
Developed technology
Other intangible assets
Average Amortization Period	8 years
Gross Carrying Amount	$ 20,600
Intangible Assets, net	$ 20,600

Goodwill and Other Intangible Assets, net - Schedule of Estimated Amortization Expense (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Estimated amortization expense
2022	$ 3,738
2023	3,667
2024	3,523
2025	3,380
2026	3,206
Thereafter	10,801
Total amortization	$ 28,315

Leases - Components of Lease Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Lessee Lease Description [Line Items]
Total operating lease cost	$ 1,400	$ 2,186	$ 5,756
Finance lease cost
Total finance lease cost	62	87	45
Total lease cost	1,462	2,273	16,369
Inventory
Lessee Lease Description [Line Items]
Total operating lease cost	276	488	4,206
Finance lease cost
Amortization of right-of-use assets	19	36
Variable lease cost			10,568
Operating Expenses
Lessee Lease Description [Line Items]
Total operating lease cost	1,644	1,698	1,550
Sublease Income	(520)
Finance lease cost
Amortization of right-of-use assets	35	41	41
Other Income (Expense), Net
Finance lease cost
Interest on lease liabilities	$ 8	$ 10	$ 4

Leases - Supplemental Cash Flow Information Related to Operating and Finance Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases	$ 1,716	$ 1,758	$ 5,419
Operating cash outflows from finance leases	69	85	44
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$ 965	1,242	8,667
Finance leases		$ 157	$ 117

Leases - Supplemental Balance Sheet Information Related to Operating and Finance Leases (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Assets and Liabilities, Lessee [Abstract]
Operating lease right-of-use assets	$ 6,488	$ 7,176
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	us-gaap:OtherAssets	us-gaap:OtherAssets
Finance lease right-of-use assets	$ 77	$ 158
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	us-gaap:OtherAssets	us-gaap:OtherAssets
Total right-of use assets	$ 6,565	$ 7,334
Operating lease liabilities	$ 1,595	$ 1,504
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Accrued and Other Current Liabilities	Accrued and Other Current Liabilities
Finance lease liabilities	$ 71	$ 84
Finance Lease, Liability, Current, Statement of Financial Position [Extensible List]	Accrued and Other Current Liabilities	Accrued and Other Current Liabilities
Operating lease liabilities	$ 5,576	$ 5,946
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Warranty Reserve and Other Long-term Liabilities	Warranty Reserve and Other Long-term Liabilities
Finance lease liabilities	$ 28	$ 77
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Warranty Reserve and Other Long-term Liabilities	Warranty Reserve and Other Long-term Liabilities
Total lease liabilities	$ 7,270	$ 7,611
Weighted average remaining lease term (years)
Operating leases	4 years	5 years
Finance leases	2 years	2 years
Weighted average discount rate
Operating leases	8.16%	7.75%
Finance leases	6.90%	6.15%

Leases - Maturities of Operating and Finance Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Operating Lease Liabilities, Payments Due [Abstract]
Operating leases, 2022	$ 2,184
Operating leases, 2023	2,269
Operating leases, 2024	1,818
Operating leases, 2025	898
Operating leases, 2026	852
Operating leases, 2027	586
Total operating lease payments	8,607
Less imputed interest, Operating leases	1,436
Total operating lease liabilities	7,171
Finance Lease Liabilities, Payments, Due [Abstract]
Finance leases, 2022	63
Finance leases, 2023	38
Finance leases, 2024	3
Total finance lease payments	104
Less imputed interest, Finance leases	5
Total finance lease liabilities	99
Lessee Lease Liability Payments Due [Abstract]
2022	2,247
2023	2,307
2024	1,821
2025	898
2026	852
2027	586
Total lease payments	8,711
Less imputed interest	1,441
Total lease liabilities	$ 7,270	$ 7,611

