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Establishment Labs Holdings Inc (ESTA)
NASDAQ:ESTA

Establishment Labs Holdings (ESTA) AI Stock Analysis

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Establishment Labs Holdings

(NASDAQ:ESTA)

48Neutral
Establishment Labs Holdings is facing significant financial performance challenges with ongoing losses and negative cash flows, which heavily weigh down its overall stock score. Despite a promising US market launch and operational improvements, technical indicators suggest bearish momentum and valuation remains a concern due to negative earnings. The strategic leadership change and positive earnings guidance offer potential upside, but global demand issues and cash use risks limit the score.
Positive Factors
Product adoption
The steady growth in average daily orders suggests continued expansion of ESTA's active accounts and increased utilization of Motiva by surgeons.
Product safety
Motiva's safety outcomes are even more pronounced and reaffirm the view that the implant offers a revolutionary safety profile relative to competitive offerings.
US market performance
The US Motiva sales exceeded the expected guidance, indicating strong market performance.
Negative Factors
International business
ESTA's international business has been weak, and we worry that the trade war could weigh on its international growth.

Establishment Labs Holdings (ESTA) vs. S&P 500 (SPY)

Establishment Labs Holdings Business Overview & Revenue Model

Company DescriptionEstablishment Labs Holdings Inc., a medical technology company, manufactures and markets medical devices for aesthetic and reconstructive plastic surgery. The company primarily offers silicone gel-filled breast implants under Motiva Implants brand name. It also provides Motiva Ergonomix and Motiva Ergonomix2 gravity sensitive round soft silicone-gel-filled breast implants; and Motiva Flora Tissue Expander, a breast tissue expander, as well as distributes Puregraft line of products for autologous adipose tissue harvesting and redistribution. The company sells its products through exclusive distributors and direct sales force in Europe, Latin America, the Asia-Pacific, and internationally. Establishment Labs Holdings Inc. was incorporated in 2004 and is headquartered in Alajuela, Costa Rica.
How the Company Makes MoneyEstablishment Labs makes money primarily through the sale of its Motiva Implants, which are distributed to plastic surgeons and healthcare facilities worldwide. The company generates revenue by marketing and selling these implants directly or through a network of distributors in various international markets. A significant portion of its earnings is derived from regions where there is a high demand for cosmetic surgery, such as Latin America, Europe, and Asia. Establishment Labs also invests in research and development to innovate and expand its product offerings, which can lead to increased sales and market share. Strategic partnerships and collaborations with healthcare providers and industry experts further enhance its market presence and contribute to revenue growth.

Establishment Labs Holdings Financial Statement Overview

Summary
Establishment Labs Holdings faces ongoing financial challenges with consistent operational losses and negative cash flows. While there is stability in revenue and gross margins, profitability remains a concern. The balance sheet shows improvements in equity, but high leverage poses risks. Continuous efforts to manage cash flows and reduce losses are critical for future financial health.
Income Statement
The company's revenue growth has been relatively flat with minor increases over recent years, showing a slight increase of 0.53% from 2023 to 2024. Despite steady gross profit margins averaging around 66%, net margins are severely negative due to consistent losses, with the 2024 net profit margin at -50.94%. The EBIT and EBITDA margins are also negative, reflecting ongoing operational challenges.
Balance Sheet
40
The company's balance sheet shows high leverage with a debt-to-equity ratio of 0.08 in 2024, indicating a low level of debt relative to equity. However, the company has a positive equity ratio of 15.30%. Despite a significant rise in stockholders' equity from previous negative values, ongoing losses affect return on equity.
Cash Flow
The cash flow statement indicates difficulties in generating positive cash flow, with negative free cash flow growth and substantial operating cash outflows. The operating cash flow to net income ratio is negative, reflecting the challenges in covering net losses. However, there was some improvement in free cash flow in 2024 compared to 2023.
Breakdown
Dec 2024Dec 2023Dec 2022Dec 2021Dec 2020
Income StatementTotal Revenue
166.03M165.15M161.70M126.68M84.68M
Gross Profit
109.53M106.98M106.59M85.40M52.50M
EBIT
-49.99M-65.03M-39.66M-25.14M-27.92M
EBITDA
-56.22M-58.31M-56.90M-26.54M-24.93M
Net Income Common Stockholders
-84.60M-78.50M-75.21M-41.14M-38.12M
Balance SheetCash, Cash Equivalents and Short-Term Investments
90.35M40.03M66.36M53.41M84.52M
Total Assets
346.83M268.64M211.06M139.53M156.39M
Total Debt
4.20M192.22M178.66M53.81M51.76M
Net Debt
-86.14M152.19M112.31M391.00K-32.77M
Total Liabilities
293.74M250.25M219.25M88.79M81.43M
Stockholders Equity
53.09M18.39M-8.19M50.74M74.96M
Cash FlowFree Cash Flow
-64.63M-113.06M-86.43M-34.26M-16.42M
Operating Cash Flow
-58.52M-88.51M-52.17M-27.53M-12.51M
Investing Cash Flow
-15.61M-24.55M-34.79M-7.16M-5.56M
Financing Cash Flow
125.89M86.23M100.25M4.05M64.67M

