Establishment Labs Hldgs Reports Q2 2026 Results: Full Earnings Call Transcript

Establishment Labs Hldgs (NASDAQ: ESTA ) reported second-quarter financial results on Thursday. The transcript from the company's second-quarter earnings call has been provided below. APIs provide real-time access to earnings call transcripts and financial data. Visit to learn more.

View the webcast at Summary Full Transcript OPERATOR Good morning and welcome to Establishment Labs Hldgs' second quarter 2026 earnings call. At this time, all participants will be in a listen-only mode. At the end of this call, we will open the line for a question-and-answer session, and instructions will follow at that time. As a reminder, today's call is being recorded.

I will now turn the call over to Malavika William, VP, Global Head of Corporate Communications and Marketing. Please go ahead. Malavika William, VP, Global Head of Corporate Communications and Marketing Thank you, operator, and thank you, everyone, for joining us. With me today is Peter Cialdini, our Chief Executive Officer, and Sandra Harris, our Chief Financial Officer.

Following our prepared remarks, we'll take your questions. Before we begin, I would like to remind you that comments made by management during this call will include forward-looking statements within the meaning of federal securities laws. These include statements on Establishment Labs Hldgs' financial outlook and the company's plans and timing for product development and sales. These forward-looking statements are based on management's current expectations and involve risks and uncertainties.

com. I'd also like to remind you that our comments may include certain non-GAAP financial measures with respect to our performance, including but not limited to sales results, which can be stated on a constant currency basis, or EBITDA, which we disclose on an adjusted EBITDA basis. Reconciliations to comparable GAAP financial measures with non-GAAP measures, if available, may be found in today's press release, which is available on our website. The content of this conference call contains time-sensitive information accurate only as of the date of this live broadcast, August 6, 2026.

Except as required by law, Establishment Labs Hldgs undertakes no obligation to revise or otherwise update any statement to reflect events or circumstances after the date of this call. With that, it is my pleasure to turn the call over to Peter. Sandra Harris (Chief Financial Officer) Thank you, Peter. The second quarter was another important step forward.

Financially, we continue to deliver strong top line growth while expanding margins and generating positive adjusted EBITDA with improving cash flow. S. business and minimally invasive platform continue to scale, we're seeing increasing operating leverage across the organization. 7% compared to the second quarter of 2025.

9% compared to the prior year. S. 6% of total company revenue and continues to be our fastest growing region. Growth was driven by continued adoption of Motiva and increasing contribution from our minimally invasive platform.

Geographically, our business outside the United States continues to perform well. 4% over the second quarter 2025. 1 million in revenue during the quarter and continues to perform ahead of our original expectations. 8% in the prior year period.

S. and OUS direct markets, favorable product mix, and the continued growth of our minimally invasive platform. 2 million of one-time charges related to restructuring and debt refinancing. Excluding these charges, underlying operating expenses remain well controlled, increasing modestly despite revenue growth of nearly 32%, reflecting continued operating leverage across the business.

5 million in the prior year period. 5 million higher than the same quarter last year, and generated positive overall cash flow. This milestone reflects the strong progress we have made improving profitability, expanding margins, and driving greater operating efficiency throughout the organization. Importantly, we have sufficient liquidity to execute our strategy and continue investing in future growth opportunities without the need for future equity raises.

Given our strong first half performance and continued momentum across the business, we are increasing our full year revenue guidance to between $269 and $271 million. S. business to be the primary driver of growth, while our OUS business remains healthy and diversified. As we look to the third quarter, I'd like to remind investors it is historically the softest quarter in the industry, reflecting the summer vacation period.

S. business to remain strong, and our OUS business should reflect the normal seasonal pattern. As always, we expect our strongest quarter to be the fourth. We remain very encouraged by the performance of the business, the continued momentum in the United States, the growing contribution of our minimally invasive platform, and the increasing profitability profile of Establishment Labs Hldgs.

Now I'll turn the call back over to Peter. Peter, CEO Thank you, Sandra. As you've heard today, we continue to execute well across the business. S.

remains a significant growth driver. Our OUS markets continue to perform well. Our minimally invasive platform is gaining momentum globally and we have a clear path to being free cash flow positive. At the same time, we continue to advance a pipeline that should support growth for many years to come.

While we are proud of what we've accomplished so far, we believe the opportunity ahead remains substantially larger than what we have achieved to date. Operator, we're now ready to take questions. OPERATOR Thank you, ladies and gentlemen. We will now begin the question and answer session.

If you have a question, please press star followed by the number one on your touchtone phone. You will hear a three-tone prompt acknowledging your request. Please limit yourself to one question. If you wish to do a follow-up, please.

If you would like to cancel your request, please press star two. One moment please for your first question. Your first question comes from the line of Josh Jennings from TD Cowen. Please go ahead.

Josh Jennings, Analyst at TD Cowen Hi, good morning Peter and San. S. momentum. Wanted to appreciate your comments on MIA during the call so far.

S. plastic surgeons that MIA ultimately could produce an entire new category in the aesthetic space where you could transition breast augmentation from a surgery to an injectable procedure. , and how does that all play out? Peter, CEO Yeah, thank you, Josh.

S. We've had good traction. It's also, you know, a key driver for the development of PRESERVE. So part of this entire minimally invasive platform, you know, I think is a significant growth driver for us.