Debt (Details)								12 Months Ended
Debt (Details)	Feb. 05, 2021 USD ($) Tranche	May 11, 2020 USD ($)	Apr. 20, 2020 USD ($)	Mar. 11, 2020 USD ($) $ / shares	Nov. 07, 2019	Jul. 01, 2019 USD ($)	Jul. 25, 2017	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Jul. 01, 2022 USD ($)	Sep. 28, 2021 USD ($) $ / shares	Jul. 01, 2021 USD ($)	Jul. 01, 2020	May 10, 2020 USD ($)
Line Of Credit Facility [Line Items]
Term loan credit and security agreement entered date							Jul. 25, 2017
Borrowing base of finished goods inventory (as a percent)						40.00%
Borrowing base availability from finished goods inventory (as a percent)						20.00%
Additional interest (as a percent)							5.00%
Amortization of debt issuance costs and discounts								$ 3,587,000	$ 4,347,000	$ 359,000
Gain on extinguishment of PPP loan								$ 6,652,000
Paycheck Protection Program
Line Of Credit Facility [Line Items]
Debt maturity date			Apr. 20, 2022
Debt instrument interest rate			1.00%
Debt instrument principal			$ 6,700,000
Debt instrument, payment terms								Company made no payments until the date which forgiveness of the PPP Loan is determined, which can be up to 10 months following the end of the covered period (which is defined as 24 weeks from the date of the loan), or the Deferral Period. Commencing one month after the expiration of the Deferral Period, and continuing on the same day of each month until the Maturity Date, the Company would have paid to Lender monthly payments of principal and interest, in an amount required to fully amortize the principal amount outstanding on the PPP Loan on the last day of the Deferral Period by the Maturity Date.
Gain on extinguishment of PPP loan								$ 6,700,000
Convertible Note
Line Of Credit Facility [Line Items]
Carrying Value								47,477,000	44,436,000
Term Loan Credit and Security Agreement and Revolving Loan Credit and Security Agreement
Line Of Credit Facility [Line Items]
Agreements amended and restated date						Jul. 01, 2019
Restated Term Loan Agreement
Line Of Credit Facility [Line Items]
Agreements amended date					Nov. 07, 2019
Line of credit facility, remaining borrowing capacity	$ 15,000,000					$ 35,000,000			10,000,000.0
Debt maturity date						Jul. 01, 2024
Exit fee percentage to aggregate amount of all term loans funded						5.00%
Periodic commitment amount	$ 1,000,000	$ 15,000,000
Unfunded tranche revised number \| Tranche	2
Debt instrument amendment fee	$ 750,000
Loan amount outstanding								16,000,000.0
Unamortized debt issuance costs								1,000,000.0
Restated Term Loan Agreement \| Tranche 4
Line Of Credit Facility [Line Items]
Periodic commitment amount													$ 5,000,000
Restated Term Loan Agreement \| Tranche 5 \| Scenario Forecast
Line Of Credit Facility [Line Items]
Periodic commitment amount											$ 5,000,000
Restated Term Loan Agreement \| London Interbank Offered Rate (LIBOR)
Line Of Credit Facility [Line Items]
Spread on variable rate basis (as a percent)						7.50%
Additional Term Loan
Line Of Credit Facility [Line Items]
Line of credit facility, remaining borrowing capacity						$ 5,000,000			15,000,000.0
Minimum revenue required to satisfy additional term loan facility						$ 100,000,000.0
Term Amendment
Line Of Credit Facility [Line Items]
Prepaid principal amount		25,000,000.0
Accrued interest prepaid		100,000
Prepaid exit fee		1,250,000
Minimum unrestricted cash amount		5,000,000.0													$ 20,000,000.0
Term Amendment \| Tranche 3
Line Of Credit Facility [Line Items]
