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Establishment Labs Holdings Inc (ESTA)
NASDAQ:ESTA
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Establishment Labs Holdings
(NASDAQ:ESTA)
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Rating:58Neutral
Price Target:
$74.00
▲(4.62% Upside)
Establishment Labs Holdings' overall stock score is primarily impacted by financial instability and valuation concerns. However, strong technical momentum and positive earnings call insights provide some optimism. The recent credit agreement amendment also supports financial flexibility, but profitability and leverage remain critical challenges.
Positive Factors
Revenue Growth
Strong revenue growth indicates robust demand for products and effective market strategies, supporting long-term business expansion.
Gross Profit Margin
High gross profit margins suggest efficient cost management and pricing power, enhancing long-term profitability potential.
Product Innovation
Innovative products like Mia and Preserve drive revenue diversification and strengthen competitive positioning in the market.
Negative Factors
High Leverage
High leverage increases financial risk and limits flexibility, potentially impacting long-term financial stability and growth.
Profitability Challenges
Persistent profitability issues highlight operational inefficiencies, which could hinder sustainable growth and investor confidence.
Cash Flow Challenges
Negative operating cash flow suggests difficulties in generating sufficient cash from core operations, affecting financial health.
Establishment Labs Holdings (ESTA) vs. SPDR S&P 500 ETF (SPY)
Market Cap
$2.06B
Dividend YieldN/A
Average Volume (3M)578.99K
Price to Earnings (P/E)―
Beta (1Y)0.98
Revenue Growth24.76%
EPS Growth-10.41%
CountryUS
Employees1,034
SectorHealthcare
Sector Strength45
IndustryMedical - Devices
Share Statistics
EPS (TTM)-0.38
Shares Outstanding29,057,867
10 Day Avg. Volume373,733
30 Day Avg. Volume578,990
Financial Highlights & Ratios
PEG Ratio6.73
Price to Book (P/B)24.44
Price to Sales (P/S)7.81
P/FCF Ratio-17.51
Enterprise Value/Market Cap0.68
Enterprise Value/Revenue7.36
Enterprise Value/Gross Profit10.70
Enterprise Value/Ebitda-29.18
Forecast
1Y Price Target
$71.75Price Target Upside1.44% Upside
Rating ConsensusStrong Buy
Number of Analyst Covering8
EPS Forecast (FY)-1.82
Revenue Forecast (FY)$210.35M
Establishment Labs Holdings Business Overview & Revenue Model
Company DescriptionEstablishment 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 MoneyEstablishment 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 Earnings Call Summary
Earnings Call Date:Nov 05, 2025
(Q3-2025)
| % Change Since: |
Next Earnings Date:Mar 04, 2026
Earnings Call Sentiment Positive
The earnings call reflected strong performance with significant achievements in revenue growth, gross margin improvement, and achieving positive EBITDA for the first time. While there are challenges such as tariff impacts and rising operating expenses, the company's robust growth in key markets, particularly the U.S. and Europe, and strategic focus on innovation and market expansion, paint an optimistic picture for the future.Q3-2025 Updates
Positive Updates
Record Revenue Growth
Global revenue grew 34% in Q3 2025, reaching $53.8 million, with $11.9 million in the U.S.
First Positive EBITDA
Achieved the first quarter of positive EBITDA in the company's history with $1.2 million in Q3 2025.
U.S. Market Performance
Q3 U.S. revenue was $11.9 million, up 16% sequentially, outperforming typical market trends.
Gross Profit Margin Milestone
Exceeded 70% gross profit margin for the first time, reaching 70.1%.
European Market Success
European direct market sales increased approximately 20% this quarter over Q3 2024.
Strong Cash Position
Cash increased $16 million in Q3 to $70.6 million, primarily from the credit facility.
Mia and Preserve Adoption
Mia expected to achieve $8-10 million in revenue in 2025; Preserve continues to see good adoption.
Negative Updates
Challenges in Distributor Markets
Sales to distributors in EMEA were lower due to timing of orders.
Tariff Impact
Goods imported from Costa Rica to the U.S. are subject to duties, impacting gross margin.
Rising Operating Expenses
SG&A expenses increased by $3.1 million from Q3 2024, reflecting higher costs.
