Establishment Labs (NASDAQ: ESTA) lifts 2026 outlook after strong Q1 growth
Filing Impact
Filing Sentiment
Form Type
8-K
Rhea-AI Filing Summary
Establishment Labs Holdings Inc. reported strong first-quarter 2026 results with revenue of $59.9 million, up 44.7% from the same period in 2025, driven by Motiva sales and minimally invasive products. Gross margin improved to 70.7%, and the company delivered its third consecutive quarter of positive adjusted EBITDA.
Net loss narrowed to $13.4 million from $20.7 million a year earlier, while cash used in the quarter fell to $7.5 million and cash on hand was $68.1 million as of March 31, 2026. Management raised full-year 2026 revenue guidance to a range of $266.5 million to $268.5 million and now expects the minimally invasive business to exceed $35 million, with positive adjusted EBITDA every quarter and free cash flow positivity in the second half of 2026.
Positive
- Revenue growth and margin expansion: Q1 2026 revenue rose 44.7% year over year to $59.9 million, while gross margin improved to 70.7% from 67.2%, indicating strong top-line momentum with better profitability per dollar of sales.
- Improving profitability metrics: Net loss narrowed to $13.4 million from $20.7 million, and adjusted EBITDA turned positive at $1.2 million versus a $12.1 million loss, marking the third consecutive quarter of positive adjusted EBITDA.
- Raised 2026 outlook: Full-year revenue guidance increased to $266.5–$268.5 million, with the minimally invasive business now expected to exceed $35 million in 2026 and management targeting positive adjusted EBITDA every quarter and free cash flow positivity in the second half of 2026.
Negative
- None.
Insights
Q1 revenue surged, margins expanded, and guidance was raised, signaling accelerating growth.
Establishment Labs delivered Q1 2026 revenue of $59.9M, up 44.7% year over year, with Motiva U.S. revenue rising to $19.6M from $6.2M. Gross margin increased to 70.7% from 67.2%, helped by geographic and channel mix.
Operating expenses grew only 8.9% to $48.8M, well below revenue growth, shrinking loss from operations to $6.5M. Adjusted EBITDA swung to income of $1.2M from a $12.1M loss, and cash use declined to $7.5M.
Management raised 2026 revenue guidance to $266.5M–$268.5M and expects positive adjusted EBITDA each quarter and free cash flow positivity in the second half of 2026. The minimally invasive business is now expected to exceed $35M for 2026, highlighting its growing contribution.
8-K Event Classification
2 items: 2.02, 9.01
2 items
Item 2.02
Results of Operations and Financial Condition
Financial
Disclosure of earnings results, typically an earnings press release or preliminary financials.
Item 9.01
Financial Statements and Exhibits
Exhibits
Financial statements, pro forma financial information, and exhibit attachments filed with this report.
Key Figures
Q1 2026 revenue: $59.9M
Gross margin Q1 2026: 70.7%
Net loss Q1 2026: $13.4M
+5 more
8 metrics
Q1 2026 revenue
$59.9M
Three months ended March 31, 2026; up 44.7% from $41.4M in 2025
Gross margin Q1 2026
70.7%
Gross profit $42.3M on $59.9M revenue vs 67.2% a year earlier
Net loss Q1 2026
$13.4M
Net loss narrowed from $20.7M in Q1 2025; loss per share $0.45
Adjusted EBITDA Q1 2026
$1.2M
Improved from a $12.1M loss in Q1 2025; third positive quarter
Cash balance
$68.1M
Cash and cash equivalents as of March 31, 2026
2026 revenue guidance
$266.5M–$268.5M
Raised from prior range of $264M–$266M for fiscal 2026
Minimally invasive revenue
$9.1M
Q1 2026 minimally invasive revenue; 2026 guidance now >$35M
Motiva U.S. revenue
$19.6M
Q1 2026 Motiva sales in the United States vs $6.2M in 2025
Key Terms
Adjusted EBITDA, free cash flow positive, minimally invasive platform, gross margin, +2 more
6 terms
Adjusted EBITDA financial
"Adjusted EBITDA income of $1.2 million compared to a loss of $12.1 million in the year-ago period"
Adjusted EBITDA is a way companies measure how much money they make from their core operations, like running a business, by removing certain costs or income that aren’t part of regular business activities. It helps investors see how well a company is doing without distractions from unusual expenses or gains, making it easier to compare companies or track performance over time.
