ESTABLISHMENT LABS HOLDINGS INC. (ESTA) Stock Analysis
ESTABLISHMENT LABS HOLDINGS INC.
▾ What's in the 68/100 risk score? (higher = riskier)
Contributions (weight × component score) sum to the total. This near-term score now includes fundamental health (leverage, FCF trend). It excludes the Altman Z score, whose retained-earnings input this filer does not report separately. See the Financial Health section for the full balance-sheet read.
How to read ESTA (pre-profit growth)
This company is reinvesting instead of generating profit, so a standard DCF cannot price it. The useful question is whether the growth the market is paying for is achievable — and whether the company can fund itself until then.
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Reverse-DCF — the growth the price demands ↓
It shows exactly how fast the business must grow to justify today's price. Compare that to what comparable companies have actually achieved.
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Cash runway ↓
Can it reach profitability before it has to raise money and dilute shareholders?
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Interactive calculator ↓
Set your own growth + margin assumptions and see what the business would be worth if you are right.
Standard DCF doesn't fit ESTA well — but that's expected for this kind of business. The Rule of 40 (Pre-Profit Growth) Lens below uses the metrics actually used by analysts who value medical devices. Reverse DCF + Football Field also work as cross-checks.
How does ESTA stack up against its closest peers?
We take the 7 same-industry companies most similar to ESTA (similar size) and check what investors are paying for each dollar of their revenue (or profits). If ESTA is much more expensive on the same yardstick, that's a red flag — unless you have a specific reason it deserves a premium. For a leveraged business, EV/EBIT and FCF yield (both in the table) are usually more reliable than EV/Sales, because revenue multiples ignore differences in margins and debt.
▾ What's "EV / Sales" in plain English?
EV (Enterprise Value) = market cap + total debt − cash. It's "what you'd pay to buy the entire company outright" — you pay the market cap to shareholders and take over their debt, but you keep their cash. EV is fairer than market cap alone because it includes the debt the new owner inherits.
EV / Sales = EV ÷ annual revenue. So "2.5×" means investors pay $2.50 of enterprise value per $1 of yearly sales. Higher = market is paying more per dollar of sales (usually because they expect future growth or fat margins).
p25 / median / p75 are the 25th, 50th (middle), and 75th percentile of the peers' multiples. Half the peers fall between p25 and p75. The median (p50) is the typical peer — that's the benchmark we compare to.
| EV / SalesEV / Sales — For every $1 of yearly revenue, this is how many dollars investors pay to own the whole business (including debt). Why it matters: Works for pre-profit growth companies where P/E and FCF don't apply. The most apples-to-apples cross-company multiple because it ignores accounting choices. Reference: 1–3x for mature companies · 4–10x for software/SaaS · 10–20x for hypergrowth · >20x is rare and demanding Full explanation → |
1.5x / 3.6x / 5.0x |
| EV / Gross ProfitEV / Gross Profit — Enterprise value divided by gross profit — the multiple paid for what each dollar of sales contributes after direct costs. Why it matters: More refined than EV/Sales for high-margin businesses (software, marketplaces) where gross margin is the real economic engine. Reference: 8–15x for SaaS · 15–25x for hypergrowth software · >30x demanding Full explanation → |
2.7x / 5.4x / 7.1x |
Bold middle number = median peer. Half the peers trade above it, half below. Computed over 7 same-industry peers; implausible multiples excluded.
⚠️ Important caveat: peer multiples only work if the peers are genuinely comparable. Always check the peer list below — if the auto-picker grabbed micro-caps or unrelated businesses, the comparison is noise. A medical-device giant priced against tiny biotech startups won't produce a useful signal.
