Establishment Labs Holdings Inc. (ESTA)

Key figures

The last twelve months reported, with the latest price and balance sheet.

Revenue, last twelve months

$245.8M

Revenue growth

38.6%

Net income, last twelve months

-$38.9M

Earnings per share

-$1.31

Gross margin

70.5%

Operating margin

-7.6%

Net margin

-15.8%

Free cash flow

-$41.5M

Return on equity

-180.0%

Market value

$2.1B

Cash

$71.2M

Debt

$261.7M

Debt to equity

12.11

Shares outstanding

29.8M

Financial statements

Revenue, profit and cash flow by fiscal year, each year linked to its annual report.

By quarter

What the company said with its results

From the third quarter 2026 results, filed 29 October 2026.

• Revenue grew 33.9% year over year. Revenue was $72.0 million, up 33.9% from $53.8 million in the same quarter of 2025.
• Net loss was smaller than last year. GAAP net loss was $10.7 million, or $(0.35) per share, against $11.1 million, or $(0.38) per share, a year earlier.
• Adjusted EBITDA rose to $6.4 million. Adjusted EBITDA was $6.4 million, or 8.9% of revenue, compared with $1.2 million, or 2.2% of revenue, a year earlier.
• GAAP operating expenses rose. GAAP operating expenses were $52.3 million, against $41.7 million a year earlier. Adjusted figures are reported separately.
• U.S. revenue grew 119.0%. U.S. revenue rose 119.0% to $26.0 million. OUS revenue rose 9.7% to $46.0 million over the same comparison.
• Minimally invasive revenue grew 124.0%. Minimally invasive revenue increased 124.0% year over year in the quarter.
• OUS distributor sales ran above expectations. Distributor sales outside the U.S. were stronger than management anticipated, adding revenue and gross profit dollars at lower margins.
• FDA approved smaller Motiva sizes. The FDA approved additional smaller Motiva implant sizes, widening the range available to U.S. surgeons and patients.
• Larger minimally invasive implant sizes. Larger implant sizes were announced for the minimally invasive platform, aimed at broader treatment options and patient population.
• U.S. footprint expanded, Preservé training. Management reported expansion of the U.S. commercial footprint and surgeon training on the Preservé technology.
• GAAP gross margin fell to 69.1%. GAAP gross profit was $49.7 million, or 69.1% of revenue, against a GAAP gross margin of 70.1% a year earlier.
• Adjusted gross margin rose to 70.8%. Excluding certain charges, adjusted gross margin was 70.8%, up 70 basis points, with support from U.S. and minimally invasive growth.
• Adjusted operating expenses fell to 68.8%. Adjusted operating expenses were $49.6 million, or 68.8% of revenue, against 77.6% a year earlier, excluding litigation and restructuring charges.
• First positive free cash flow quarter. Net cash from operating activities was about $7.7 million, and free cash flow was $5.1 million, the first positive quarter in the company's history.

Revenue by segment

As the company reports it in the segment note of its annual report.

By region, FY2025

Company events

The newest 8-K filings of 100 held.

Every filing

The newest filings with the SEC of 194 held.

Insider trades

Form 4 trades by officers, directors and 10% owners, last 12 months.

Planned insider sales

Form 144 notices, filed when the sell order goes to the broker.

Large holders

Schedule 13D and 13G filings by holders of more than 5% of the voting shares.

Short interest

Shares sold short and not yet bought back, on each FINRA settlement date.

Funds that hold it

From each fund's latest Form 13F.

229 funds held it at 30 Jun 2026: 120 added and 48 trimmed in the quarter. The largest:

Peers

Companies in the same industry.

• Intuitive Surgical Inc. (ISRG): revenue $11.6B, market value $154.0B
• Edwards Lifesciences Corp. (EW): revenue $6.5B, market value $52.9B
• Steris plc (STE): revenue $6.0B, market value $22.3B
• Zimmer Biomet Holdings, Inc. (ZBH): revenue $8.5B, market value $18.4B
• Smith & Nephew plc (SNN): revenue $6.2B, market value $13.2B
• Align Technology Inc. (ALGN): revenue $4.1B, market value $10.9B
• MSA Safety Inc. (MSA): revenue $1.9B, market value $6.8B
• Enovis Corp. (ENOV): revenue $2.3B, market value $1.3B

What the company does

Establishment Labs Holdings is a global medical technology company focused on breast aesthetics and reconstruction. It was incorporated in Costa Rica in 2004 and reorganised in 2013 under a parent holding company in the British Virgin Islands. Its main product is the Motiva Implants line of silicone gel-filled breast implants, which accounted for over 99% of revenue in 2025. Motiva Implants are registered to be sold in over 100 countries.

