Ann: Results of 2018 Annual Meeting of Stockholders, page-72

Good points. Until you know whether these surgeons are early adopters or more aesthetic in their practice, you do not really know if they are even the correct targets, therefore, of course they would be cautious.
I believe that most surgeons trial a new technology first, with caution, on their easiest patients before opening up the rest of their other patients. What you mention about J&J or any other player is true, but don't they also have a lot to lose in cannibalization at a lower GM if they were to make a go of it with AXP ? AX needs to get traction in the market, period. Without that, they have no leverage.