Sign in

You're signed outSign in or to get full access.

EL

ESTABLISHMENT LABS HOLDINGS INC. (ESTA)·Q3 2025 Earnings Summary

Executive Summary

  • Q3 2025 delivered strong execution: revenue rose 33.8% year over year to $53.8M and gross margin hit a record 70.1%; Adjusted EBITDA turned positive at $1.2M, marking the first EBITDA-positive quarter .
  • Estimates were beaten: revenue exceeded consensus ($53.8M vs $52.3M) and EPS loss narrowed better than expected (-$0.38 vs -$0.53); strength was driven by mix shift to the U.S., pricing, and operating expense discipline [functions.GetEstimates]*.
  • Guidance raised: 2025 revenue now expected to exceed $210M (from $208–$212M) and U.S. Motiva sales are set to meaningfully exceed $40M; management expects EBITDA to remain positive and to reach cash flow positive in 2026 .
  • Near-term catalysts: accelerating U.S. adoption (Q3 U.S. revenue $11.9M, +16% sequential in a seasonally slow quarter), minimally invasive platform uptake (PreserVe early experience ~300 cases U.S.), and gross margin expansion; APAC rebounded (+46% seq) .

What Went Well and What Went Wrong

What Went Well

  • Record gross margin 70.1% (up 620 bps YoY, +130 bps QoQ) on higher-margin U.S. sales and pricing; first positive Adjusted EBITDA ($1.2M) achieved ahead of plan .
  • U.S. momentum: Q3 U.S. revenue $11.9M (+16% QoQ), >1,300 surgeons now using Motiva; survey showed Motiva practices up 14.6% procedures YTD as patients request Motiva by name .
  • Minimally invasive traction: PreserVe early experience estimated ~300 cases, with ~100 women waitlisted; NEO tracking $8–$10M 2025 revenue, and combined NEO+PreserVe expected >$30M in 2026 .

What Went Wrong

  • GAAP net loss remains significant: Q3 net loss $11.1M despite operational progress; tariffs on Costa Rica imports persist, though impact managed .
  • China remains challenging with slower distributor scaling; management removed China contributions from near-term expectations earlier this year and continues to work with partners .
  • Operating expenses elevated versus prior year: Q3 OpEx $41.7M (+$2.8M YoY), reflecting U.S. investment; though trending lower QoQ vs Q2 spike .

Financial Results

Quarterly P&L and Key Metrics

MetricQ1 2025Q2 2025Q3 2025
Revenue ($USD Millions)$41.4 $51.3 $53.8
Diluted EPS ($USD)-$0.70 -$0.57 -$0.38
Gross Margin (%)67.2% 68.8% 70.1%
Adjusted EBITDA ($USD Millions)-$12.10 -$8.53 $1.17
Total Operating Expenses ($USD Millions)$44.8 $49.4 $41.7

Q3 2025 Comparative View

ComparisonValue
Q3 Revenue YoY$53.8M vs $40.2M (+33.8%)
Q3 Gross Margin YoY70.1% vs 63.9% (+620 bps)
Q3 vs Q2 Revenue$53.8M vs $51.3M (+$2.5M)
Q3 vs Q2 Adjusted EBITDA$1.17M vs -$8.53M (+$9.70M)

Consensus vs Actuals

MetricQ1 2025Q2 2025Q3 2025
Revenue Consensus Mean ($USD Millions)$41.1*$51.1*$52.3*
Revenue Actual ($USD Millions)$41.4 $51.3 $53.8
Primary EPS Consensus Mean ($USD)-$0.81*-$0.53*-$0.53*
Primary EPS Actual ($USD)-$0.70 -$0.56 -$0.38
EPS # of Estimates8*8*9*
Revenue # of Estimates7*8*8*

Values with asterisks retrieved from S&P Global.

Segment and Geographic Mix (Q3 2025)

Segment/RegionQ3 2025
U.S. Motiva Sales ($USD Millions)$11.9
Europe/Middle East/Africa (% of total)35.6%
United States (% of total)22.1%
Latin America (% of total)21.7%
Asia-Pacific (% of total)20.6%
APAC Sequential Growth+46%

KPIs

KPIQ3 2025
Surgeons using Motiva (U.S.)>1,300
U.S. revenue sequential change (Q3 vs Q2)+16%
PreserVe early experience cases (U.S.)~300
Flora tissue expander hospitals (U.S.)>150
Cash balance (quarter-end)$70.6M
Adjusted EBITDA$1.17M

Guidance Changes

MetricPeriodPrevious GuidanceCurrent GuidanceChange
Total RevenueFY 2025$208M–$212M Exceed $210M Raised (tightened to “> $210M”)
U.S. Motiva SalesFY 2025At least $40M Meaningfully exceed $40M Raised (qualitatively)
Gross MarginFY 2025+200–300 bps vs 2024 ~300 bps higher vs 2024 Raised (upper end)
Operating ExpensesQuarterly (2025)~$45–$46M per quarter ~$45–$46M per quarter (reaffirmed) Maintained
EBITDA Run-rateQ4 2025+First positive quarter in 2025 Remain EBITDA positive and improve Raised (trajectory)
Cash FlowFY 2026CF positive in 2026 CF positive in 2026; no equity needed Maintained (clarified financing)
Reconstruction PMA Supplement2025N/AFile PMA supplement by year-end New milestone
U.S. Small Sizes ApprovalEarly 2026N/AOn track for early 2026 New milestone
Minimally Invasive Portfolio (NEO+PreserVe)FY 2026NEO $8–$10M FY25 >$30M FY26 (combined) New FY26 target

