Establishment Labs Holdings Inc. (ESTA)

Price$74.29Cached quoteAs of 2026-09-06 03:00 UTC

AI: Fair-priced

Price checkShares carry a premium sales valuation, but strong growth and improving profitability partly support it.

Establishment Labs Holdings Inc. trades on the Nasdaq Capital Market under ESTA. At the observed market value and roughly 29.8 million shares outstanding, equity value is about nine times trailing revenue and a little above eight times management’s 2026 revenue-guidance midpoint. Those are premium sales multiples for a company still reporting GAAP losses. The premium is partly justified by rapid U.S. adoption, higher margins, and improving EBITDA, but leaves limited room for execution misses.

Big pictureRevenue is accelerating while losses shrink, yet durable cash generation still needs to be proven.

Second-quarter revenue rose 31.7% year over year to $67.5 million, gross margin reached 70.6%, adjusted EBITDA was $3.7 million, and the GAAP operating loss narrowed to $4.3 million. First-half operating cash burn was $20.9 million and capital spending was $5.5 million. Cash ended June at $71.2 million, while the debt carrying value was $261.7 million. Management says liquidity should cover at least 12 months and expects positive free cash flow, meaning cash left after operations and capital spending, in the second half.

Business strengthU.S. adoption and minimally invasive products support growth, though elective procedure demand can swing.

U.S. sales reached $24.7 million in the second quarter, up 26% sequentially, while minimally invasive products generated $12.1 million. More than five million Motiva devices have been delivered, supporting the adoption case. The trade-off is concentration in elective breast aesthetics and reconstruction, where procedure volumes can be sensitive to consumer confidence and discretionary spending. Product safety, regulatory execution, surgeon adoption, competition, and manufacturing quality are important. Stronger mix toward higher-margin U.S. and minimally invasive sales could support sustained margin expansion.

What could change the storyFaster cash conversion and sustained growth help; weaker demand, costly debt, or dilution would hurt.

Bull case: revenue growth remains above 25% through 2027, gross margin holds near the low-70% range, free cash flow becomes consistently positive, and leverage declines. Bear case: growth falls below 15%, consumer demand weakens, or interest costs keep absorbing cash, forcing additional financing. Shares outstanding increased about 1.7% from year-end to June, and 1.42 million potential option and restricted-stock-unit shares were excluded from diluted loss per share. Dilution means each existing share represents a smaller ownership stake. The debt maturity extension to 2031 reduces near-term refinancing pressure, but borrowing remains expensive.

AI: News

Guidance Raised AgainRaised guidance followed another quarter of rapid growth, stronger margins, and positive adjusted EBITDA.

On August 6, Establishment Labs reported second-quarter revenue of $67.5 million, up 31.7% year over year, and raised full-year revenue guidance to $269 million-$271 million. Gross margin improved to 70.6%, adjusted EBITDA stayed positive, and U.S. sales rose sequentially. Management also repeated its expectation for positive free cash flow in the second half, making cash conversion and continued U.S. adoption central checkpoints for the raised outlook.

Debt Refinanced Through 2031The refinancing extended maturity and financial runway, but the borrowing rate keeps interest costs meaningful.

On April 30, the company refinanced its Oaktree facility with a senior secured term loan of up to $300 million. The initial $265 million tranche largely repaid the prior facility and transaction costs, while maturity moved to April 2031. The stated annual rate is 8.75%, subject to conditions, and the effective rate was 9.7% at June-end. The extension improves runway, but sizable interest expense remains a meaningful claim on future cash.

Russell 2000 AdditionIndex inclusion may broaden ownership and liquidity without changing the company’s underlying earnings power.

On June 25, Establishment Labs said it would join the Russell 2000 effective at the June 29 market open as part of the annual index reconstitution. Membership can bring demand from index-tracking funds and broaden institutional visibility, potentially improving liquidity. It does not change underlying revenue, margins, cash flow, or competitive position, so it is better viewed as a market-structure event than a fundamental change in business value.

Motiva Passes Five MillionThe five-million-device milestone strengthens adoption evidence as U.S. and minimally invasive sales expand.

On April 7, Establishment Labs announced that more than five million Motiva devices were in market across more than 100 countries. Management presented the milestone as evidence of sustained global adoption and linked 2026 momentum to the U.S. launch and minimally invasive platform. The count is cumulative rather than recurring revenue, so future value still depends on procedure growth, pricing, surgeon retention, product safety, and execution in key markets.