Minimum revenue required to satisfy additional term loan facility		30,000,000.0
Periodic commitment amount		$ 15,000,000.0													$ 10,000,000.0
Revolving Loan
Line Of Credit Facility [Line Items]
Amount available under revolving loan								0
Debt maturity date						Jul. 01, 2024
Loan amount outstanding								2,200,000
Borrowing base of accounts receivable (as a percent)						85.00%
Revolving Loan \| Maximum
Line Of Credit Facility [Line Items]
Loan amount outstanding						$ 10,000,000.0
Revolving Loan \| Other Assets
Line Of Credit Facility [Line Items]
Unamortized debt issuance costs								46,000
Revolving Loan \| London Interbank Offered Rate (LIBOR)
Line Of Credit Facility [Line Items]
Spread on variable rate basis (as a percent)						4.50%
Term Loan and Revolving Loan
Line Of Credit Facility [Line Items]
Amortization of debt issuance costs								$ 500,000	900,000	$ 400,000
Deerfield Facility Agreement
Line Of Credit Facility [Line Items]
Derivative liability fair value												$ 41,000,000.0
Deerfield Facility Agreement \| Convertible Note
Line Of Credit Facility [Line Items]
Term loan credit and security agreement entered date				Mar. 11, 2020
Debt maturity date				Mar. 11, 2025
Carrying Value				$ 60,000,000.0
Debt instrument interest rate				4.00%				12.00%						4.00%
Debt instrument conversion rate per principal amount				14,634
Debt instrument principal amount per conversion unit				$ 1,000
Debt instrument conversion price \| $ / shares				$ 4.10
Debt instrument principal				$ 60,000,000.0
Minimum percentage of number of shares of common stock owned by conversion of debt instrument				4.985%
Minimum percentage of change in ownership percentage entitling lender to demand repayment of all outstanding debt				50.00%
Debt instrument, call feature								Deerfield has the option to demand repayment of all outstanding principal, and any unpaid interest accrued thereon, in connection with a Major Transaction (as defined in the Convertible Note), which shall include, among others, any acquisition or other change of control of the Company; the sale or transfer of assets of the Company equal to more than 50% of the Enterprise Value (as defined in the Convertible Note) of the Company; a liquidation, bankruptcy or other dissolution of the Company; or if at any time shares of the Company’s common stock are not listed on an Eligible Market (as defined in the Convertible Note). The Convertible Note is subject to specified events of default, the occurrence of which would entitle Deerfield to immediately demand repayment of all outstanding principal and accrued interest on the Convertible Note. Such events of default include, among others, failure to make any payment under the Convertible Note when due, failure to observe or perform any covenant under the Deerfield Facility Agreement or the other transaction documents related thereto (subject to a standard cure period), the failure of the Company to be able to pay debts as they come due, the commencement of bankruptcy or insolvency proceedings against the Company, a material judgement levied against the Company and a material default by the Company under the Convertible Note.
Unamortized debt discount and issuance costs								$ 12,500,000
Amortization of debt issuance costs and discounts								$ 3,000,000.0	$ 2,200,000
Deerfield Facility Agreement \| Maximum
Line Of Credit Facility [Line Items]
Share price \| $ / shares												$ 1.50
Deerfield Facility Agreement \| Minimum
Line Of Credit Facility [Line Items]
Share price \| $ / shares												$ 30.00