Earnings Call Themes & Trends

TopicPrevious Mentions (Q1 & Q2)Current Period (Q3)Trend
U.S. Motiva adoption & sales force>900 accounts; 40–43 reps; U.S. guidance ≥$40M; sequential growth despite seasonality U.S. revenue $11.9M; >1,300 surgeons; adding ~15 reps for 2026 Acceleration
Gross margin expansion & tariffs+200–300 bps YoY despite tariffs (<50 bps impact) 70.1% gross margin; ~300 bps higher vs 2024; tariffs managed Improving
Minimally invasive (Mia, PreserVe)Mia $8–$10M FY25; PreserVe launch OUS; complementary positioning PreserVe ~300 U.S. cases; U.S. launch early 2026; NEO on track; >$30M FY26 target Strong adoption
China/Distributor dynamicsRemoved 2H China from guidance; slower ramp Stabilization OUS; China progress but cautious Stabilizing but cautious
Reconstruction (Flora expander; PMA)>90 hospitals; submit supplement in 2025 >150 hospitals; PMA supplement filing by year-end Progressing
Marketing & patient demandMeghan Trainor campaign; patients asking for Motiva Surgeons report patients choosing Motiva; social media advocacy Sustained momentum
Cash & financingCash use declining; $25M credit availability Cash $70.6M; drew $25M; considering refinance; index eligibility (Russell) Improving liquidity planning

Management Commentary

  • CEO: “We grew global revenue 34%… exceeded a 70% gross profit margin… achieved the first quarter of positive EBITDA… focus towards reaching cash flow positive next year.”
  • CFO: “Gross profit… 70.1%… primarily the result of higher margin sales in the United States… operating expenses… ~$45–$46M per quarter… Adjusted EBITDA was positive $1.2M… expect EBITDA will continue to improve… remain EBITDA positive from here on.”
  • CEO on demand: “Plastic surgeons consistently tell us that if they offer patients a choice between Motiva and legacy implants, it’s almost unanimous that patients will choose Motiva.”
  • CEO on PreserVe: “We are seeing as much as a 40% price premium… estimate that 300 PreserVe cases have been performed in the U.S., and at least 100 women on waitlist.”

Q&A Highlights

  • U.S./Q4 cadence: U.S. is largest market; momentum strong but prudent Q4 midpoint given first U.S. Q4; expect to exceed prior $40M U.S. guide .
  • China outlook: Working with partners; sell-out improving; building the business “the right way”; cautious near term .
  • Market dynamics vs peers: Not seeing weakness; growth driven by share capture and category expansion in breast aesthetics .
  • Market share math: U.S. augmentation market estimated ~$390–$400M (≈300k procedures; ASP ~$1,300); exit ~20% share by year-end .
  • 2026 growth drivers: Add ~15 reps; PreserVe U.S. launch; small sizes approval; combine new accounts with deeper penetration .

Estimates Context

  • Q3 2025 beat: Revenue $53.8M vs $52.3M consensus; EPS -$0.38 vs -$0.53 consensus; both stronger than expected, reflecting U.S. mix, pricing, and OpEx control [functions.GetEstimates]*.
  • Prior quarters also modestly positive vs consensus: Q1 revenue slightly above; EPS better than expected; Q2 in line to modest beat [functions.GetEstimates]*.
  • Implication: Street likely to raise FY 2025 revenue (above $210M) and tighten loss trajectory; ongoing gross margin expansion supports medium-term EPS revisions higher .

Values with asterisks retrieved from S&P Global.

Key Takeaways for Investors

  • Momentum inflecting: first positive Adjusted EBITDA, record 70.1% gross margin, accelerating U.S. adoption; sets up continued EBITDA expansion in Q4 and 2026 .
  • Guidance trend positive: FY25 revenue >$210M with U.S. “meaningfully” >$40M; mix and pricing drive margin trajectory toward upper end of prior range .
  • Structural growth drivers: minimally invasive (PreserVe, Mia) expanding TAM; NEO + PreserVe guided >$30M for FY26; U.S. reconstruction PMA supplement milestone near-term .
  • Watch list items: China distributor execution; tariff environment; operating expense discipline vs growth investment; refinancing of credit facility to reduce cash use .
  • Trading setup: Narrative catalysts—margin expansion, sustained U.S. growth, minimally invasive uptake—support estimate revisions; any confirmation of Q4 U.S. strength and PMA filing could be stock-positive .
  • Medium-term thesis: Path to cash flow positive in 2026 without equity; leverage from higher-margin U.S. revenue and controlled OpEx underpins EPS trajectory into 2027+ .
  • Execution checkpoint: Track U.S. surgeon adoption (>1,300), PreserVe training ramp in early 2026, and APAC distributor order cadence following Q3 rebound .