Establishment Labs Holdings Inc (ESTA)
NASDAQ:ESTA
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Establishment Labs Holdings
(NASDAQ:ESTA)
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Rating:47Neutral
Price Target:
$64.00
▼(-4.59% Downside)
Action:ReiteratedDate:03/31/26
The score is held down primarily by weak financial performance (ongoing losses and historically heavy cash burn) and a clearly bearish technical setup (below major moving averages with negative MACD). Offsetting these are constructive earnings-call guidance for strong 2026 growth, margin expansion, and improving profitability/cash flow trajectory, but valuation remains constrained by negative earnings and no dividend support.
Positive Factors
Sustained Revenue Growth and U.S. Adoption
Consistent, multi-year top-line expansion with strong Q4 acceleration demonstrates durable demand and scaling. Rising U.S. adoption (U.S. Motiva sales and rising share) enlarges a higher‑value addressable market and supports sustainable revenue growth over the next 2–6 months.
Negative Factors
Historic Cash Burn and Unproven FCF Sustainability
Significant multi‑year operating cash deficits highlight reliance on external funding and execution to convert margin gains into durable cash generation. While 2025 shows improvement, sustaining positive free cash flow remains unproven and is critical to long‑term financial self‑sufficiency.
Read all positive and negative factors
Positive Factors
Negative Factors
Sustained Revenue Growth and U.S. Adoption
Consistent, multi-year top-line expansion with strong Q4 acceleration demonstrates durable demand and scaling. Rising U.S. adoption (U.S. Motiva sales and rising share) enlarges a higher‑value addressable market and supports sustainable revenue growth over the next 2–6 months.
Read all positive factors
Establishment Labs Holdings (ESTA) vs. SPDR S&P 500 ETF (SPY)
Market Cap
$1.95B
Dividend YieldN/A
Average Volume (3M)510.67K
Price to Earnings (P/E)―
Beta (1Y)1.04
Revenue Growth24.76%
EPS Growth-10.41%
CountryUS
Employees1,034
SectorHealthcare
Sector Strength45
IndustryMedical - Devices
Share Statistics
EPS (TTM)-0.09
Shares Outstanding29,320,847
10 Day Avg. Volume576,705
30 Day Avg. Volume510,665
Financial Highlights & Ratios
PEG Ratio0.99
Price to Book (P/B)91.68
Price to Sales (P/S)10.23
P/FCF Ratio-37.92
Enterprise Value/Market Cap1.10
Enterprise Value/Revenue10.21
Enterprise Value/Gross Profit14.73
Enterprise Value/Ebitda-85.49
Forecast
1Y Price Target
$87.71Price Target Upside30.75% Upside
Rating ConsensusStrong Buy
Number of Analyst Covering7
EPS Forecast (FY)-1.01
Revenue Forecast (FY)$264.60M
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...
How the Company Makes Money
Establishment Labs makes money primarily by selling breast implants and related surgical/aesthetic products to customers in the healthcare channel (e.g., hospitals, clinics, and surgeons) across the geographies where it is approved to market and d...
Establishment Labs Holdings Earnings Call Summary
Earnings Call Date:Feb 24, 2026
(Q4-2025)
| % Change Since: |
Next Earnings Date:May 11, 2026
Earnings Call Sentiment Positive
The call presents strong positive momentum: robust revenue growth (Q4 +45.2%, FY +27.2%), expanding U.S. adoption and materially improved margins and adjusted EBITDA. Management provided constructive 2026 guidance (≈25% growth) and a path to full-year cash flow profitability in 2027, supported by product momentum (Motiva, Preserve, Mia) and a growing account base. Notable risks include China/distributor volatility, a reconstruction revenue cadence pushed to 2027, elevated operating expenses and refinancing considerations, and execution risk tied to rapid commercial expansion and a leadership transition. Overall, the positive operational and financial trends materially outweigh the listed challenges.Positive Updates
Strong Quarterly and Full-Year Revenue Growth
Q4 2025 revenue $64.6M, up 45.2% year-over-year; total 2025 revenue $211.1M, up 27.2% versus 2024.
Negative Updates
China and Distributor Market Volatility
China experienced challenges in the period and remains a management focus; distributor markets exhibit timing-related ebbs and flows that can produce quarter-to-quarter volatility in reported sales.
Read all updates
Q4-2025 Updates
Positive
Negative
Strong Quarterly and Full-Year Revenue Growth
Q4 2025 revenue $64.6M, up 45.2% year-over-year; total 2025 revenue $211.1M, up 27.2% versus 2024.
Read all positive updates
Company Guidance
Management guided 2026 revenue of $264–266 million (a 25.1%–26.0% increase versus 2025’s $211.1M), with OUS growth in the single digits and the U.S. rising to >30% of sales (vs. ~22% in 2025); they expect gross margins to expand 200–300 basis points (Q4 2025 gross margin was 70.5% and 2025 margins improved ~330 bps YoY), operating expenses of approximately $195–200 million (cash operating spend ~ $175–180M excluding non‑cash items), adjusted EBITDA to be positive every quarter in 2026, and free cash use to be less than half of 2025 with the company reaching cash‑flow positive in 2026 without additional equity (supported by $75.6M year‑end cash). Management also cited product metrics and investments: global minimally invasive demand >$30M in 2026, Preserve ASPs roughly 2x traditional augmentation (average U.S. augmentation ~$9K today), plan to add up to 15 U.S. sales reps (majority already hired), train ≥200 surgeons on Preserve by year‑end, and view reconstruction as a key 2027 growth driver.Establishment Labs Holdings Financial Statement Overview
Summary
Income Statement
46
Neutral
Balance Sheet
62
Positive
Cash Flow
18
Very Negative
| 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 | 264.47M | 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
Positive
67.08
Price Trends
67.05
Positive
68.50
Negative
56.75
Positive
Market Momentum
-0.08
Negative
57.79
Neutral
80.77
Negative
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 67.08 is above the 20-day moving average (MA) of 60.74, above the 50-day MA of 67.05, and above the 200-day MA of 56.75, indicating a bullish trend. The MACD of -0.08 indicates Negative momentum. The RSI at 57.79 is Neutral, neither overbought nor oversold. The STOCH value of 80.77 is Negative, 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 66 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 |
|---|---|---|---|---|---|---|---|
74 Outperform | $902.86M | 10.12 | 14.52% | ― | -13.98% | 15.94% | |
65 Neutral | $878.11M | 21.81 | 4.97% | ― | 1.58% | ― | |
59 Neutral | $1.82B | 211.68 | 2.44% | ― | 9.81% | -1067.00% | |
56 Neutral | $1.22B | 26.78 | 4.68% | 2.02% | 4.69% | -51.57% | |
51 Neutral | $7.86B | -0.30 | -43.30% | 2.27% | 22.53% | -2.21% | |
49 Neutral | $981.13M | -88.99 | -30.23% | ― | 159.43% | 67.42% | |
47 Neutral | $1.95B | -42.28 | -201.79% | ― | 24.76% | -10.41% |
* Healthcare Sector Average
ESTA
Establishment Labs Holdings
67.08
37.67
128.09%
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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.