free cash flow positive financial
"We expect to be free cash flow positive in the second half of the year"
minimally invasive platform technical
"The U.S. launch of our minimally invasive platform is off to a strong start"
gross margin financial
"Gross margin of 70.7% compared to 67.2% in the year-ago period"
Gross margin is the difference between how much money a company makes from selling its products and how much it costs to produce them, expressed as a percentage of sales. It shows how efficiently a company is turning sales into profit before other expenses like marketing or salaries. Higher gross margin means the company keeps more money from each sale, which is a good sign of financial health.
forward-looking statements regulatory
"This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933"
Forward-looking statements are predictions or plans that companies share about what they expect to happen in the future, like estimating sales or profits. They matter because they help investors understand a company's outlook, but since they are based on guesses and assumptions, they can sometimes be wrong.
restructuring charges financial
"Restructuring charges | (1,373) | | | | | | | —"
Restructuring charges are costs that a company pays when it changes how it operates, like closing factories or laying off employees. These expenses are often one-time and happen to help the company become more efficient in the long run. They matter because they can affect the company's profits and how investors see its future prospects.
Earnings Snapshot
Revenue: $59.9M · Guidance included
Q1 2026
Revenue
$59.9M
+44.7% YoY
Gross margin
70.7%
up from 67.2% YoY
Net loss
$13.4M
improved from $20.7M loss YoY
Adjusted EBITDA
$1.2M
from $(12.1)M YoY
Guidance
For 2026, revenue is guided to $266.5M–$268.5M, gross margin to 71.2%–72.2%, operating expenses to $195M–$200M, with positive adjusted EBITDA every quarter and free cash flow positive in the second half of 2026.
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 8-K
CURRENT REPORT
Pursuant to Section 13 or 15(d)
of the Securities Exchange Act of 1934
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Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (§230.405 of this chapter) or Rule 12b-2 of the Securities Exchange Act of 1934 (§240.12b-2) of this chapter.
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Item 2.02 Results of Operations and Financial Condition.
On May 6, 2026, Establishment Labs Holdings Inc. (the “Company”) issued a press release announcing the Company’s financial results for the three months ended March 31, 2026 and recent corporate highlights. A copy of the press release is furnished herewith as Exhibit 99.1.*
* The information in Item 2.02 of this Form 8-K shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934 (the “Exchange Act”) or otherwise subject to the liabilities of that section, nor shall it be deemed incorporated by reference in any filing under the Securities Act of 1933 or the Exchange Act, except as expressly set forth by specific reference in such a filing.
Item 9.01 Financial Statements and Exhibits.
(d) Exhibits.
| Exhibit No. | Description | ||||
| 99.1 | Press Release of Establishment Labs Holdings Inc. dated May 6, 2026. | ||||
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this Report to be signed on its behalf by the undersigned hereunto duly authorized.
ESTABLISHMENT LABS HOLDINGS INC. | ||||||||||||||
Dated: | May 6, 2026 | By: | /s/ Cassandra "Sandra" Harris | |||||||||||
Name: | Cassandra "Sandra" Harris | |||||||||||||
Title: | Chief Financial Officer | |||||||||||||
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| EXHIBIT 99.1 | ||||||||
PRESS RELEASE | Investor/Media Contact: Malavika William mwilliam@establishmentlabs.com | ||||
Establishment Labs Reports First Quarter 2026 Financial Results
NEW YORK, NY, May 6, 2026 -- Establishment Labs Holdings Inc. (NASDAQ: ESTA), a global medical technology company dedicated to improving women’s health and wellness, principally in breast aesthetics and reconstruction, today announced financial results for the first quarter ended March 31, 2026.