Debt (Schedule of Future Principal and Exit Fee Payments of Outstanding Debt) (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Debt Disclosure [Abstract]
2023	$ 10,667
2024	5,333
2025	60,000
Total	$ 76,000

- Definition

Amount, after unamortized (discount) premium and debt issuance costs, of long-term debt. Includes, but not limited to, notes payable, bonds payable, debentures, mortgage loans and commercial paper. Excludes capital lease obligations.

+ References + Details

Income Taxes - Schedule of Provision for Income Tax (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Federal	$ 11	$ 12	$ 9
State	10	10	9
Foreign		11	16
Income tax (benefit) expense	$ 21	$ 33	$ 34

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes (Details) - USD ($)	12 Months Ended
Income Taxes (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Statutory federal income tax rate
Statutory federal income tax rate (as a percent)	21.00%	21.00%	21.00%
Deferred tax assets:
Valuation allowance against deferred tax assets	$ 137,700,000	$ 131,309,000
Tax Credit Carryforwards
Unrecognized tax benefits	619,000	$ 619,000	$ 1,116,000
Unrecognized Tax Benefits Penalties and Interest
Interest expense or penalties related to unrecognized tax benefits	0
Research and development
Tax Credit Carryforwards
Unrecognized tax benefits	600,000
Federal
Deferred tax assets:
Net operating loss carryforwards	483,100,000
Federal \| Tax Year 2027
Deferred tax assets:
Net operating loss carryforwards	$ 9,800,000
Net operating loss carryforwards, expiration year	2027
Federal \| Minimum
Income Tax Uncertainties [Abstract]
Tax years	2018
Federal \| Maximum
Income Tax Uncertainties [Abstract]
Tax years	2020
Federal \| Research and development
Tax Credit Carryforwards
Tax credit carryforwards	$ 30,000
Tax credit carryforwards, expiration year	2029
State
Deferred tax assets:
Net operating loss carryforwards	$ 330,100,000
State \| Tax Year 2017
Deferred tax assets:
Net operating loss carryforwards	$ 8,300,000
Net operating loss carryforwards, expiration year	2017
State \| Minimum
Income Tax Uncertainties [Abstract]
Tax years	2017
State \| Maximum
Income Tax Uncertainties [Abstract]
Tax years	2020
State \| Research and development
Tax Credit Carryforwards
Tax credit carryforwards	$ 2,700,000

Income Taxes - Schedule of Reconciliation of Actual Income Tax Expense Obtained by Applying Statutory Federal Income Tax Rate (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Reconciliation of actual income tax expense obtained by applying the statutory federal income tax rate
Tax at federal statutory rate	$ (13,124)	$ (18,882)	$ (22,424)
State, net of federal benefit	(770)	(2,372)	(2,109)
PPP loan forgiveness	(1,397)
Permanent items	606	2,282	857
Benefit state rate change	(184)	20	337
Other	8,499	2,984	368
Goodwill impairment			1,602
Change in valuation allowance	6,391	16,001	21,403
Income tax (benefit) expense	$ 21	$ 33	$ 34

Income Taxes - Schedule of Tax Effects of Temporary Differences and Carryforwards that Give Rise to Significant Portions of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred tax assets and liabilities
Net operating loss carryforwards	$ 122,570	$ 113,374
Research and development credits	2,121	2,121
Lease liabilities	1,798	1,861
Derivative liability		6,495
Accruals and reserves	14,961	10,175
Intangibles	1,732	3,053
Gross deferred tax assets	143,182	137,079
Less valuation allowance	(137,700)	(131,309)
Total deferred tax assets	5,482	5,770
Depreciation	(717)	(276)
Convertible debt discount	(2,800)	(3,440)
Right-of-use assets	(1,624)	(1,793)
Intangibles - deferred tax liability	(434)	(333)
Total deferred tax liabilities	(5,575)	(5,842)
Net deferred taxes	$ (93)	$ (72)

Income Taxes - Schedule of Reconciliation of Beginning and Ending Amount of Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Reconciliation of the beginning and ending amount of unrecognized tax benefits
Balance at beginning of the period	$ 619	$ 1,116
Additions based on tax positions taken in the current year	0	10
Decreases based on tax positions taken in the prior year		(507)
Balance at end of the period	$ 619	$ 619

Employee Benefit Plans (Details) - USD ($) $ in Millions	12 Months Ended
Employee Benefit Plans (Details) - USD ($) $ in Millions	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Retirement Benefits [Abstract]
Company contribution (as a percent)	3.00%
Company contribution	$ 0.6	$ 0.5	$ 0.7