▾ View peer list (8)
| Ticker | Company | Industry | Mcap | EV/Sales | EV/GP | EV/EBIT | FCF Yield |
|---|---|---|---|---|---|---|---|
| XRAY | DENTSPLY SIRONA Inc. | Medical Devices | $2.1B | 0.7x | 1.3x | — | 3.4% |
| NVCR | NovoCure Ltd | Medical Devices | $2.0B | 3.3x | 4.4x | — | 1.2% |
| TMDX | TransMedics Group, Inc. | Medical Devices | $2.3B | 3.8x | 6.4x | 21.4x | 3.6% |
| PLSE | PULSE BIOSCIENCES, INC. | Medical Devices | $1.7B | 4,943.6x | — | — | — |
| PRCT | PROCEPT BioRobotics Corp | Medical Devices | $1.5B | 5.0x | 7.9x | — | 15.5% |
| IRTC | iRhythm Holdings, Inc. | Medical Devices | $3.7B | 5.0x | 7.1x | — | 9.4% |
| TNDM | TANDEM DIABETES CARE INC | Medical Devices | $1.2B | 1.5x | 2.7x | — | 11.0% |
| UFPT | UFP TECHNOLOGIES INC | Medical Devices ·fallback | $1.7B | 3.0x | 10.8x | 19.9x | 4.8% |
Quality & solvency checks
Cheap stocks can be cheap for a reason. These screens warn when a low valuation comes paired with structural fragility.
Why it matters: Cheap-looking stocks (low P/E or P/B) often have low Z-scores because the market knows the company is dying. Z-score warns you before you fall into a value trap.
Reference: > 3.0 = safe zone · 1.81–3.0 = grey zone · < 1.81 = distress zone
Full explanation →
We can't produce a trustworthy Altman Z here: retained earnings weren't separately reported in our data, so a core input would have to be fabricated. Rather than show a categorical "distress" verdict from an invented number, we mark it unavailable. Judge financial health from the leverage, cash position, and the measurable Piotroski checks instead.
Why it matters: High score = fundamentals improving. Low score = deteriorating. Especially powerful for filtering cheap stocks: cheap + high F-score historically outperforms; cheap + low F-score is often a value trap.
Reference: 7–9 = strong · 4–6 = mediocre · 0–3 = weak
Full explanation →
▾ The checks — what passed, what didn't (and what we couldn't measure)
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✗ Positive net incomeNet income -$51.1M in FY2025.Why this matters: Does the company actually earn a profit? Sustained losses eventually force it to raise money — diluting you — or take on debt.
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✗ Positive operating cash flowOperating cash flow -$50.9M (was -$58.5M the prior year).Why this matters: Profit can be an accounting figure; cash from running the business is harder to fake. Negative operating cash flow means the core business consumes cash and must be funded externally.
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✓ Cash flow backs up reported profitOperating cash flow -$50.9M vs net income -$51.1M.
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✓ Return on assets improvingReturn on assets -14.3% vs -24.4% a year ago.
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✗ Debt load (vs assets)Long-term debt is 69.3% of assets vs 63.3% a year ago ($247.5M of $357.2M assets).Why this matters: Rising debt relative to assets means more risk and more cash going to interest instead of shareholders. Falling debt is a sign of strengthening.
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✗ Short-term liquidity (current ratio)Current ratio 3.04x vs 3.56x a year ago.Why this matters: The current ratio compares assets it can turn to cash within a year against bills due within a year. Below 1.0 means it may struggle to cover near-term obligations.
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✗ Share count (dilution)Share count rose 5.2% (28.2M → 29.6M year-over-year).Why this matters: Issuing lots of new shares splits the pie into more pieces, shrinking your slice. Stable or falling share count protects existing owners.
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✓ Pricing power (gross margin)Gross margin 69.3% vs 66.0% a year ago.
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✓ Sales per asset (asset turnover)Asset turnover 0.59x vs 0.48x a year ago.
Missing data is never counted as a pass or a fail — it's shown as n/a and excluded from the denominator. Each check compares the company against its own prior year.
Plain English: the company holds about $76M in cash and is burning roughly $51M/year in operations. At that pace, the cash lasts 18 mo before it must raise capital (diluting shareholders), take on debt, or cut spending.
Assumes constant burn and ignores financing/asset sales. For pre-profit biotech and growth companies, this matters more than a DCF — a great drug pipeline is worthless if they run out of money before approval.
What if you assume different inputs?
Here's where we land — and what happens if you change the assumptions. Drag the sliders to set your own Discount RateDiscount Rate — The annual return you demand for taking single-stock risk instead of buying a safe Treasury or index fund.
Why it matters: Higher discount rate = stricter valuation (a stock has to produce more cash to be worth holding). Lower = more generous.
Reference: 8–12% is standard · 9–10% matches S&P 500 historical return · Below 7% is illogical for single-stock risk
Full explanation → (the annual return you demand for single-stock risk) and terminal growth; the value updates live so you can see whether the stock looks cheaper or richer. The discount rate starts at 10.0%, the figure our model used for ESTA. Open Advanced to also change beta, growth and the rate path.