First Quarter Highlights and Outlook (Unaudited)
•Revenue of $59.9 million, up 44.7% from Q1 2025, with guidance raised to $266.5 million to $268.5 million
•$19.6 million of Motiva sales in the United States, up 13.3% from Q4 2025
•Minimally invasive revenue of $9.1 million for the quarter
•Gross margin of 70.7% compared to 67.2% in the year-ago period
•Loss from operations was $6.5 million compared to a loss of $16.9 million in the year-ago period
•Adjusted EBITDA income of $1.2 million compared to a loss of $12.1 million in the year-ago period
•Cash use of $7.5 million compared to use of $21.2 million in the year-ago period
•Cash balance of $68.1 million as of March 31, 2026
“Our momentum is accelerating across both the United States and OUS (outside of the U.S.) markets,” said Peter Caldini, Chief Executive Officer. “The U.S. launch of our minimally invasive platform is off to a strong start and is contributing meaningfully to our growth; we now expect it to make up at least 13% of 2026 revenue, up from previous guidance. At the same time, we’ve delivered our third consecutive quarter of positive adjusted EBITDA, underscoring the strength of our execution and the operational leverage inherent to this business.”
“Our first quarter performance gives us confidence to raise our annual guidance,” said Sandra Harris, Chief Financial Officer of Establishment Labs. “Our recent refinancing with Oaktree extends our debt maturity and further enhances our financial flexibility. We expect to be free cash flow positive in the second half of the year and are focused on meaningfully increasing earnings per share every year moving forward.”
First Quarter 2026 Financial Results (Unaudited)
Total revenue for the quarter ended March 31, 2026 was $59.9 million, compared to $41.4 million for the same period in 2025, representing a growth of approximately 44.7%, with Motiva U.S. revenue increasing to $19.6 million from $6.2 million in the prior-year period.
Gross profit for the first quarter of $42.3 million, or 70.7% of revenue, increased compared to $27.8 million, or 67.2% of revenue, for the same period in 2025. The improvement in gross profit margin was primarily driven by geographic and channel mix.
Total operating expenses for the first quarter were $48.8 million, $4.0 million higher compared to $44.8 million in the first quarter of 2025. This represents a 8.9% increase supporting a 44.7% growth of revenue, showing our ability to leverage operating expenses as we scale the business.
Net loss for the first quarter was $13.4 million, compared to a net loss of $20.7 million in the year-ago period. Adjusted EBITDA increased by $13.3 million to an income of $1.2 million compared to a loss of $12.1 million in the year-ago period, achieving our third consecutive quarter of positive adjusted EBITDA.
The Company’s cash balance on March 31, 2026 was $68.1 million.
Fiscal 2026 Outlook
The Company raises guidance based on the first-quarter 2026 performance, and expects the following results:
•Revenue: $266.5 million to $268.5 million, up from our previous range of $264 million to $266 million. Minimally invasive business to exceed $35 million in 2026 up from the previous guidance of $30 million.
•Gross margin: 71.2% to 72.2%
•Operating expenses: $195 million to $200 million
•Adjusted EBITDA: Positive every quarter
•Free cash flow positive in the second half of the year
Conference Call and Webcast Information
Establishment Labs will host a conference call and webcast today at 8:30 a.m. Eastern Time to discuss its financial results. To participate in the conference call, Dial: 877-407-8037 (US & Canada) or +1 201-689-8037 (international). The call will also be available via live or archived webcast on the “Investor Relations” section of the Establishment Labs website at www.establishmentlabs.com.