Company Guidance
In the Establishment Labs Third Quarter 2025 Earnings Call, the company reported a 34% increase in global revenue, reaching $53.8 million, with $11.9 million from the U.S. market. Establishment Labs achieved a gross profit margin of 70.1% and marked its first quarter of positive EBITDA, recording $1.2 million. The U.S. business segment, noted as a key growth driver, saw a 16% sequential revenue increase despite the typically slower seasonal period for breast procedures. The company raised its 2025 revenue guidance to exceed $210 million and anticipates ending the year with a 20% share of the U.S. breast augmentation market. Internationally, the company experienced robust growth, particularly in European direct markets, which grew approximately 20% over Q3 2024. Establishment Labs also highlighted the success of its Preserve procedure, which has seen early positive feedback and a 40% price premium over standard procedures. The minimally invasive platforms, Mia and Preserve, are expected to generate over $30 million in revenue in 2026. The company aims to achieve cash flow positive status in 2026 without further equity raises, supported by a strong cash position of $70.6 million.Establishment Labs Holdings Financial Statement Overview
Summary
Establishment Labs Holdings shows moderate revenue growth but struggles with profitability, high leverage, and negative return on equity. Cash flow improvements are modest, but overall cash generation remains weak, indicating financial instability.Income Statement
Establishment Labs Holdings shows a moderate revenue growth rate of 7.64% TTM, indicating some positive momentum. However, the company struggles with profitability, as evidenced by negative net profit and EBIT margins. The gross profit margin is relatively strong at 68.74%, but the persistent negative net income highlights ongoing challenges in achieving profitability.45
Neutral
Balance Sheet
The balance sheet reveals a high debt-to-equity ratio, indicating significant leverage, which poses a risk. The return on equity is negative, reflecting the company's inability to generate profits from shareholders' equity. The equity ratio is low, suggesting limited financial stability and a reliance on debt financing.30
Negative
Cash Flow
Cash flow analysis shows a slight improvement in free cash flow growth rate at 7.91% TTM, but operating cash flow remains negative. The operating cash flow to net income ratio is also negative, indicating cash flow challenges. The free cash flow to net income ratio is close to 1, suggesting that free cash flow is nearly matching net income, albeit both are negative.40
Negative
| Breakdown | TTM | Dec 2024 | Dec 2023 | Dec 2022 | Dec 2021 | Dec 2020 |
|---|---|---|---|---|---|---|
Income Statement | ||||||
| Total Revenue | 190.97M | 166.03M | 165.15M | 161.70M | 126.68M | 84.68M |
| Gross Profit | 131.27M | 109.53M | 106.98M | 106.59M | 85.40M | 52.50M |
| EBITDA | -48.14M | -56.22M | -58.31M | -56.90M | -26.54M | -24.93M |
| Net Income | -82.98M | -84.60M | -78.50M | -75.21M | -41.14M | -38.12M |
Balance Sheet | ||||||
| Total Assets | 338.89M | 346.83M | 268.64M | 211.06M | 139.53M | 156.39M |
| Cash, Cash Equivalents and Short-Term Investments | 70.62M | 90.35M | 40.03M | 66.36M | 53.41M | 84.52M |
| Total Debt | 261.16M | 225.29M | 192.22M | 179.35M | 54.21M | 52.54M |
| Total Liabilities | 322.53M | 293.74M | 250.25M | 219.25M | 88.79M | 81.43M |
| Stockholders Equity | 16.36M | 53.09M | 18.39M | -8.19M | 50.74M | 74.96M |
Cash Flow | ||||||
| Free Cash Flow | -77.53M | -74.08M | -113.06M | -86.43M | -34.26M | -16.42M |
| Operating Cash Flow | -71.42M | -58.52M | -88.51M | -52.17M | -27.53M | -12.51M |
| Investing Cash Flow | -7.18M | -15.61M | -24.55M | -34.79M | -7.16M | -5.56M |
| Financing Cash Flow | 108.86M | 125.89M | 86.23M | 100.25M | 4.05M | 64.67M |
Establishment Labs Holdings Technical Analysis
Positive
70.73
Price Trends
54.75
Positive
47.40
Positive
42.29
Positive
Market Momentum
4.16
Positive
69.40
Neutral
70.52
Neutral
Evaluating momentum and price trends is crucial in stock analysis to make informed investment decisions. For ESTA, the sentiment is Positive. The current price of 70.73 is above the 20-day moving average (MA) of 67.22, above the 50-day MA of 54.75, and above the 200-day MA of 42.29, indicating a bullish trend. The MACD of 4.16 indicates Positive momentum. The RSI at 69.40 is Neutral, neither overbought nor oversold. The STOCH value of 70.52 is Neutral, not indicating any strong overbought or oversold conditions. Overall, these indicators collectively point to a Positive sentiment for ESTA.
