Key Highlights

  • Revenue of USD 72.0 million rose 33.9% and beat the consensus estimate of USD 66.81 million.
  • GAAP loss per share of USD 0.35 was wider than the USD 0.26 consensus estimate but narrowed from USD 0.38.
  • U.S. Revenue climbed 119.0% to USD 26.0 million, while revenue outside the U.S. rose 9.7% to USD 46.0 million.
  • Adjusted EBITDA reached USD 6.4 million, and free Cash Flow of USD 5.1 million was the first positive quarter.

Establishment Labs Holdings Inc. (NASDAQ:ESTA) reported third quarter 2026 revenue of USD 71.99 million, up 33.9% from USD 53.8 million and above a consensus estimate of USD 66.81 million. The GAAP net loss was USD 10.7 million, or USD 0.35 per share, compared with USD 11.1 million, or USD 0.38, a year earlier. The loss per share was larger than a consensus estimate of a USD 0.26 loss. The loss from operations narrowed to USD 2.6 million from USD 4.0 million.

Gross Margin, Operating Leverage and Cash Flow

GAAP Gross Profit was USD 49.7 million, or 69.1% of revenue, against 70.1% a year earlier. Excluding USD 1.3 million of restructuring related inventory charges, adjusted gross Margin was 70.8%, up 70 basis points on growth in the higher margin U.S. Business and minimally invasive platform. Stronger distributor sales outside the U.S., about 60% of that revenue versus a planned 50%, diluted the mix. GAAP operating expenses were USD 52.3 million versus USD 41.7 million, while adjusted operating expenses were USD 49.6 million, or 68.8% of revenue, an improvement of 880 basis points.

Adjusted EBITDA rose to USD 6.4 million, an 8.9% margin, from USD 1.2 million. Operating Cash Flow was USD 7.7 million and free cash flow was USD 5.1 million, the first positive quarter in the company history. Cash totaled USD 75.8 million, and the note payable under the Oaktree Credit agreement stood at USD 267.8 million. Minimally invasive revenue grew 124% to about USD 9 million, and the company counted more than 2,100 U.S. accounts and over 400 surgeons trained on Preservé.

Raised 2026 Guidance and 2027 Growth Target

Chief Executive Officer Peter Caldini said the quarter showed strong global growth, rising operating leverage and a cash generation milestone. The company raised its 2026 revenue guidance to more than USD 274 million from USD 269 to 271 million. It projects adjusted gross margin of about 70.7%, adjusted operating expenses of USD 195 to 200 million, unchanged, and positive adjusted EBITDA for the full year. Management also raised minimally invasive revenue guidance to above USD 40 million from above USD 35 million.

Looking to 2027, the company targets 25% revenue growth and positive cash flow. Regulatory and Supply items also shape the outlook: the FDA approved additional smaller Motiva sizes in October, with commercial availability targeted before year end; the review of Motiva for breast reconstruction is progressing; and a new supply agreement with NuSil supports long term silicone capacity.

Markers for the Fourth Quarter and 2027

Several figures anchor the next report. Full year revenue above USD 274 million and adjusted gross margin near 70.7% set the 2026 reference points. The count of surgeons trained on Preservé, with 500 targeted by year end, and the 85% reorder rate among accounts that ordered Motiva in the second quarter track adoption. The FDA decision on Motiva for reconstruction remains pending. On the balance sheet, shareholders Equity was USD 15.6 million at September 30 against USD 23.5 million at year end, which keeps the cash flow trend and the Oaktree Debt balance in view.