Establishment Labs Holdings (ESTA) AI Stock Analysis

• Market Cap: $2.09B
• Dividend Yield: N/A
• Average Volume (3M): 510.67K
• Price to Earnings (P/E): ―
• Beta (1Y): 0.89
• Revenue Growth: 24.76%
• EPS Growth: -10.41%
• Country: US
• Employees: 1,034
• Sector: Healthcare
• Sector Strength: 45
• Industry: Medical - Devices
• EPS (TTM): -0.09
• Shares Outstanding: 29,320,847
• 10 Day Avg. Volume: 576,705
• 30 Day Avg. Volume: 510,665
• PEG Ratio: 0.99
• Price to Book (P/B): 91.68
• Price to Sales (P/S): 10.23
• P/FCF Ratio: -37.92
• Enterprise Value/Market Cap: 0.96
• Enterprise Value/Revenue: 9.45
• Enterprise Value/Gross Profit: 13.63
• Enterprise Value/Ebitda: -79.09
• 1Y Price Target: $88.00
• Price Target Upside: 23.75% Upside
• Rating Consensus: Strong Buy
• Number of Analyst Covering: 8
• EPS Forecast (FY): -1.05
• Revenue Forecast (FY): $264.45M

• Rating: 67 Neutral
• Price Target: $86.00 ▲(20.94% Upside)
• Action: Reiterated Date: 02/25/26
• Date: Action: Reiterated 02/25/26

The score is driven primarily by strong technical momentum and a constructive earnings outlook (accelerating growth, margin expansion, and a stated path to positive EBITDA and improved cash flow). Offsetting this, financial performance is still constrained by ongoing losses and a history of significant cash burn, and valuation is weaker due to the negative P/E and lack of dividend support.

Positive Factors

Revenue Growth

Sustained, accelerating top-line growth demonstrates expanding surgeon and patient adoption across markets and products. A meaningful re-acceleration in 2025 and a strong Q4 imply durable demand and expanding account penetration that supports multi-quarter revenue momentum and scale benefits.

Margin Expansion

High and improving gross margins reflect advantaged product economics for Motiva/Preserve/Mia, allowing the business to convert revenue growth into operating leverage. Durable margin improvement supports sustainable profitability as commercial scale increases and product mix shifts toward higher‑ASP, minimally invasive offerings.

Improved Leverage

Marked reduction in leverage materially lowers refinancing and solvency risk while preserving capacity to invest in commercial expansion. A stronger balance sheet provides a more durable runway to fund U.S. scale-up and regulatory/commercial initiatives without immediate capital raises.

Negative Factors

Historical Cash Burn

Persistent multi-year negative operating and free cash flow highlights structural reliance on financing during the earlier growth phase. Although 2025 shows improvement, the company must sustain cash-flow positivity to avoid re‑reliance on markets or lenders, making execution on margin and working capital key to long-term financial stability.

Ongoing Cash Use & Refinancing Risk

Projected continued cash use in 2026 combined with a near-term credit facility maturity creates a structural funding and refinancing consideration. If operational improvements or cash conversion slip, the company could face tighter financing terms or need to access capital markets, pressuring strategic flexibility.

Regulatory & Execution Timing Risk

Material revenue upside from reconstructive indications is delayed to 2027, extending the timeline for a key addressable market. Combined with a rapid U.S. commercial ramp and recent leadership transition, this lengthens the period in which execution risk and adoption hurdles could hamper near-term returns.

Establishment Labs Holdings Business Overview & Revenue Model

Company Description

Establishment Labs Holdings Inc., a medical technology company, manufactures and markets medical devices for aesthetic and reconstructive plastic surgery. The company primarily offers silicone gel-filled breast implants under Motiva Implants brand name. It also provides Motiva Ergonomix and Motiva Ergonomix2 gravity sensitive round soft silicone-gel-filled breast implants; and Motiva Flora Tissue Expander, a breast tissue expander, as well as distributes Puregraft line of products for autologous adipose tissue harvesting and redistribution. The company sells its products through exclusive distributors and direct sales force in Europe, Latin America, the Asia-Pacific, and internationally. Establishment Labs Holdings Inc. was incorporated in 2004 and is headquartered in Alajuela, Costa Rica.

How the Company Makes Money

Establishment Labs generates revenue primarily through the sale of its breast implants and related products, which are marketed to plastic surgeons and medical facilities worldwide. The company's revenue model includes direct sales to hospitals and clinics, as well as partnerships with distributors in various regions. Key revenue streams include the sale of implants, surgical tools, and ancillary services related to the use of their products. Additionally, the company may benefit from ongoing relationships with healthcare providers and educational initiatives aimed at promoting the safety and efficacy of its offerings, which can drive repeat business and brand loyalty.

Establishment Labs Holdings Financial Statement Overview

Summary

Revenue has scaled strongly with improving gross margins, and leverage risk improved materially in 2025 as debt fell. However, profitability is still negative and historical operating/free cash flow has been deeply negative, with 2025 not yet demonstrating sustained positive cash generation.

