Establishment Labs (ESTA) Q1 2026 earnings summary

Executive summary

• Q1 2026 revenue reached $59.9 million, up 45% year-over-year, driven by strong U.S. sales, Motiva adoption, and minimally invasive platform launches.

• Gross margin improved to 70.7% from 67.2% in Q1 2025, benefiting from higher-margin U.S. business and favorable channel mix.

• Adjusted EBITDA was $1.2 million, marking the third consecutive positive quarter; net loss narrowed to $13.4 million from $20.7 million.

• Cash balance stood at $68.1 million at quarter end, with cash use significantly reduced year-over-year.

• In April 2026, a new $300 million credit agreement was executed, with $265 million advanced to refinance prior debt.

Financial highlights

• Gross margin improved by 350 basis points to 70.7% from 67.2% in Q1 2025.

• SG&A expenses rose to $43.6 million, mainly due to higher sales and U.S. investment; adjusted SG&A was $41 million (68.4% of revenue).

• Total operating expenses increased to $48.8 million, supporting 44.7% revenue growth.

• Interest expense increased to $7.1 million, reflecting higher debt principal.

• Net cash used in operating activities was $4.3 million, a significant improvement from $20.7 million in Q1 2025.

Outlook and guidance

• Full-year 2026 revenue guidance raised to $266.5–$268.5 million, up 26–27% over 2025.

• Minimally invasive business expected to exceed $35 million in 2026.

• Gross margin guidance for 2026 is 71.2–72.2%.

• Positive adjusted EBITDA expected every quarter; free cash flow positive in the second half of 2026.

• Management expects available cash and operations to cover liquidity needs for at least the next 12 months.