Establishment Labs Holdings Inc. (ESTA) stock analysis
Close on Nov 12, 2026Market cap $2.05BP/E –Yield –
StockData Score
Prices as of Nov 12, 2026How the score works
Weak5 of 30 checks passed
Establishment Labs passes 5 of the 30 checks behind our score; 13 could not be run for lack of data and count as not passed. Each dot in the shape is one check — hover it for the numbers.
- Valuation
- 0/6
- Growth
- 3/6
- Past performance
- 1/6
- Financial health
- 1/6
- Dividend
- 0/6
What stands out
Guidance raised
Establishment Labs raised its full-year 2026 revenue outlook on Oct 29, 2026.
Growing faster than the industry
Revenue grew 38.3% over the last twelve months; the Surgical, Medical, and Dental Instruments and Supplies median is 10.6%.
Gross margin improving
Gross margin was 70.2% over the last twelve months, against 68.7% a year earlier.
Net margin above its 5-year average
Net margin was -14.6% over the last twelve months, against a 5-year average of -40.3%.
What to watch
Return on equity under 15%
Return on equity was -241% over the last twelve months and averaged -465% over five years; we look for 15% on both.
Return on capital under 10%
Return on invested capital was -6.7%, below the 10% that usually covers the cost of capital.
High debt
Debt is 1717% of shareholders' equity, above the 40% we consider low.
Revenue growing under 10% a year
Revenue grew 9.3% a year over the last three fiscal years, short of the 10% we look for.
Valuation0/6
P/E against its history
Not enough price and earnings history to compare.
P/E against the industry
Needs positive earnings and enough profitable companies in the industry.
EV/EBITDA against its history
Needs positive EBITDA and price history.
P/B above the industry
Establishment Labs's price-to-book of 131.14 is above the Surgical, Medical, and Dental Instruments and Supplies median of 3.41.
Price against fair value
We could not estimate a fair value: it needs at least two valuation methods with positive inputs.
Margin of safety
Depends on the fair value estimate.
Growth3/6
Revenue growing under 10% a year
Revenue grew 9.3% a year over the last three fiscal years, short of the 10% we look for.
EPS growth over 3 years
Needs positive EPS three years ago and today.
Earnings acceleration
Needs positive net income now, a year ago and five years ago.
Growing faster than the industry
Revenue grew 38.3% over the last twelve months; the Surgical, Medical, and Dental Instruments and Supplies median is 10.6%.
Guidance raised
Establishment Labs raised its full-year 2026 revenue outlook on Oct 29, 2026.
Gross margin improving
Gross margin was 70.2% over the last twelve months, against 68.7% a year earlier.
Past performance1/6
Return on equity under 15%
Return on equity was -241% over the last twelve months and averaged -465% over five years; we look for 15% on both.
Return on capital under 10%
Return on invested capital was -6.7%, below the 10% that usually covers the cost of capital.
Return on equity below the industry
Establishment Labs's return on equity of -241% is below the Surgical, Medical, and Dental Instruments and Supplies median of -30.2%.
Earnings over 5 years
Needs positive net income five years ago and in the latest year.
Net margin above its 5-year average
Net margin was -14.6% over the last twelve months, against a 5-year average of -40.3%.
Net margin below the industry
Establishment Labs's net margin of -14.6% is below the Surgical, Medical, and Dental Instruments and Supplies median of -13.5%.
Financial health1/6
High debt
Debt is 1717% of shareholders' equity, above the 40% we consider low.
Debt rising against equity
Debt to equity rose from 66.5% five years ago to 1717%.
Debt not well covered by cash flow
Operating cash flow over the last twelve months equals -5.0% of total debt; we look for at least 20%.
Interest not well covered
Operating income covers interest expense -0.6 times; we look for at least 5.
Short-term assets cover short-term debts
Current assets are 3.57 times current liabilities.
Bankruptcy risk in the grey zone
The Altman Z-score is 2.69; above 3 is the safe zone and below 1.8 the distress zone.
Dividend0/6
No dividend
Establishment Labs has not paid a dividend in the last twelve months.
