ESTABLISHMENT LABS HOLDINGS (ESTA)·Q4 2025 Earnings Summary

Establishment Labs Q4 2025 Earnings: Triple Beat, First Profitable Quarter

February 24, 2026 · by Fintool AI Agent

Establishment Labs delivered a breakthrough quarter, posting its first positive Adjusted EBITDA while crushing revenue expectations with 45% year-over-year growth. The medical aesthetics company beat on all major metrics as U.S. Motiva adoption accelerated — achieving approximately 20% U.S. augmentation market share in just one year — and its Preservé tissue-preserving technology drove market expansion.

Did Establishment Labs Beat Earnings?

Yes — across the board. ESTA beat on revenue, EPS, and EBITDA in Q4 2025:

The EPS beat is particularly notable — the loss was 58% smaller than expected, reflecting the operating leverage management has long promised. Revenue growth of 45.2% YoY (from $44.5M in Q4 2024) demonstrates strong underlying demand.

Full Year 2025 Performance:

What Made This Quarter Different?

Three factors drove the inflection to profitability:

1. U.S. Motiva Dominance: U.S. revenue reached $17.3M in Q4 and $45.6M for the full year — achieving approximately 20% augmentation market share exiting 2025, something that "took the last new entrant almost 10 years to achieve." Over 1,500 accounts have been onboarded since launch.

2. Surgeon and Patient Demand: In a recent blinded survey, 88% of plastic surgeons said they either use or are interested in trying Motiva. When patients ask for an implant by name, 93% of the time it's Motiva. Surgeons with greater than 50% Motiva share saw year-over-year augmentation volume growth more than double that of surgeons primarily using another brand.

3. Preservé Excitement: The minimally invasive procedure is "game-changing" per surgeons — 81% of organic website leads said they're only interested in breast augmentation if they can get Preservé. The procedure commands pricing 2x traditional augmentation ($18K+ vs ~$9K average).

"For decades, plastic surgeons contended these ideas were not important to patients. You just have to look at the social media response and know that patients feel very differently." — CEO Peter Caldini

4. Operating Discipline: Despite 45% revenue growth, operating expenses were flat year-over-year at $49.5M. SG&A was flat at $44.0M while revenues scaled dramatically.

What Did Management Guide?

Management provided strong forward guidance that exceeded Street expectations:

Key 2026 guidance metrics:

• U.S. to exceed 30% of total sales (up from ~22% in 2025)
• OUS growth expected in single digits
• Gross margins to improve 200-300 bps
• Operating expenses of $195-200M
• Positive Adjusted EBITDA every quarter
• Free cash flow positive expected in second half

"We are positioned for our first quarter of positive cash flow in 2026, and full year of positive cash flow in 2027." — CEO Peter Caldini

How Did the Stock React?

Down 4.7% to $71.43 from the prior close of $74.96.

The muted reaction despite strong results may reflect:

• High expectations already priced in (stock up 169% from 52-week low of $26.56)
• Guidance in-line with elevated Street estimates
• Q1 typically the seasonally weakest quarter

Geographic Segment Breakdown

Q4 2025 revenue by geography:

Direct markets focus paying off: European direct markets delivered more than 20% growth for the third consecutive quarter, led by outstanding performances in the UK, Germany, and Spain.

Preservé: The Market Expansion Driver

Preservé is moving from early experience to full launch in March 2026. Key metrics:

"One plastic surgeon told me recently that Preservé was game-changing. He used to have a local practice occasionally, regionally. Now he has patients flying in from all over America." — CEO Peter Caldini

Management expects the minimally invasive platform (Preservé + Mia) to exceed $30 million globally in 2026.

Could Preservé reach 50% of U.S. revenues? SVP Global Strategy Raj Denhoy said it's "not outside the realm of possibilities" and noted the higher margins would be a "tailwind to what you're going to see on the gross margin side."

What Changed From Last Quarter?

The sequential acceleration is notable:

• Revenue growth accelerated from +4.9% QoQ in Q3 to +20.1% QoQ in Q4
• EBITDA flipped positive for the first time, rising $6.7M sequentially
• Cash increased $4.9M vs. typical quarterly burn, signaling cash flow inflection

Reconstruction: Doubling the TAM

Management submitted Motiva implants to the FDA for primary and revision breast reconstruction in December 2025. This effectively doubles the total addressable market in the United States with higher ASPs.

• Flora breast tissue expander already in 200 facilities nationwide
• Revenue impact expected primarily in 2027-2028 per management
• Will require sales force expansion with hybrid reps and dedicated hospital network coverage

"It is likely a 2027 and 2028 and beyond story for us... There is the blocking and tackling of simply getting into hospitals, right? It takes time to work through the VAC committees and to get on contracts." — SVP Global Strategy Raj Denhoy

Q&A Highlights

On U.S. Sales Force Expansion (Josh Jennings, TD Cowen):

• Adding up to 15 more sales reps in 2026; majority already hired
• Continuing to hire "seasoned industry veterans" with strong track records
• Best-in-class commercial organization is "a key driver for our success"

On Minimally Invasive Market Expansion (Josh Jennings):

• CEO Caldini confirmed the minimally invasive platform is driving both share gains and new patient acquisition
• 15% of U.S. Preservé patients "were not considering breast augmentation prior to learning about the procedure"
• "It's a real driver for what we think is not only to drive share for us in the market, but also to bring new patients and new women to the category"

On China (Mason Carrico, Stephens):

• "A big focus for us" with improved sell-out in second half of 2025
• Distributor building commercial capability "slower than we would have liked"
• Expectation remains "to have the same type of dominant share in China that we do throughout the rest of Asia"

On 2026 Growth Algorithm (Mason Carrico):

• Majority of U.S. growth will come from continued unit growth and share gains
• Preservé will contribute but "we're still so early in the penetration"
• "For us, it's still primarily about penetration into this market and taking share from the incumbents"

On Account Penetration (Caitlin Roberts, Canaccord):

• Many of the 1,500+ accounts are still in early stages of adoption
• "We're still quite low in a number of markets" based on timing of onboarding
• 2026 focus: "continuing to expand the number of accounts" AND "going quite a bit deeper into all these accounts"

Management Transition

Effective March 9, 2026:

• Raj Denhoy transitions from CFO to SVP, Global Strategy to focus on business development, go-to-market strategies, and innovation prioritization
• Cassandra Harris joins as Chief Financial Officer, bringing "strong background in operational excellence and proven track record of strengthening financial discipline"

"With the financial performance of the company in a very good spot, there are things like business development, go-to-market strategies, the way that we prioritize things in our portfolio of innovation that I can now spend more time focusing on." — Raj Denhoy

Key Risks to Monitor

1. Debt Overhang: The $248M Oaktree note carries meaningful interest expense (~$7M/quarter). Credit facility enters last year of term in April; management considering refinancing options.

2. U.S. Execution Dependency: With U.S. expected to exceed 30% of sales, continued penetration is critical to hitting growth targets.

3. Competition: The breast implant market is competitive with established players like Allergan and Mentor.

4. China Turnaround: While improving, China remains below expectations and needs continued management attention.

5. Seasonality: Q1 is typically the weakest quarter; management noted sequential growth will be modest.

Looking Ahead: 2026 Catalysts

Innovation Pipeline: Small sizes, reconstruction indication, Ergonomix-2 (enables Mia launch in U.S.), and GEM are all in development. Management called it a "super cycle of innovation."

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View the full Q4 2025 earnings call transcript or explore Establishment Labs company research.