Establishment Labs Holdings Technical Analysis

Technical Analysis Sentiment
Negative
Last Price33.27
Price Trends
50DMA
35.80
Negative
100DMA
36.85
Negative
200DMA
40.03
Negative
Market Momentum
MACD
-0.66
Negative
RSI
52.06
Neutral
STOCH
84.85
Negative
Evaluating momentum and price trends is crucial in stock analysis to make informed investment decisions. For ESTA, the sentiment is Negative. The current price of 33.27 is above the 20-day moving average (MA) of 31.08, below the 50-day MA of 35.80, and below the 200-day MA of 40.03, indicating a neutral trend. The MACD of -0.66 indicates Negative momentum. The RSI at 52.06 is Neutral, neither overbought nor oversold. The STOCH value of 84.85 is Negative, not indicating any strong overbought or oversold conditions. Overall, these indicators collectively point to a Negative sentiment for ESTA.

Establishment Labs Holdings Risk Analysis

Establishment Labs Holdings disclosed 62 risk factors in its most recent earnings report. Establishment Labs Holdings reported the most risks in the “Legal & Regulatory” category.
Finance & Corporate - Financial and accounting risks. Risks related to the execution of corporate activity and strategy
Latest Risks Added 0 New Risks

Establishment Labs Holdings Peers Comparison

Overall Rating
UnderperformOutperform
Sector (52)
Financial Indicators
Name
Overall Rating
Market Cap
P/E Ratio
ROE
Dividend Yield
Revenue Growth
EPS Growth
73
Outperform
$1.17B89.443.42%14.88%-86.70%
65
Neutral
$1.16B-12.08%3.85%-339.15%
NENEO
52
Neutral
$989.66M-8.57%10.10%8.79%
52
Neutral
$5.23B3.70-41.86%2.84%16.58%-0.16%
OPOPK
50
Neutral
$1.02B-3.04%-13.79%82.82%
48
Neutral
$954.55M-236.67%0.53%2.23%
* Healthcare Sector Average
Performance Comparison
Ticker
Company Name
Price
Change
% Change
ESTA
Establishment Labs Holdings
33.27
-17.98
-35.08%
OPK
Opko Health
1.25
0.00
0.00%
PCRX
Pacira Pharmaceuticals
25.18
-4.47
-15.08%
INVA
Innoviva
18.74
3.18
20.44%
NEO
NeoGenomics
8.00
-7.13
-47.12%
KMTS
Kestra Medical Technologies Ltd.
21.84
0.85
4.05%