Establishment Labs Holdings Risk Analysis
Establishment Labs Holdings disclosed 62 risk factors in its most recent earnings report. Establishment Labs Holdings reported the most risks in the "Legal & Regulatory" category.
Finance & Corporate - Financial and accounting risks. Risks related to the execution of corporate activity and strategy
Latest Risks Added 0 New Risks
Establishment Labs Holdings Peers Comparison
UnderperformOutperform
Sector (51)
Name | Overall Rating | Market Cap | P/E Ratio | ROE | Dividend Yield | Revenue Growth | EPS Growth |
|---|---|---|---|---|---|---|---|
71 Outperform | $911.48M | 6.67 | 21.52% | ― | -13.98% | 15.94% | |
64 Neutral | $1.41B | 12.91 | 6.60% | 2.00% | 4.69% | -51.57% | |
64 Neutral | $586.79M | 63.13 | 4.97% | ― | 1.58% | ― | |
58 Neutral | $2.06B | ― | -338.19% | ― | 24.76% | -10.41% | |
58 Neutral | $2.11B | ― | -2.45% | ― | 9.81% | -1067.00% | |
51 Neutral | $7.86B | -0.30 | -43.30% | 2.27% | 22.53% | -2.21% | |
51 Neutral | $1.20B | ― | -43.42% | ― | 159.43% | 67.42% |
* Healthcare Sector Average
ESTA
Establishment Labs Holdings
70.73
27.46
63.46%
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Establishment Labs Holdings Corporate Events
Private Placements and FinancingBusiness Operations and Strategy
Establishment Labs Amends Credit Agreement with Oaktree
Positive
Oct 3, 2025
On September 29, 2025, Establishment Labs Holdings Inc. amended its Credit Agreement with Oaktree Fund Administration, allowing for the immediate availability of Tranche D Term Loans and increasing the required minimum liquidity from $25 million to $30 million. The company fully borrowed $25 million under the new terms, which could enhance its financial flexibility and support its operational strategies.
Glossary
BuyA stock rated as a "Buy" is expected to perform better than the overall market or a specific benchmark over the near-to-medium term. This rating suggests the stock is likely to deliver higher returns compared to other stocks in the same sector or market index. Note: This is not investment advice; please consult a financial advisor before making investment decisions.
HoldA stock rated as a "Hold" is expected to perform in line with the overall market or a specific benchmark. This rating indicates that the stock is neither particularly compelling nor unfavorable for investment. Note: This is not investment advice; please consult a financial advisor before making investment decisions.
SellA stock rated as a "Sell" is expected to perform worse than the overall market or a specific benchmark over the near-to-medium term. This rating suggests the stock may deliver lower returns compared to other stocks in the same sector or market index. Note: This is not investment advice; please consult a financial advisor before making investment decisions.
Disclaimer
This AI Analyst Stock Report is automatically generated by our AI systems using advanced algorithms and publicly available financial, technical, and market data. While the information provided aims to be accurate and insightful, it is intended for informational purposes only and should not be considered financial advice. Any content created by an AI (Artificial Intelligence) system may contain inaccuracies and/or contain errors. Investing in stocks carries inherent risks, and past performance is not indicative of future results. This report does not account for your personal financial circumstances, objectives, or risk tolerance. Always conduct your own research or consult with a qualified financial advisor before making investment decisions. The analysis and recommendations provided are based on historical and current data and may not fully reflect future market conditions or unexpected developments. Neither the creators of this report nor its affiliated entities guarantee the accuracy, completeness, or reliability of the information presented. Use this report at your own discretion and risk.