Note: no headline intrinsic value is published for this stock (the valuation is held for a data-quality reason — see the notes above). The calculator below is a what-if tool: the values it produces are your assumptions played out, not our estimate.
A full intrinsic value isn't shown for ESTA because the valuation is currently held for a data-quality reason (see the guardrail notes above). The reverse-DCF reading still works — it needs only the price and cash flow — but we won't publish a forward value until the underlying data passes our checks.
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⚙ Advanced — tinker with every input (beta, growth, rate path, margin → full intrinsic value)
A standard discounted cash flowDCF — Discounted Cash Flow — sums up all future cash a business will produce, adjusted for the fact that future dollars are worth less than dollars today.
Why it matters: It is the most fundamentally honest valuation method when applicable — but only works for companies with predictable, positive cash flow.
Reference: Best for: mature, profitable businesses. Fails for: pre-profit growth, banks, REITs.
Full explanation → (DCF) valuation is not meaningful for Establishment Labs Holdings Inc. due to its negative operating cash flow and net income, indicating a cash-burning growth stage. Investors are likely betting on continued revenue growth and potential future profitability from its medical device products. The primary quantifiable risk is the rising long-term debt, which has increased from $0M to $248M.
As of 3 months ago
Anatomy of a share
What you're buying per share. Bars are at the same scale so you can see the relative size of revenue, costs, cash flow, and debt — not just read them in a table.
What's free cash flow / what do these mean?
Revenue per share — how much the business earns from customers, divided by the number of shares outstanding. Top of the income statement.
Earnings per share — profit left after operating costs, interest, and taxes, per share. Two versions appear on this page and are not interchangeable: GAAP diluted EPS uses the company's weighted-average diluted share count during the reporting period (this is the "earnings" in "price-to-earnings"); net income per current share divides annual net income by today's share count. They differ whenever the share count has changed.
Owner-earnings free cash flow per share — the cash the business produces for shareholders. Savng's owner-earnings FCF subtracts capital expenditures and stock-based compensation from operating cash flow (SBC is a real dilution cost even though it's non-cash). This is deliberately more conservative than "standard" FCF, which subtracts only capital expenditures — so our figure is lower than the headline FCF you'll see elsewhere. FCF funds dividends, buybacks, debt repayment, and acquisitions; a company can report positive earnings yet negative FCF.
Debt per share — total interest-bearing borrowings divided by shares. High debt-per-share next to thin FCF-per-share is a fragility signal.
What you actually need to decide
Every stock price is a disagreement. Here's the single thing that must go right for the bulls, the single thing that breaks the thesis, and the concrete signposts to watch so you can update your view as real results arrive.
- Acceleration or deceleration of revenue growth in upcoming quarters
- Improvement in operating cash flow towards positive territory
- Updates on new product launches or regulatory approvals
The trend, in plain numbers (FY2024 → FY2025, latest reported)
Straight from the financial statements — no model, no opinion. For a small or unprofitable company, the direction of these numbers usually tells you more than any single valuation.
- Revenue grew +27% to $211.1M.
- Free cash flow is negative at -$68.4M — the cash burn narrowed vs last year.
- Gross margin improved to 69% (+3 pts).
- Still unprofitable at -$51.1M — loss narrowing.
Nothing was clearly worsening year-over-year.
Management & Leadership
Juan José Chacón-Quirós serves as the CEO and founder of Establishment Labs, leading the company since its inception. His leadership has focused on developing and commercializing advanced medical aesthetics technologies, particularly in breast aesthetics.
Names marked "per latest SEC filing" come from Form 4 / Item 408 filings and take precedence over our AI-compiled roster when they differ.
What They Make
Establishment Labs Holdings Inc. develops and manufactures medical aesthetic products, primarily focusing on advanced silicone breast implants and related technologies, sold to plastic surgeons and aesthetic clinics.
End Markets
Revenue Drivers
Why Is It Priced Like This?
Why Customers Pay
What we use instead: earnings (P/E, EV/EBIT), book value (P/B) — computed from the figures this company does report, shown in the sections below. Those numbers are unaffected by the missing cash-flow data.