About Establishment Labs
Establishment Labs Holdings Inc. is a global medical device company dedicated to improving women’s health and wellness in breast aesthetics and reconstruction through the power of science, engineering, and technology. The company offers a portfolio of solutions for breast health, breast aesthetics, and breast reconstruction in over 100 countries. With five million Motiva® devices delivered to plastic and reconstructive surgeons since 2010, the company’s products have created a new standard for safety and patient satisfaction. The company’s minimally invasive platform consists of Mia Femtech®, a unique minimally invasive experience for breast harmonization, and Preservé™, a breast tissue preserving and minimally invasive technology for primary breast augmentation and primary mastopexy augmentation. GEM® is a next generation minimally invasive system for gluteal ergonomic modeling currently undergoing an IRB approved pivotal study. The Motiva Flora® tissue expander is used to improve outcomes in breast reconstruction following breast cancer and is the only regulatory-approved expander in the world with an integrated port using radio-frequency technology that is MRI conditional. Zensor™ is an RFID technology platform used to safely identify implantable devices from outside the body, and includes the company’s first biosensor Zen™, currently part of an IRB approved pivotal study to measure core breast temperature. These solutions are supported by over 200 patent applications in 20 separate patent families worldwide and over 100 scientific and clinical studies and publications in peer reviewed journals. Establishment Labs manufactures at two facilities in Costa Rica compliant with all applicable regulatory standards under ISO13485:2024 and FDA 21 CFR 820. Please visit our website for additional information at www.establishmentlabs.com.
Non-GAAP Financial Measures
To supplement our financial results presented in accordance with GAAP, this release includes the following measures defined by the Securities and Exchange Commission as non-GAAP financial measures: EBITDA and Adjusted EBITDA. These non-GAAP measures are not based on any comprehensive set of accounting rules or principles and should not be considered a substitute for, or superior to, financial measures calculated in accordance with GAAP, and may be different from non-GAAP measures used by other companies, limiting the usefulness of the measures for comparison with other companies.
EBITDA is defined as net income or loss excluding: (1) interest income and expense; (2) provision for income taxes; and (3) depreciation and amortization. We consider EBITDA useful to an investor in evaluating and facilitating comparisons of our operating performance between periods by removing the impact of our capital structure (primarily interest expense) and asset base (primarily depreciation and amortization) from our operating results.
We also present Adjusted EBITDA which includes additional adjustments for items such as other non-cash charges, gains or losses on extinguishment of debt, share-based compensation, contract termination costs, foreign currency gains and losses and restructuring costs. We believe that Adjusted EBITDA provides useful supplemental information to investors regarding our ongoing operating performance that, when considered with net income and EBITDA, is beneficial to an investor's understanding of our performance.
We believe disclosure of this information is also useful to investors as it provides insight into the earnings that management uses to make strategic decisions. These non-GAAP financial measures should be considered along with, but not as alternatives to, net income or loss as prescribed by GAAP as a measure of our operating performance. EBITDA and Adjusted EBITDA do not represent cash generated from operating activities under GAAP and should not be considered as alternatives to cash flows from operations or any other operating performance measure prescribed by GAAP. These measures are not measures of our liquidity, nor are indicative of funds available to fund our cash needs. These measurements do not reflect cash expenditures for long-term assets and other items that have been and will be incurred. EBITDA and Adjusted EBITDA may include funds that may not be available for management’s discretionary use due to functional requirements to conserve funds for capital expenditures, property acquisitions, and other commitments and uncertainties.
Please see “Reconciliation of EBITDA and Adjusted EBITDA” for a reconciliation of these measures to net income (loss), the most directly comparable financial measure. This release also includes information about our expectations regarding Adjusted EBITDA on a forward-looking basis. We have not provided a reconciliation of such forward-looking Adjusted EBITDA information because a reconciliation of such measure to our expected GAAP net income (loss) on a forward-looking basis is not available without unreasonable efforts. The timing or amount of various reconciling items that would impact the forward-looking expectations for this non-GAAP financial measure are uncertain, depend on various factors and cannot be reasonably predicted. Such unavailable information could be material to our results computed in accordance with U.S. GAAP.
