Establishment Labs Holdings Inc.

Q1 2026 revenue was $59.9 million, up 44.7% year over year. Adjusted EBITDA was $1.2 million, compared with a loss of $12.1 million in Q1 2025, marking the third consecutive quarter of positive adjusted EBITDA. Gross profit was $42.3 million, or 70.7% of revenue, versus 67.2% in Q1 2025, a 350 basis point improvement. U.S. revenue was $19.6 million, up 216% year over year and 13.3% quarter over quarter. OUS revenue grew about 15% year over year. Cash ended the quarter at $68.1 million, down $7.5 million from year-end 2025. Full-year revenue guidance was raised to $266.5 million-$268.5 million, up from $264 million-$266 million, implying roughly 26%-27% growth over 2025. Full-year gross margin guidance is 71.2%-72.2%, operating expenses are expected at $195 million-$200 million, minimally invasive revenue is expected to exceed $35 million in 2026, and the company expects adjusted EBITDA to be positive in each quarter of 2026.

Peter Caldini said the quarter showed strong operating leverage and early proof that the U.S. launch is accelerating, with record weekly U.S. order counts and rising account penetration. He emphasized that Motiva’s safety data, the minimally invasive platform, and the broader product pipeline could expand the category rather than just take share, and he repeatedly framed Preserve and Mia as market-expanding innovations. His tone was confident but still cautious, noting the company is forecasting conservatively because of geopolitics and its focus on becoming cash flow positive.

Sandra Harris highlighted the main financial drivers: higher U.S. mix, growth in the direct business, and the launch of minimally invasive procedures in the U.S., which lifted gross margin to 70.7% from 67.2%. She said SG&A rose to $43.6 million from $39.7 million, while adjusted SG&A was $41 million, or 68.4% of revenue, showing about 50 basis points of leverage. Cash fell to $68.1 million, mainly due to U.S. investment, but she said the refinancing improved liquidity, introduced PIK interest, and that the company has enough cash to reach cash flow positive with no plans for equity financing. She also guided to 71.2%-72.2% gross margin, $195 million-$200 million in operating expenses, and noted Q2 EBITDA should be about double Q1 despite elevated spending.

Analysts focused on how much of the U.S. momentum came from new Motiva account conversions versus Preserve adoption, and management said both are contributing, though the base Motiva business is still the larger driver today. Questions also centered on whether Preserve is incremental or cannibalistic; management said the minimally invasive platform appears complementary, expands the patient base, and in some markets has helped bring in new accounts. Other questions covered supplier pricing, the debt refinancing, and the macro backdrop, including the Middle East; management said silicon costs are locked in for 2026, freight has seen some surcharges, and the Middle East is less than 5% of revenue with no broad demand slowdown seen so far.