The market is pricing ESTA based on expectations for continued revenue growth (13.6%/yr over 4yr) and the potential for future profitability, despite current negative net income and operating cash flow. The market may be assigning value to the company's product pipeline and potential for market share gains in the premium breast aesthetics segment, which is not fully captured by backward-looking cash flow models.
Business Model & Valuation
How They Make Money
The company funds itself primarily through equity raises and debt, as evidenced by rising long-term debt from $0M to $248M, given its negative operating cash flow.
Growth / Revenue DCF
Negative free cash flow: revenue/margin growth model used - standard FCF DCF is unreliable for companies still scaling.
Show advanced inputs
| Revenue Growth | 13.6% |
What this model does NOT do: this is a consolidated owner-earnings FCF model. Standalone segment assumptions: none. It does not project its revenue segments independently; their combined effect is embedded in the historical revenue and cash-flow trend the model extrapolates. The calculator above can only approximate a segment's impact through the single consolidated growth rate — it cannot model any one line separately. For a true segment-level view, build a separate model from the company's segment disclosures.
Maturity & Competitive Position
Moat Signals
Revenue is growing at 13.6%/yr over the last four years, from $127M to $211M.
Geography & Markets
Establishment Labs is headquartered in Costa Rica with a global presence, distributing its products internationally across various regions, though specific geographic revenue percentages are not available from current data.
Geographic Risks
Market Signals
These are timing signals, not value signals — they describe the stock's recent price behavior, not what the business is worth. Use them for the "the thesis looks good, but is now the moment?" question. Each tile below explains what it's saying.
Why it matters: Short-term contrarian indicator. Extreme readings often precede mean reversion, though not always.
Reference: 30–70 normal · >70 overbought · <30 oversold
Full explanation → (14)53.8NeutralMomentum is balanced — neither overbought nor oversold.
Why it matters: When the fast line crosses above the slow line, short-term momentum is turning up; below, turning down. A timing cue, not a value signal.
Reference: Line above signal = bullish momentum · below = bearish
Full explanation →BullishLine above signalThe fast trend is above the slow trend — short-term momentum is currently upward.
Technicals describe price, not the business. A great company can have a "bearish" tape (a buying chance) and a weak one a "bullish" tape (a trap). Pair these with the valuation and health sections above.
QUALITY
Data Quality & Risk Flags (4 notes — click to expand/collapse)
Guardrail Notes (4)
- FCF negative: revenue/margin growth model projects future cash flows from revenue trajectory.
- Price is far above the model output - market may be pricing optionality, narrative catalysts, or margin expansion beyond what trailing cash flows support.
- Extreme valuation (P/IV withheld — see the note above); output dominated by data/units issue (often a multi-class share-count mismatch). Suppressed.
- DATA UNAVAILABLE: per-share values suppressed due to missing/unreliable shares data.
FINANCIALS
Financial Statements (5-year tables — click to expand)
From ESTABLISHMENT LABS HOLDINGS INC.'s SEC filings (EDGAR).
Income (5yr)
| Year | Revenue | Net Income | EPS |
|---|---|---|---|
| 2025 | 211.1M | -51.1M | $-1.72 |
| 2024 | 166.0M | -84.6M | $-3.00 |
| 2023 | 165.2M | -78.5M | $-3.07 |
| 2022 | 161.7M | -75.2M | $-3.08 |
| 2021 | 126.7M | -41.1M | $-1.72 |
Cash Flow (5yr)
| Year | Operating CF | CapEx | − SBC & adj. | Free Cash Flow |
|---|---|---|---|---|
| 2025 | -50.9M | 6.0M | 11.4M | -68.4M |
| 2024 | -58.5M | 6.1M | 14.4M | -79.0M |
| 2023 | -88.5M | 7.9M | 14.4M | -110.8M |
| 2022 | -52.2M | 2.9M | 13.4M | -68.4M |
| 2021 | -27.5M | 2.4M | 10.4M | -40.4M |
How we define FCF: operating cash flow − capital expenditure − stock-based compensation (owner-earnings basis — SBC is a real cost to shareholders even though it's non-cash). Latest year: -50.9M − 6.0M − 11.4M (SBC & adj.) = -68.4M. This is the same owner-earnings FCF definition the valuation model uses, though the DCF's starting value is a projected from revenue × terminal margin, not this single year.
Balance Sheet
| Total Assets | 357.2M |
| Total Liabilities | 333.6M |
| Equity | 23.5M |
| Total Debt | 247.5M |
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