Forward-Looking Statements
This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). You can find many (but not all) of these statements by looking for words such as “approximates,” “believes,” “expects,” “anticipates,” “estimates,” “intends,” “plans,” “intends to,” “would,” “will,” “may” or other similar expressions in this press release. Any statements that refer to projections of our future financial or operating performance, anticipated trends in our business, our goals, strategies, focus and plans, including related product development and commercialization and regulatory approvals, and other characterizations of future events or circumstances, including statements expressing general optimism about future operating results, related to the company’s performance are forward-looking statements. We claim the protection of the safe harbor contained in the Private Securities Litigation Reform Act of 1995. We caution investors that any forward-looking statements presented in this report, or that we may make orally or in writing from time to time, are expressions of our beliefs and expectations based on currently available information at the time such statements are made. Such statements are based on assumptions, and the actual outcome will be affected by known and unknown risks, trends, uncertainties, and factors that are beyond our control. Although we believe that our assumptions are reasonable, we cannot guarantee future performance, and some will inevitably prove to be incorrect. As a result, our actual future results and the timing of events may differ from our expectations, and those differences may be material. Factors, among others, that could cause actual results and events to differ materially from those described in any forward-looking statements include risks and uncertainties relating to: our ability to successfully, timely and cost-effectively develop, seek and obtain regulatory clearance for and commercialize our product offerings; the rate of adoption of our products by healthcare providers or other customers; the success of our marketing initiatives; the safe and effective use of our products; our ability to
protect our intellectual property; our future expansion plans and capital allocation; our ability to expand upon and/or secure sources of credit or capital; our ability to develop and maintain relationships with qualified suppliers to avoid a significant interruption in our supply chains; our ability to attract and retain key personnel; our ability to scale our operations to meet market demands; the effect on our business of existing and new regulatory requirements; and other economic and competitive factors. These and other factors that could cause or contribute to actual results differing materially from our expectations include, among others, those risks and uncertainties discussed in the company's annual report on Form 10-K filed on February 27, 2026, which risks and uncertainties may be updated in the future in other filings made by the company with the Securities and Exchange Commission. The risks included in those documents are not exhaustive, and additional factors could adversely affect our business and financial performance. We operate in a very competitive and rapidly changing environment. New risk factors emerge from time to time, and it is not possible for us to predict all such risk factors, nor can we assess the impact of all such risk factors on our business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in any forward-looking statements. We are not undertaking any obligation to update any forward-looking statements. Accordingly, investors should use caution in relying on past forward-looking statements, which are based on known results and trends at the time they are made, to anticipate future results or trends.
ESTABLISHMENT LABS HOLDINGS INC.
Consolidated Statements of Operations
(In thousands, except share and per share data)
(Unaudited)
| Three Months Ended March 31, | |||||||||||
| 2026 | 2025 | ||||||||||
| Revenue | $ | 59,877 | $ | 41,377 | |||||||
| Cost of revenue | 17,542 | 13,569 | |||||||||
| Gross profit | 42,335 | 27,808 | |||||||||
| Operating expenses: | |||||||||||
| Sales, general and administrative | 43,605 | 39,699 | |||||||||
| Research and development | 5,241 | 5,055 | |||||||||
| Total operating expenses | 48,846 | 44,754 | |||||||||
| Loss from operations | (6,511) | (16,946) | |||||||||
| Interest income | 26 | 250 | |||||||||
| Interest expense | (7,088) | (5,853) | |||||||||
Other income, net | 479 | 2,753 | |||||||||
| Loss before income taxes | (13,094) | (19,796) | |||||||||
| Provision for income taxes | (288) | (914) | |||||||||
| Net loss | $ | (13,382) | $ | (20,710) | |||||||
| Basic and diluted net loss per share | $ | (0.45) | $ | (0.70) | |||||||
| Weighted average outstanding shares used for basic and diluted net loss per share | 29,947,157 | 29,475,649 | |||||||||
ESTABLISHMENT LABS HOLDINGS INC.
