ESTA — Establishment Labs Holdings Inc.

Summary of Establishment Labs Q1 2026 Earnings Call

1. Key Financial Results and Metrics

• Revenue: $59.9 million, up 45% from Q1 2025.
• Adjusted EBITDA: Positive $1.2 million, marking the third consecutive quarter of positive adjusted EBITDA.
• U.S. Revenue: $19.6 million, a 216% increase year-over-year and 13.3% quarter-over-quarter growth.
• Gross Margin: Improved to 70.7%, up 350 basis points from 67.2% in Q1 2025.
• Cash Position: Decreased by $7.5 million to $68.1 million, primarily due to investments in the U.S. market.

2. Strategic Updates and Business Highlights

• The U.S. market is a significant growth driver, now accounting for 32.7% of total revenue, up from 26.8% in Q4 2025.
• The launch of the minimally invasive platform (Preserve and Mia) is showing strong traction, generating $9.1 million in Q1 and expected to exceed $35 million for the year.
• The company has trained over 260 surgeons in the U.S. for the Preserve procedure, surpassing its goal of 200 by the end of 2026.
• Establishment Labs is actively pursuing FDA approval for Motiva implants in breast reconstruction, which could double its addressable market.

3. Forward Guidance and Outlook

• Revenue guidance for 2026 raised to $266.5 million to $268.5 million, reflecting a growth of approximately 26% to 27% over 2025.
• Gross margins expected to range between 71.2% and 72.2% for the full year.
• The company anticipates being cash flow positive in the second half of 2026, supported by improved profitability and working capital efficiency.

4. Bad News, Challenges, or Points of Concern

• The geopolitical landscape remains a concern, prompting a conservative approach to forecasting.
• The Middle East market represents less than 5% of total revenue, and while orders are expected in Q2, the company is monitoring potential macroeconomic impacts.
• Increased SG&A expenses due to higher sales and foreign exchange impacts, which could pressure margins if not managed effectively.

5. Notable Q&A Insights

• Management emphasized that the Preserve procedure is not cannibalizing the Motiva business but rather expanding the market by attracting new patients.
• There is optimism that minimally invasive procedures could become the standard of care in breast augmentation, driven by patient demand for less invasive options.
• Discussions with the silicone supplier, NuSil, are ongoing for a long-term agreement, focusing on co-development rather than just pricing.
• The company is closely monitoring the macroeconomic environment, particularly in the Middle East, but has not yet seen a significant impact on global demand.

This summary encapsulates the key points from the earnings call, highlighting both the successes and challenges faced by Establishment Labs as they navigate their growth strategy in the breast aesthetics market.