Establishment Labs Holdings Earnings Call Summary

Earnings Call Date:May 07, 2025
(Q4-2024)
|
% Change Since: 0.00%|
Next Earnings Date:Aug 12, 2025
Earnings Call Sentiment Positive
The earnings call presented strong highlights, particularly around the successful US launch and operational efficiency improvements, which were offset by challenges in global demand, particularly in Latin America, and high cash usage due to US market investments.
Q4-2024 Updates
Positive Updates
Strong US Launch
US sales totaled $3.3 million in the first two months of the launch, exceeding expectations. Over 650 accounts have been fully onboarded with 450 placing orders, and 88% reordering.
Revenue Growth
Fourth-quarter revenue increased by 41% year-over-year to $44.5 million. Full-year sales were $166 million, with a forecast of 25% growth over 2024.
Operational Efficiency
Operating expenses reduced by $12.5 million in 2024 compared to 2023. EBITDA loss improved to $13.1 million from $17.4 million last year.
Expansion in Europe
Acquired distributor in Benelux to leverage infrastructure and achieve synergies. European distribution center in Antwerp is set for expansion.
Positive Gross Margin Trends
Gross profit improved to 68.5% of revenue compared to 65.2% last year, driven by higher production volumes and lower manufacturing costs.
Innovative Product Line
Strong interest in Motiva and new products like Mia and Preservé expected to drive growth. Mia Femtech and Preservé are anticipated to expand the market.
Negative Updates
Uneven Global Demand
Global demand outside the US remains uneven, with significant weakness in Latin America and meaningful declines in some EMEA countries.
Cash Usage
High cash usage in Q4 and expected in Q1 due to investments in US commercial efforts and inventory to support US launch.
Latin America Weakness
Revenues in Latin America were flat, indicating stabilization but no growth. Continued weakness in this region offset other strengths.
Uncertain Regulatory Timelines
Future growth partially dependent on US FDA approvals for new products, with timelines extending to 2026 and beyond for some indications.
Company Guidance
During Establishment Labs' fourth-quarter 2024 earnings call, the company provided guidance for 2025, projecting revenue between $205 million and $210 million, representing a 23% to 26% growth over 2024. The company highlighted a strong start in the U.S. market, with $3.3 million in sales in the first two months of its launch and an expectation of generating $5.5 million in sales for the first quarter of 2025. Establishment Labs plans to achieve its first positive EBITDA quarter in 2025, driven by U.S. sales growth and operational efficiencies. The company also noted that global demand outside the U.S. remains uneven, with mid-single-digit growth expected in EMEA and APAC regions, while Latin America is expected to remain flat. Establishment Labs aims for a gradual return to growth in these markets and has set a target of $35 million in U.S. revenue for 2025. Additionally, the company discussed its ongoing efforts to manage operating expenses, with a focus on achieving EBITDA positivity in the latter half of 2025 and cash flow breakeven by 2026.

Establishment Labs Holdings Corporate Events

Executive/Board ChangesBusiness Operations and Strategy
Establishment Labs Appoints Filippo Caldini as CEO
Positive
May 7, 2025

On May 6, 2025, Establishment Labs Holdings Inc. appointed Filippo ‘Peter’ Caldini as the Chief Executive Officer, effective May 7, 2025, following an extensive search process. Caldini, who has been serving as the interim CEO since March 2025, will also join the Board of Directors as a Class II director. This leadership change is expected to drive the company’s strategic goals, including achieving EBITDA positive status in 2025 and cash flow positive in 2026, as the company continues to innovate and expand its market presence, particularly with its upcoming launch in the United States.

Spark’s Take on ESTA Stock

According to Spark, TipRanks’ AI Analyst, ESTA is a Neutral.

The overall stock score is weighed down by financial performance challenges, including ongoing losses and negative cash flows. While the U.S. market launch and operational improvements are promising, global demand issues and high cash usage present risks. The technical indicators suggest a bearish outlook, and the negative P/E ratio reflects valuation concerns, leading to a lower overall score.

To see Spark’s full report on ESTA stock, click here.

Glossary
OutperformA stock rated as "Outperform" is expected to perform better than the overall market or a specific benchmark over the near-to-medium term. This rating suggests that the stock is likely to deliver higher returns compared to the average returns of other stocks in the same sector or market index. Investors might consider this stock a good buying opportunity.
NeutralA stock rated as "Neutral" is expected to perform in line with the overall market or a specific benchmark. This rating indicates that the stock is neither particularly attractive nor unattractive for investment. Investors may consider holding onto the stock, as it is not expected to either significantly outperform or underperform the market.
UnderperformA stock rated as "Underperform" is expected to perform worse than the overall market or a specific benchmark over the near-to-medium term. This rating suggests that the stock may deliver lower returns compared to the average returns of other stocks in the same sector or market index. Investors might consider selling the stock or avoiding it as an investment.

Disclaimer

This AI Analyst Stock Report is automatically generated by our AI systems using advanced algorithms and publicly available financial, technical, and market data. While the information provided aims to be accurate and insightful, it is intended for informational purposes only and should not be considered financial advice. Any content created by an AI (Artificial Intelligence) system may contain inaccuracies and/or contain errors. Investing in stocks carries inherent risks, and past performance is not indicative of future results. This report does not account for your personal financial circumstances, objectives, or risk tolerance. Always conduct your own research or consult with a qualified financial advisor before making investment decisions. The analysis and recommendations provided are based on historical and current data and may not fully reflect future market conditions or unexpected developments. Neither the creators of this report nor its affiliated entities guarantee the accuracy, completeness, or reliability of the information presented. Use this report at your own discretion and risk.