Consolidated Balance Sheets
(In thousands)
| March 31, 2026 | December 31, 2025 | ||||||||||
| (Unaudited) | |||||||||||
| Assets | |||||||||||
| Current assets: | |||||||||||
Cash and cash equivalents | $ | 68,101 | $ | 75,572 | |||||||
Accounts receivable, net | 77,076 | 77,497 | |||||||||
| Inventory, net | 86,659 | 85,611 | |||||||||
| Prepaid expenses and other current assets | 13,991 | 11,260 | |||||||||
| Total current assets | 245,827 | 249,940 | |||||||||
| Long-term assets: | |||||||||||
Property and equipment, net | 74,654 | 75,615 | |||||||||
| Goodwill | 1,209 | 1,209 | |||||||||
Intangible assets, net | 9,303 | 9,942 | |||||||||
| Right-of-use operating lease assets, net | 3,930 | 4,339 | |||||||||
| Other non-current assets | 16,114 | 16,122 | |||||||||
| Total assets | $ | 351,037 | $ | 357,167 | |||||||
Liabilities and Shareholders’ Equity | |||||||||||
| Current liabilities: | |||||||||||
| Accounts payable | $ | 41,813 | $ | 43,109 | |||||||
| Accrued liabilities | 22,211 | 18,856 | |||||||||
| Other liabilities, short-term | 19,129 | 20,177 | |||||||||
| Total current liabilities | 83,153 | 82,142 | |||||||||
| Long-term liabilities: | |||||||||||
Note payable, net | 248,592 | 247,522 | |||||||||
Operating lease liabilities, long-term | 2,407 | 2,820 | |||||||||
| Other liabilities, long-term | 2,102 | 1,136 | |||||||||
| Total liabilities | 336,254 | 333,620 | |||||||||
Shareholders’ equity: | |||||||||||
Total shareholders’ equity | 14,783 | 23,547 | |||||||||
Total liabilities and shareholders’ equity | $ | 351,037 | $ | 357,167 | |||||||
ESTABLISHMENT LABS HOLDINGS INC.
Reconciliation of EBITDA and Adjusted EBITDA
(In thousands)
(Unaudited)
The following is a reconciliation of net loss to EBITDA and Adjusted EBITDA:
| Three Months Ended March 31, | |||||||||||
| 2026 | 2025 | ||||||||||
| Net loss | $ | (13,382) | $ | (20,710) | |||||||
| Interest expense | (7,088) | (5,853) | |||||||||
| Interest income | 26 | 250 | |||||||||
| Provision for income taxes | (288) | (914) | |||||||||
| Depreciation and amortization | (2,478) | (2,335) | |||||||||
| EBITDA | (3,554) | (11,858) | |||||||||
| Stock compensation expense & compensation paid in stock | (3,100) | (2,544) | |||||||||
| Foreign currency gain (loss) | (285) | 2,784 | |||||||||
| Restructuring charges | (1,373) | — | |||||||||
| Adjusted EBITDA | $ | 1,204 | $ | (12,098) | |||||||
FAQ
How did Establishment Labs (ESTA) perform financially in Q1 2026?
Establishment Labs reported Q1 2026 revenue of $59.9 million, up 44.7% from $41.4 million in Q1 2025. Gross profit was $42.3 million with a 70.7% margin, and net loss narrowed to $13.4 million compared to a $20.7 million loss a year earlier.
What guidance did Establishment Labs (ESTA) give for fiscal 2026?
The company raised its 2026 revenue guidance to $266.5 million to $268.5 million, up from $264–$266 million. It expects gross margin of 71.2%–72.2%, operating expenses of $195–$200 million, positive adjusted EBITDA every quarter, and to be free cash flow positive in the second half of 2026.
How is Establishment Labs’ minimally invasive business performing?
In Q1 2026, minimally invasive revenue was $9.1 million. Management now expects this business to generate more than $35 million in 2026, up from prior guidance of $30 million, and indicated it could represent at least 13% of total 2026 revenue.
What was Establishment Labs’ profitability and adjusted EBITDA in Q1 2026?
Q1 2026 loss from operations was $6.5 million, improving from a $16.9 million loss in Q1 2025. Adjusted EBITDA was positive at $1.2 million, compared with a loss of $12.1 million a year earlier, marking the company’s third consecutive quarter of positive adjusted EBITDA.
What is Establishment Labs’ cash position and cash usage?
The company ended March 31, 2026 with a cash balance of $68.1 million. Cash use during the quarter was $7.5 million, an improvement compared to cash use of $21.2 million in the prior-year quarter, reflecting reduced cash burn alongside higher revenue.
How did Motiva U.S. revenue trend for Establishment Labs?
Motiva sales in the United States reached $19.6 million in Q1 2026. This compares with $6.2 million in the prior-year period and was also up 13.3% from Q4 2025, showing rapid U.S. growth for the company’s core breast aesthetics product line.