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Roberto de Mezerville Chief Technology Officer INVESTOR DAY - COSTA RICA | JUNE 18TH | RDI

Since 2004 - Motiva Evolution Company confidential. Proprietary information. Do not distribute.

Motiva Implants® focus on customer needs – the Patient Aesthetics issues - reoperation Clinical issues - reoperation EXCESSIVE LACK OF MALPOSITION & RUPTURE CAPSULAR FIRMNESS DYNAMICS ROTATION CONTRACTION Safety through Innovation Company confidential. Proprietary information. Do not distribute.

Capsular Contracture Implant Placement Immune Response Bacteria Colonization Surface & & Biofilm Particles Filling material Surgical Techniques (diffusion) Company confidential. Proprietary information. Do not distribute.

Design Thinking Ergonomy Concept Company confidential. Proprietary information. Do not distribute.

2010 – First product launched 100% filled Company confidential. Proprietary information. Do not distribute. MIT – Robert Langer Lab images from rabbit model pilot testing

Company confidential. Proprietary information. Do not distribute.

TrueMonobloc® UNIFORM SHELL THICKNESS Company confidential. Proprietary information. Do not distribute.

Motiva Implants® focus on customer needs – the Patient CAPSULAR CONTRACTION Company confidential. Proprietary information. Do not distribute.

Traditional “Smooth” surface is not really smooth Difficult to control, Silicone flow and air drying creates waves and irregularities Source: Barr, S. Hill, E., and Bayat, A. Current Implant Surface Technology: An Examination of Their Nanosurface and their influence on Fibroblast Alignment and Biocompatibility, Eplasty. 2009; 9: e22. Company confidential. Proprietary information. Do not distribute. Illustrative image by Establishment Labs

Traditional Breast Implants Surfaces Manufacturing Secondary processes to add texturing Company confidential. Proprietary information. Do not distribute. Illustrative image by Establishment Labs

Micro & Macro - Surfaces commercially available breast implants Internal Study - Establishment Labs property, Salt-loss process Company confidential. Proprietary information. Do not distribute.

2010 - SmoothSilk®/SilkSurface® Company confidential. Proprietary information. Do not distribute.

Learning from other areas the immune cascade response Surface optimization had improved the biocompatibility and longevity of medical implants BONE-ANCHORED IMPLANTS VASCULAR GRAFTS Company confidential. Proprietary information. Do not distribute.

Science based - SmoothSilk®/SilkSurface® Company confidential. Proprietary information. Do not distribute.

Motiva® way - controlled surfaces – SmoothSilk®/SilkSurface® Company confidential. Proprietary information. Do not distribute. Illustrative image by Establishment Labs

Motiva® Controlled Surface Process Company confidential. Proprietary information. Do not distribute. Illustrative image by Establishment Labs

Biocompatibility Risk Assessment – Shell & Filling Gel Patient Benefits Biocompatibility Testing: Regulatory Requirements - Leachable characterization - Cytotoxicity - ISO 10993 - Sensitization - ISO 14971 - Irritation or intracutaneous reactivity - EU Directive 93/42/EEC - Acute systemic toxicity - Subacute toxicity - Brazil ANBT NBR ISO - Genotoxicity 14949:2011 - Implantation Biocompatibility - US FDA General Guidance - Biodegradation - Carcinogenicity 2016 - Immunocitoxicity - US FDA Guidance for - Chronic toxicity Industry and Staff - Reproductive/developmental toxicity Biocompatibility - Toxicokinetics Risk Assessment of - Other organ-specific toxicity Motiva Implants® Activators / Drivers High Freq Low Risk Surface Characterization - Roughness - Less Capsular - Kurtosis Contracture Risk Patient-Focused - Skewness - Density of peaks Low Freq High Risk Risk Assessment of - Hydrophobicity - Lower inflammation Motiva Implants® - Friction coefficient - Historical absence of Surface Area Surfaces -Biofilm contamination Double Capsule/Late Particles Seroma -Debris - Historical absence of BIA- -Gel Bleed -Process / Environment ALCL Company confidential. Proprietary information. Do not distribute.

2010 - SmoothSilk®/SilkSurface® SmoothSilk® Barr, S., Hill, E., & Bayat, A. (2010). Patterning of novel breast implant surfaces by enhancing silicone biocompatibility, using biomimetic topographies. Eplasty, 10, e31. Company confidential. Proprietary information. Do not distribute.

2012 – BluSeal® Company confidential. Proprietary information. Do not distribute.

2012 – ProgressiveGel® PLUS Company confidential. Proprietary information. Do not distribute.

2012 – ProgressiveGel® PLUS - Rheology: Visco-Elasticity ProgressiveGel® ProgressiveGelPLUS® Maintains upper-pole fullness A more natural look and feel Company confidential. Proprietary information. Do not distribute.

Since 2014 – Ergonomix® Company confidential. Proprietary information. Do not distribute.