Yield against Treasuries
No dividend.
Yield against the market
No dividend.
Dividend stability
No dividend.
Earnings cover
No dividend.
Cash-flow cover
No dividend.
Fair value
How we estimate itWe don't publish a fair value for Establishment Labs. It needs a US-dollar share price, at least two valuation methods with positive inputs (earnings, EBITDA, book value or sales) and, for companies with several share classes, classes that trade at the same price.
Valuation over time
Using the earnings and balance sheet published at each date, not today's.
- P/B at month end
- Own 5-year median 32.0
- Surgical, Medical, and Dental Instruments and Supplies median 3.4
An estimate from reported numbers and market multiples, not a price target or investment advice. It can be far off for companies whose profits are about to change sharply.
Market risk
From the past year of daily prices.
Liquidity
Low risk
- Average value traded per day
- $30.88M
- Value traded per 1% price move
- $10.76M
Downside
Medium risk
- Typical loss in a bad month
- 24.8%
- Volatility (annualized)
- 50%
- Sharpe ratio, 1 year
- -0.09
- Beta to the S&P 500 (5Y)
- 1.17
Typical bad-month loss, week by week
Margins
Share of revenue, fiscal years 2016 to 2025
Gross margin
Operating margin
Net margin
Growth rates
Compound annual growth to fiscal 2025
| Per year | 1 year | 3 years | 5 years | 10 years | Five-year pace |
|---|---|---|---|---|---|
| Revenue | +27.1% | +9.3% | +20.0% | – | |
| Gross profit | +33.6% | +11.1% | +22.7% | – |
Returns and balance sheet
10 fiscal years. Hover a measure to see how it is calculated.
| Measure | FY2016 | FY2020 | FY2025 | Trend |
|---|---|---|---|---|
| Return on equity | – | -66.5% | -133.3% | |
| Return on assets | – | -27.9% | -14.5% | |
| Current ratio | – | 5.11 | 3.04 | |
| Debt to equity | – | 0.66 | 10.51 | |
| Net debt to EBITDA | – | – | -5.24× | |
| Interest coverage | – | -3.0× | -1.5× | |
| Inventory turnover | – | 1.2× | 0.8× | |
| Capex to revenue | – | 2.5% | 2.9% | |
| Diluted shares | – | 23M | 30M |
Where the cash went
Fiscal 2021 to 2025, five years combined
Establishment Labs generated $277.62M from operations and spent $25.35M on capital expenditure, dividends and share buybacks. 100% of that went back into the business.
DuPont analysis
Return on equity split into margin, efficiency and leverage
| Fiscal year | Net margin | Asset turnover | Equity multiplier | Return on equity |
|---|---|---|---|---|
| FY2025 | -24.2% | 0.60× | 9.19× | -133.3% |
| FY2024 | -51.0% | 0.54× | 8.61× | -236.7% |
| FY2023 | -47.5% | 0.69× | 46.98× | -1537.7% |
| FY2022 | -46.5% | 0.92× | 8.24× | -353.5% |
| FY2021 | -32.5% | 0.86× | 2.35× | -65.5% |
| FY2020 | -45.0% | 0.62× | 2.38× | -66.5% |
| FY2019 | -42.6% | 0.77× | 2.14× | -69.9% |
| FY2018 | -34.5% | 0.70× | 2.69× | -65.4% |
Piotroski F-Score
Nine tests of profitability, balance sheet and efficiency, fiscal 2025 against fiscal 2024
- ProfitableNet income above zero-$51.06M
- Cash generatingOperating cash flow above zero-$50.89M
- Return on assets improvedROA up on the prior year-31.5% → -14.7%
- Earnings backed by cashOperating cash flow above net income-$50.89M vs -$51.06M
- Less leverageLong-term debt to assets fell63.3% → 69.3%
- Better liquidityCurrent ratio rose3.56 → 3.04
- No dilutionShare count did not rise28M → 30M
- Gross margin improvedGross margin up on the prior year65.97% → 69.32%
- More efficientAsset turnover rose0.62 → 0.61
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