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Financial statements

	2025	2024	2023	2022	2021	2020	2019	2018	2017
Revenue	$211.1M	$166.0M	$165.2M	$161.7M	$126.7M	$84.7M	$89.6M	$61.2M	$34.7M
Gross profit	$146.3M	$109.5M	$107.0M	$106.6M	$85.4M	$52.5M	$54.9M	$36.1M	$17.7M
Gross margin	69.32%	65.97%	64.78%	65.92%	67.42%	62.00%	61.25%	59.01%	51.04%
Research & development	$20.2M	$19.7M	$26.4M	$20.3M	$18.3M	$13.8M	$15.0M	$12.7M	$6.9M
Operating expenses	$185.3M	$159.5M	$172.0M	$146.3M	$110.5M	$80.4M	$85.8M	$60.0M	$37.7M
Operating income	−$39.0M	−$50.0M	−$65.0M	−$39.7M	−$25.1M	−$27.9M	−$30.9M	−$23.9M	−$20.0M
Operating margin	−18.48%	−30.11%	−39.37%	−24.53%	−19.84%	−32.97%	−34.55%	−38.99%	−57.62%
EBITDA	−$32.8M	−$45.3M	−$62.2M	−$37.2M	−$22.6M	—	—	—	—
EBITDA margin	−15.54%	−27.28%	−37.68%	−22.98%	−17.87%	—	—	—	—
Net income	−$51.1M	−$84.6M	−$78.5M	−$75.2M	−$41.1M	−$38.1M	−$38.1M	−$21.1M	−$34.9M
Net profit margin	−24.19%	−50.95%	−47.53%	−46.51%	−32.47%	−45.02%	−42.59%	−34.47%	−100.62%
Basic EPSper basic share	-$1.72	-$3.00	-$3.07	-$3.08	-$1.72	-$1.63	-$1.86	-$1.22	-$3.41
Diluted EPSper diluted share	-$1.72	-$3.00	-$3.07	-$3.08	-$1.72	-$1.63	-$1.86	-$1.22	-$3.41

Review official source filings ↗

Owners

Reported shareholders

Reference date Jun 30, 2026

9.04%of listed shares

JW Asset Management, LLC2.69M shares · Jun 30, 2026

View holders

Top 20 reported holders of ESTA
Holder	% owned
JW Asset Management, LLC	9.04%2.69M shares
RTW INVESTMENTS, LP	8.91%2.66M shares
BlackRock, Inc.	5.31%1.58M shares
PRICE T ROWE ASSOCIATES INC /MD/	5.15%1.53M shares
BROWN ADVISORY INC	4.41%1.31M shares
LEWIN NICHOLAS SHERIDAN	≈3.69%1.1M shares
FINDELL CAPITAL MANAGEMENT LLC	3.68%1.1M shares
Chacon Quiros Juan Jose	≈3.26%972.7K shares
Mudita Advisors LLP	2.43%723.06K shares
WILLIAM BLAIR INVESTMENT MANAGEMENT, LLC	2.40%714.05K shares
Rubric Capital Management LP	2.31%688.33K shares
Nantahala Capital Management, LLC	2.25%671.66K shares
FRANKLIN RESOURCES INC	2.06%613.7K shares
BANK OF AMERICA CORP /DE/	2.04%608.04K shares
Tyro Capital Management LLC	2.03%605.56K shares
D. E. Shaw & Co., Inc.	1.90%566.91K shares
RICE HALL JAMES & ASSOCIATES, LLC	1.88%560.94K shares
UBS Group AG	1.84%548.96K shares
TORONTO DOMINION BANK	1.81%540.02K shares
SUMMIT PARTNERS PUBLIC ASSET MANAGEMENT, LLC	1.65%491.49K shares

Percentages use 29.79M shares of this listed class outstanding on Jun 30, 2026. ≈ compares the latest reported holding with a share total from a different date; it is not a confirmed current stake.

Gray completes the 100% scale. Reported positions may overlap; holders have different reporting dates.

Source: SEC Form 13F ↗Updated Sep 29, 2026 · Quarterly data

Insider buys & sells

Jul 1, 2024–Jun 30, 2026

Buys4$377.9K disclosed value

Sells (SEC code S)40$42.51M disclosed value

Transaction	Insider	Type	Shares	Price	Value	Owned after
May 28, 2026Form 4	JW Partners, LP +4Other	SellCommon Shares · indirect	65.1K	$72.89	$4.75M	2.89M
May 27, 2026Form 4	JW Partners, LP +4Other	SellCommon Shares · indirect	113	$72.50	$8.2K	2.96M
May 26, 2026Form 4	JW Partners, LP +4Other	SellCommon Shares · indirect	25.3K	$74.39	$1.88M	2.96M
May 21, 2026Form 4	JW GP, LLC +4TenPercentOwner	SellCommon Shares · indirect	17.0K	$71.40	$1.21M	2.98M
May 20, 2026Form 4	JW GP, LLC +4TenPercentOwner	SellCommon Shares · indirect	3.6K	$70.56	$252.6K	3.00M

Review ownership filings at SEC.gov ↗

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Establishment Labs Holdings Inc. (ESTA)

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