What it sells

Motiva Implants come in five product families: Round and Ergonomix Round, Ergonomix Oval, Anatomical TrueFixation, Ergonomix2 Round and Ergonomix2 Diamond, and the Flora Tissue Expander. The catalog includes over 1,000 product variations in round, oval and anatomical shapes, with volumes from 95cc to 1060cc. The Flora Tissue Expander is used in reconstruction to stretch breast tissue for less than six months before a long-term implant is placed. It is registered in 79 countries.

The company also sells surgical techniques built around its implants. Mia Femtech, launched in April 2023, is a procedure done under local anesthesia through smaller incisions. Preservé, launched in February 2025, is a breast tissue-preserving technology for augmentation, revision augmentation and mastopexy augmentation. It first launched in Brazil, and the company says it expects a full United States launch in 2026.

How the products are built

- SmoothSilk, a smooth shell surface designed to reduce capsular contracture. - ProgressiveGel silicone fill. - TrueMonobloc construction, which binds shell, gel and other components together. - BluSeal, a barrier layer that shows its coverage by color so it can be checked. - An optional RFID microtransponder, called Qid or the newer ZEN, that gives each implant a unique 15-digit serial number. Patients can look up their implant through the MotivaImagine application.

The Motiva Always Confident Warranty offers a free replacement for any Motiva Implant that ruptures, for the life of the product. It also covers replacement for capsular contracture of Baker Grade III or IV in the first 10 years after implantation.

Who buys from it and where

Revenue comes from two types of customers: medical device distributors, and direct sales to physicians, hospitals and clinics. Exclusive distributors serve most markets. The company sells through its own sales force in the United States, Brazil, Argentina and several European countries. Its sales organization had 278 employees and contractors at 31 December 2025. By that date it had secured over 1,500 accounts in the United States.

The company received FDA premarket approval for Motiva Implants in September 2024 and began commercial sales in the United States in October 2024. It also reports approvals in Japan, from the Pharmaceuticals and Medical Devices Agency, and in China, from the National Medical Products Administration.

Demand is seasonal. United States breast augmentation volumes typically peak in spring and again from October to December. They fall in January and February and from late June through early August, with market declines of approximately 20% to 30% in some periods.

Where it makes things

All manufacturing takes place in the Coyol Free Zone in Alajuela, Costa Rica. The original facility, opened at the end of 2016, can produce over 400,000 implants a year. In 2025 the FDA authorized the Costa Rican facilities to make all Motiva USA premarket-approved products. Both facilities are certified Carbon Neutral by the Costa Rican Ministry of Environment, Energy, and Telecommunications.

Shell surfaces are made with a 3D negative imprinting molding technique. The company buys NuSil brand medical-grade silicone from Avantor, which is a sole-source supplier to the majority of the silicone breast implant industry. The master supply agreement has an initial term ending 31 December 2026.

How it competes

In the United States, the silicone breast implant market is relatively concentrated among Allergan Aesthetics, a division of AbbVie, Mentor Worldwide LLC, a division of Johnson & Johnson, and Sientra, which Tiger Aesthetics Medical acquired. Internationally the market is more fragmented, with producers including GC Aesthetics plc, Silimed, Groupe Sebbin SAS, Hans Biomed, Polytech Health & Aesthetics and Arion Laboratories. The company says its major competitors have more market share and resources.

The company lists these competitive factors: - Safety and outcomes data from clinical studies. - - - Complementary non-implant products. - Price. - - Support from key opinion leaders.

It says its own strengths are its patient safety profile, its implant technologies, its surgical procedures, its vertically integrated manufacturing and its mix of distributors and direct sales.

Regulation and intellectual property

Breast implants are Class III devices in the United States and require an approved premarket approval application. A post-approval study is under way, planned to enroll 2,400 patients at up to 50 sites in the United States. The company also continues its IDE clinical trial and monitors those patients for ten years. In Europe, products must carry the CE mark under the EU Medical Devices Regulation.

At 31 December 2025 the company owned or had rights to 36 issued, 1 allowed and 12 pending United States patents. It also held 178 issued, 1 allowed and 48 pending foreign applications, plus 1 pending Patent Cooperation Treaty application. It says its owned and licensed patents are expected to expire between March 2032 and February 2040.

*From Establishment Labs's annual report on Form 10-K for the year ended 31 December 2025. [The filing](https://www.sec.gov/Archives/edgar/data/1688757/000168875726000022/esta-20251231.htm)*

From the company's 10-K.