Company confidential. Proprietary information. Do not distribute.

Company confidential. Proprietary information. Do not distribute.

2014 – ProgressiveGel ULTIMA® Rheology: Visco-Elasticity Gravity sensitive ProgressiveGel® ProgressiveGel PLUS® Ergonomix® ProgressiveGel ULTIMA® Maintains upper-pole fullness A more natural look and feel The most natural look and feel Company confidential. Proprietary information. Do not distribute.

Motiva Implants® Rheology & Morphology Shell & Filling gel interaction Company confidential. Proprietary information. Do not distribute.

Biomechanical Tissue Characterization (BTC-2000™) Rheological map in breast implant filling gel Company confidential. Proprietary information. Do not distribute.

Breast Implants Rheology Map Company confidential. Proprietary information. Do not distribute.

2014 – Qid® Safety Technology UNIQUE SERIAL TEMPERATURE OTHER IDENTIFICATION NUMBER BIOSENSING PARAMETERS Company confidential. Proprietary information. Do not distribute.

Motiva® Evolution continues… - 2016 MotivaImagine® South Korea MFDS and Australia TGA approval - 2017 MotivaHybrid® MDSAP Quality Certification Brazil ANVISA/INMETRO approval US FDA IDE submission -2018 USA FDA Clinical Trial Started Aesthetics cohorts completed March 2019 Company confidential. Proprietary information. Do not distribute.

Company confidential. Proprietary information. Do not distribute.

THE SCIENCE OF THE BREAST MANAGEMENT The Scientific Evidence Company confidential. Proprietary information. Do not distribute.

Research Fields on Breast Implant Surfaces Topographies Breast Implants Surface Characterization and Biocompatibility • In vivo testing • In vitro testing • Immune response • Immunocytochemistry Inmune response Surface Characterization Biofilm Tribology • Bacteria attachment • Friction coefficient • Biofilm formation • Wear particles Company confidential. Proprietary information. Do not distribute.

Research Developed in Collaboration with ESTA Company confidential. Proprietary information. Do not distribute.

Activator: Surface Characteristics Resulting of Manufacturing Process Traditional Smooth “Foam imprint” surface Salt-loss surface SmoothSilk®/SilkSurface® VelvetSurface® SEM images of different textures available in the market, at a scale of 500 µm and 100X magnification. Images Property of Establishment Labs (2017). From CIEMIC, University of Costa Rica. Company confidential. Proprietary information. Do not distribute.

Activator: Surface Characteristics Resulting of Manufacturing Process Traditional Smooth SmoothSilk®/SilkSurface® VelvetSurface® “PU foam imprint” “Salt-loss” texture Company confidential. Proprietary information. Do not distribute.

SmoothSilk®/SilkSurface® has more peaks than valleys Peaks that function as contact points for cells attachment during the immune response Negative Skewness: Means more valleys than peaks Positive Skewness: Means more peaks than valleys Company confidential. Proprietary information. Do not distribute. Skewness parameter comparison of different breast implants available in the market, measured with uSurf Mobile non-contact profilometer. Results Property of Establishment Labs (2017).

Size comparison of a fibroblast on the surface Representation of how a fibroblast may look on a breast implant surface at the same magnification, considering the standardized fibroblast size of 25 µm used by Dalby et al. (2004). Company confidential. Proprietary information. Do not distribute. Dalby MJ, Riehle MO, Johnstone H, Affrossman S, Curtis ASG. Investigating the limits of filopodial sensing: a brief report using SEM to image the interaction between 10 nm high nano-topography and fibroblast filopodia. Cell Biol Int. 2004;28(3):229–36.

Optimization of Surfaces biocompatibility Fibroblasts & Macrophages Attachment - Experimental Results Company confidential. Proprietary information. Do not distribute. SEM images of fibroblasts (obtained from breast tissue) and macrophages (from THP-1 monocytes cell line, ATCC) growing on different silicone surfaces from University of Manchester.

Cytokines expression for SmoothSilk®/SilkSurface® at 12 hours & 24 hours Company confidential. Proprietary information. Do not distribute.

Cappellano G. et al; Immunophenotypic characterization – 7 BI surfaces Company confidential. Proprietary information. Do not distribute.

Evaluation of miniature breast implants surfaces on fibrosis animal model (C57BL/6 pro-fibrotic rodent strain) Research performed at the Robert Langer Laboratory at MIT, Boston , USA Veiseh, O. Next Generation Biomaterials Design for Chronic Implants. 5 Oct 2018. 4th World Symposium on Ergonomic Implants, Lago di Garda. Company confidential. Proprietary information. Do not distribute.

6 Months Explanted miniature implants with tissue overgrowth Control: Traditional Smooth Breast Implant Surface SmoothSilk®/SilkSurface® Breast Implant Surface Company confidential. Proprietary information. Do not distribute. Veiseh, O. Next Generation Biomaterials Design for Chronic Implants. 5 Oct 2018. 4th World Symposium on Ergonomic Implants, Lago di Garda.