Stockholders' Equity (Details) - $ / shares	Dec. 31, 2021	Dec. 31, 2020
Stock other disclosures
Common and preferred stock, shares authorized	210,000,000
Common stock, shares authorized	200,000,000	200,000,000
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0

Stockholders' Equity (Options) (Details) - USD ($)	12 Months Ended
Stockholders' Equity (Options) (Details) - USD ($)	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Nov. 03, 2014	Apr. 30, 2007
Stock options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Balance at the end of the period (in shares)	1,703,963	1,959,501	1,880,846
Number of options
Balance at the beginning of period (in shares)	1,959,501	1,880,846
Options granted (in shares)	0	600,000	0
Options exercised (in shares)	(72,726)	(9,817)
Options forfeited (in shares)	(182,812)	(511,528)
Balance at the end of the period (in shares)	1,703,963	1,959,501	1,880,846
Number of options vested and expected to vest (in shares)	1,703,963
Number of options vested and exercisable (in shares)	1,266,428
Weighted average exercise price
Balance at the beginning of period (in dollars per share)	$ 4.79	$ 7.42
Options granted (in dollars per share)		3.58
Options exercised (in dollars per share)	3.99	2.89
Options forfeited (in dollars per share)	5.49	8.87
Balance at the end of period (in dollars per share)	$ 4.75	$ 4.79	$ 7.42
Additional information
Weighted average remaining contractual term	5 years 4 months 28 days	5 years 11 months 1 day	5 years 5 months 23 days
Weighted average remaining contractual term, vested and exercisable	7 years 3 months 7 days
Options granted (in shares)	0	600,000	0
Weighted average grant date fair value (in dollars per share)		$ 3.58
Stock-based compensation expense	$ 500,000	$ 100,000	$ 600,000
Number of years from the date of grant for tax benefits	2 years
Number of years from the date of exercise for tax benefits	1 year
Unrecognized compensation costs (in dollars)	$ 1,500,000
Aggregate intrinsic value (in dollars)	$ 208,000	$ 14,000	$ 600,000
Stock Option
Assumptions used to estimate the fair value of stock options
Expected term (in years)		6 years 6 months
Expected volatility		82.65%
Risk-free interest rate		0.27%
2007 Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Common stock reserved for issuance (in shares)					1,690,448,000
Balance at the end of the period (in shares)	114,120,000
Number of shares available for future grants	0
Number of options
Balance at the end of the period (in shares)	114,120,000
2014 Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Common stock reserved for issuance (in shares)	8,717,856,000			1,027,500,000
Number of shares available for future grants	2,190,272,000
Inducement Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of shares available for future grants	606,112,000
Number of shares awarded	1,983,411,000
Grant period of stock awards	10 years
Number of additional years of requisite service period		3 years
Vesting period	1 year
Inducement Plan \| On the first anniversary
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting percentage	25.00%
Inducement Plan \| Minimum [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Purchase price of awards expressed as a percentage of fair value of shares on the date of grant	100.00%
Percentage of possible payouts of the target award	0.00%
Inducement Plan \| Minimum [Member] \| Individual options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting percentage	25.00%
Inducement Plan \| Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Percentage of possible payouts of the target award	100.00%
2007 Plan and 2014 Plan \| Stock options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Grant period of stock awards	10 years
2007 Plan and 2014 Plan \| Stock options \| Minimum [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Purchase price of awards expressed as a percentage of fair value of shares on the date of grant	100.00%
Percentage of voting power owned by shareholder	10.00%
2007 Plan and 2014 Plan \| Stock options \| Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Purchase price of awards expressed as a percentage of fair value of shares on the date of grant	110.00%