Income Statement

Revenue has scaled meaningfully over the period (from $84.7M in 2020 to $211.1M in 2025), with 2025 showing a clear re-acceleration (+10.5% year over year) after flat growth in 2024. Gross margin is consistently strong and improving (about 69% in 2025), signaling solid product economics. The key weakness remains profitability: the company is still operating at sizable losses (2025 net margin about -24%), though losses narrowed substantially versus 2024 (about -51%), indicating improving cost leverage but not yet a profitable model.

Balance Sheet

Balance sheet risk appears to have improved sharply in 2025: total debt drops to ~$2.8M and leverage looks low (debt-to-equity ~0.12) versus very high leverage in 2023–2024. Total assets are sizable (~$357.2M) and equity is positive (~$23.5M), but equity is relatively thin and returns remain deeply negative due to ongoing losses. Overall, the trajectory on leverage is a strength, while sustained losses and modest equity cushion remain notable risks.

Cash Flow

Cash generation is the biggest weak point. Operating cash flow and free cash flow were materially negative from 2020–2024 (for example, 2024 operating cash flow of about -$58.5M and free cash flow of about -$74.1M), indicating the business has required ongoing cash funding to support operations and growth. 2025 shows operating cash flow and free cash flow reported at 0, which is a meaningful improvement versus prior-year burn but is not enough (based on the provided data) to demonstrate sustained positive cash generation.

Breakdown	Dec 2025	Dec 2024	Dec 2023	Dec 2022	Dec 2021
Income Statement
Total Revenue	211.08M	166.03M	165.15M	161.70M	126.68M
Gross Profit	146.31M	109.53M	106.98M	106.59M	85.40M
EBITDA	-32.77M	-56.22M	-58.31M	-56.90M	-26.54M
Net Income	-51.06M	-84.60M	-78.50M	-75.21M	-41.14M
Balance Sheet
Total Assets	357.17M	346.83M	268.64M	211.06M	139.53M
Cash, Cash Equivalents and Short-Term Investments	75.57M	90.35M	40.03M	66.36M	53.41M
Total Debt	2.82M	225.29M	192.22M	179.35M	54.21M
Total Liabilities	333.62M	293.74M	250.25M	219.25M	88.79M
Stockholders Equity	23.55M	53.09M	18.39M	-8.19M	50.74M
Cash Flow
Free Cash Flow	-56.94M	-74.08M	-113.06M	-86.43M	-34.26M
Operating Cash Flow	-50.89M	-58.52M	-88.51M	-52.17M	-27.53M
Investing Cash Flow	-7.03M	-15.61M	-24.55M	-34.79M	-7.16M
Financing Cash Flow	40.43M	125.89M	86.23M	100.25M	4.05M

Establishment Labs Holdings Technical Analysis

• Technical Analysis Sentiment: Neutral
• Last Price: 71.11
• 50DMA: Negative
• 100DMA: Positive
• 200DMA: Positive
• MACD: Positive
• RSI: Neutral
• STOCH: Neutral

Evaluating momentum and price trends is crucial in stock analysis to make informed investment decisions. For ESTA, the sentiment is Neutral. The current price of 71.11 is below the 20-day moving average (MA) of 73.95, below the 50-day MA of 71.31, and above the 200-day MA of 52.68, indicating a neutral trend. The MACD of 1.73 indicates Positive momentum. The RSI at 45.49 is Neutral, neither overbought nor oversold. The STOCH value of 56.27 is Neutral, not indicating any strong overbought or oversold conditions. Overall, these indicators collectively point to a Neutral sentiment for ESTA.

Establishment Labs Holdings Peers Comparison

Name	Overall Rating	Market Cap	P/E Ratio	ROE	Dividend Yield	Revenue Growth	EPS Growth
INMD	74 Outperform	$861.68M	9.40	13.53%	―	-13.98%	15.94%
ESTA	67 Neutral	$2.09B	-40.86	-338.19%	―	24.76%	-10.41%
BVS	64 Neutral	$723.35M	77.83	4.97%	―	1.58%	―
CNMD	61 Neutral	$1.34B	28.74	6.60%	2.02%	4.69%	-51.57%
AORT	59 Neutral	$1.85B	193.39	-2.45%	―	9.81%	-1067.00%
Sector *	51 Neutral	$7.86B	-0.30	-43.30%	2.27%	22.53%	-2.21%
SSII	45 Neutral	$929.38M	-75.59	-43.42%	―	159.43%	67.42%

Establishment Labs Holdings Corporate Events

Establishment Labs Shares Preliminary Data at Healthcare Conference

On January 14, 2026, Establishment Labs presented at the J.P. Morgan Healthcare Conference, where it shared presentation materials with investors and stakeholders, later furnishing these materials in a Form 8-K filing. The company emphasized that the furnished information, including preliminary financial data and forward-looking elements, is not deemed filed for liability purposes under U.S. securities laws and has not been audited or reviewed by its independent accounting firm, underscoring that investors should not place undue reliance on the preliminary figures.

The most recent analyst rating on (ESTA) stock is a Buy with a $85.00 price target. To see the full list of analyst forecasts on Establishment Labs Holdings stock, see the ESTA Stock Forecast page.