Low inflammation response at different timepoints Control SmoothSilk®/SilkSurface® Less macrophages presence with SilkSurface® SmoothSilk® / SilkSurface® decreases fibrosis-dependent innate immune macrophages Veiseh, O. Next Generation Biomaterials Design for Chronic Implants. 5 Oct 2018. 4th World Symposium on Ergonomic Implants, Lago di Garda. Company confidential. Proprietary information. Do not distribute. Research performed at the Robert Langer Laboratory at MIT, Boston , USA

Full-size Human-scale Implants testing in Higher Order Rabbit Model 3-week retrievals Veiseh, O. Next Generation Biomaterials Design for Chronic Implants. 5 Oct 2018. 4th World Symposium on Ergonomic Implants, Lago di Garda.Company confidential. Proprietary information. Do not distribute. Research performed at the Robert Langer Laboratory at MIT, Boston , USA

Tribology: the study of surfaces moving relative to one another Wear particles Wear rate Friction coefficient Company confidential. Proprietary information. Do not distribute.

Tribology: Friction and Wear Company confidential. Proprietary information. Do not distribute.

Study of the particles and the inflammatory response Company confidential. Proprietary information. Do not distribute.

James G. et al. Bacteria & Biofilm on Breast Implant Surfaces Company confidential. Proprietary information. Do not distribute.

Biofilm formation (24 h) Smooth Microtexture Macrotexture As per ISO 14607:2018 0 - 10µm 10 - 50µm >50 µm SmoothSilk® / “Traditional Smooth” VelvetSurface® “Foam imprint surface” “Salt-loss” texture SilkSurface® Staph. epidermidis Gram + Pseudomonas aeruginosa Gram - Ralstonia pickettii Gram - 630x magnification630x Company confidential. Proprietary information. Do not distribute. James, G. A., Boegli, L., Hancock, J., Bowersock, L., Parker, A., & Kinney, B. M. (2018). Bacterial Adhesion and Biofilm Formation on Textured Breast Implant Shell Materials. Aesthetic Plastic Surgery. https://doi.org/10.1007/s00266-018-1234-7

ISO 14607:2018 Non-active surgical implants – Mammary implants Published in April 2018 Company confidential. Proprietary information. Do not distribute.

Jones et al. Bacteria & Biofilm Research on Breast Implant Surfaces Company confidential. Proprietary information. Do not distribute.

Jones et al. Proposes a Breast Implant Surface Classification Company confidential. Proprietary information. Do not distribute.

Surface & Medical Complications Reported Linkage Traditional Smooth SmoothSilk® (SilkSurface®) Company confidential. Proprietary information. Do not distribute.

Less inflammation – less fibrosis Motiva Implants® Post-Market Surveillance Company confidential. Proprietary information. Do not distribute. Quirós, M.C., Bolaños, M.C., Fassero, J.J. (2018). Six-Year Prospective Outcomes of Primary Breast Augmentation With Nano Surface Implants. Aesthet Surg J., 39(5):495-508. doi: 10.1093/asj/sjy196.

Summary of scientific advantages on Motiva® Surface Low Low Friction Roughness Low Surface Low Biofilm Area Development Less medical complication Less s according Inflammation to PMS Company confidential. Proprietary information. Do not distribute.

Clinical Evaluation Process Design and Development Real Pre- World Clinical Evidence Clinical Data Evaluation Process Published Clinical Data Data COMPANY CONFIDENTIAL. PROPRIETARY. DO NOT DISTRIBUTE.

Motiva Implants® US IDE CLINICAL TRIAL Overview CLIN-17-008 “Study of the safety and effectiveness of the Motiva Implants®” Indication Breast implant Surgery Devices Motiva Implants® Round Plus and Ergonomix® with or without Q Inside Safety Technology® Estimated 800 participants Enrollment Primary Aesthetic breast augmentation and breast reconstruction purpose Study Start Date March 2018 Study Progress 83% Enrolled subjects (661/800) *Aesthetic cohorts completed as of March 2019 Active sites 27 COMPANY CONFIDENTIAL. PROPRIETARY. DO NOT DISTRIBUTE.

Motiva Implants® US IDE CLINICAL TRIAL Overview Submit Modular PMA Module 1 Module 2 Module 3 Non-Clinical Tests Module 4 Non-Clinical Tests Clinical Data • Physico-Chemical • Eng/Bench Manufacturing • Biocomp/Tox • Financial Disclosure • Sterilization/Shelf- Information • Proposed Labeling • Animal/Biological life & Packaging • Post-Market Surveillance Plan Complete PMA Submit to FDA COMPANY CONFIDENTIAL. PROPRIETARY. DO NOT DISTRIBUTE.

Thank you! ¡Muchas gracias!