Stockholders' Equity (Restricted Stock) (Details) - Restricted stock units - 2014 Plan - USD ($) $ / shares in Units, $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Stockholders' Equity, other disclosures
Requisite service period, annually	3 years
Granted	$ 7.06	$ 4.77	$ 8.02
Stock-based compensation expense	$ 9.3	$ 7.5	$ 11.2
Unrecognized compensation costs (in dollars)	$ 9.8
Weighted average period over which unrecognized compensation costs are expected to be recognized	2 years 10 days
Number of shares
Balance at beginning of the period	3,093,790	2,232,956
Granted	1,636,969	3,070,430
Vested	(1,452,893)	(1,150,707)
Forfeited	(478,314)	(1,058,889)
Balance at end of the period	2,799,552	3,093,790	2,232,956
Weighted average grant date fair value
Balance at beginning of the period	$ 6.97	$ 11.99
Granted	7.06	4.77	$ 8.02
Vested	6.42	10.06
Forfeited	2.31	7.82
Balance at end of the period	$ 8.11	$ 6.97	$ 11.99

Stockholders' Equity (Stock Purchase) (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Oct. 31, 2014
Employee Stock Purchase Plan
Assumptions used to estimate the fair value of stock options
Expected volatility, minimum (as a percent)	64.00%	68.00%	69.00%
Expected volatility, maximum (as a percent)	101.00%	139.00%	77.00%	42.00%
Risk-free interest rate, minimum (as a percent)	0.06%	0.14%	1.87%
Risk-free interest rate, maximum (as a percent)	0.20%	1.57%	2.06%	3.03%
Employee Stock Purchase Plan \| Minimum
Assumptions used to estimate the fair value of stock options
Expected term (in years)	6 months	6 months	6 months
Employee Stock Purchase Plan \| Maximum
Assumptions used to estimate the fair value of stock options
Expected term (in years)	2 years	2 years	2 years
2014 Employee Stock Purchase Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Purchase period of offering	6 months
Rate of purchase price of stock on fair value (as a percent)	85.00%
Number of shares reserved for future issuance	2,252,652
Rate of increase in the number of shares available for grant every year on outstanding common stock (as a percent)	1.00%
Number of shares available for future grants	1,253,615
Purchases under the award	199,071	203,728
Weighted Average purchase price	$ 3.38	$ 4.11
Stock-based compensation expense	$ 600,000	$ 600,000	$ 800,000
Incremental compensation cost	$ 0	$ 0	$ 0
2014 Employee Stock Purchase Plan \| Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Discount rate on the value of shares through payroll deductions (as a percent)	15.00%
Expiration period of each offering	27 months
Number of shares reserved for future issuance					255,500
Number of shares available for future grants	3,000,000

Segment Reporting and Geographic Information (Details)	12 Months Ended
Segment Reporting and Geographic Information (Details)	Dec. 31, 2021 Segment
Segment Reporting [Abstract]
Number of reportable segments	1

Segment Reporting and Geographic Information - Summary of Net Sales by Geographical Regions (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Segment Reporting Information [Line Items]
Net sales	$ 80,683	$ 54,997	$ 46,363
North America
Segment Reporting Information [Line Items]
Net sales	79,037	53,284	46,295
International
Segment Reporting Information [Line Items]
Net sales	$ 1,646	$ 1,713	$ 68

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 2: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130545-203045

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Subsequent Events (Details) - Additional Term Loan [Member] - USD ($)	Mar. 30, 2022	Dec. 31, 2020	Jul. 01, 2019
Subsequent Event [Line Items]
Line of credit facility, remaining borrowing capacity		$ 15,000,000.0	$ 5,000,000
Subsequent Event [Member]
Subsequent Event [Line Items]
Increased prepayment fee	0.50%
Subsequent Event [Member] \| Tranche Four [Member]
Subsequent Event [Line Items]
Line of credit facility, remaining borrowing capacity	$ 5,000,000
Subsequent Event [Member] \| Tranche Six [Member]
Subsequent Event [Line Items]
Line of credit facility, remaining borrowing capacity	$ 9,000,000