It brings in a number of new patients to the category. We've seen that through market research. , similar type of numbers because it does address a number of the barriers that are preventing women from doing a breast augmentation. When you talk about minimal anesthesia, you talk about also those smaller scars and quicker recovery.

S. S. Josh Jennings, Analyst at TD Cowen Thanks for that. And I know I'm focused on the pipeline here with my questions, but you referenced GEM on the call so far.

S. kind of commercial—OUS, excuse me—commercial launch maybe next year. Any more details you can provide on where that development program stands and any kind of regulatory or commercial milestones we should have on our catalyst calendar? Thanks for taking the questions.

Peter, CEO Yeah. So, Josh, regarding GEM, you know, we see this as a tremendous opportunity, really leveraging a lot of the technology from the minimally invasive platform in really providing a safer alternative, also with more predictable results, to the traditional Brazilian butt lift. So where we are in that process is we're doing a clinical study in Costa Rica. We expect next year in the back half to do an early experience in Latin America.

S. as well as OUS, primarily in Europe. But we're very pleased with the progress we've made so far. I mean, it's a very differentiated technology and, you know, we see this as very much an untapped market.

, we have so many things that we're going to be driving growth over the next couple years. S. until 2028 and beyond, but we're still working through what that regulatory pathway is going to be. S.

Bancorp. Please go ahead. S. Bancorp Hi, good morning.

Thanks for taking the questions here and congrats on the nice quarter. —300 surgeons now certified. S. business over the back half of the year.

Peter, CEO Yeah, thanks, Sam. I mean, it's pretty clear we're, you know, we're off to a great start with PRESERVE. There's significant demand. You know, I think our original target was around 200 surgeons.

You know, we quickly surpassed that. We're really expanding our capacity in terms of training. So there's no shortage of surgeons that are interested. What we're finding is that, you know, as soon as they're certified, it's very quick adoption in terms of the initial ordering, and then it's a process of working through their schedules and getting the right patients.

And we fully expect that this is going to continue to be a key driver for our growth in the back half of this year. We're targeting to train approximately 500 surgeons for the full year 2026. And, you know, this is really driven by tremendous demand in the marketplace. And, you know, it is addressing a significant barrier that patients have with doing a breast augmentation.

And that's really been playing out in what we're seeing in the marketplace. S. Bancorp Okay, really helpful. Maybe if I could just squeeze in a quick follow-up.

The global minimally invasive revenue for the quarter—$12 million—certainly passed our expectations. As I think about the prior $35 million guidance, it seems like you're on pace to achieve well beyond that. I guess any updated thoughts on how we should be thinking about that number? Peter, CEO Yeah, Sam, I think we said over $35 million.

And, you know, what we said recently is that we're going to be approaching for the full year about 15% of our revenue. So I think that depending upon how you look at our guidance, that gives you the guide for minimally invasive going forward. S. Bancorp Okay, great.

Thanks for taking the questions. OPERATOR Your next question comes from the line of Mason Carricko from Stephens. Your line is now open. Mason Carricko, Analyst at Stephens Hey guys, thanks for taking the question here.

Could you give a sense of Motiva mix among PRESERVE-trained surgeons compared to that of an untrained one? Have you seen PRESERVE certification lift overall Motiva mix or share at that account? S. volumes do you think could ultimately be PRESERVE?

Peter, CEO Yeah, so thanks. So we are seeing in the accounts, I mean, there's such strong interest in PRESERVE. It's truly a unique innovation in the marketplace that's really been starving for innovation. So, you know, we're seeing strong interest and a number of surgeons are really—once they get trained and accustomed to using PRESERVE—a lot of them see this as really the future of the industry, and it will continue to be a bigger part of the practice.

It certainly generates significant revenue opportunities for them. So we see that over time that will continue to be a bigger part of that market. S. S.

OPERATOR Your next question comes from the line of Caitlin Roberts from Canaccord Genuity. Please go ahead. Caitlin Roberts, Analyst at Canaccord Genuity Great. Thanks so much for taking the question and congrats on a great quarter.

Would love to touch on recon. Have you had any convos with the FDA on the recon indication and updated expectations for this approval timeline? And how many hospitals are you now in with Flora? Thank you.

Peter, CEO Yeah, thanks, Caitlin. You know, obviously recon is a tremendous opportunity for us. It doubles the TAM for us in the US and we fully expect to have the same level of success in recon in the US that we've experienced in augmentation. So in terms of the feedback we have heard back from the FDA, we're in the process of responding to what we consider some routine questions.

You know, what I think is very positive, they have now started the BIMO audits of our clinical study sites, which I think is a normal part of the process. And I think it's a good indication that things are progressing well. In terms of the actual approval timing, I mean, it's really up to the FDA, but what we're seeing, everything is positive, moving in the right direction. And just to remind everybody, we don't really expect from a planning standpoint to achieve material revenue in recon until 2020.

OPERATOR Your next question comes from the line of Joanne Wunsch from Citi. Your line is now open. Jane Marie Lai, Analyst at Citi Hello, this is Jane Marie Lai on Sergio M. from Citi.

Thanks for the question. At this half-year mark, could you provide more color on your expectations for the second half of the year? And I know it's a bit early, but for 2027, how should we think about that? And do you have any kind of color on that as well?

Peter, CEO Yeah, so I'm not sure I fully heard the question. My understanding is what's our expectation in terms of the back half of the year. You know, listen, I think we're going to continue to see the strong momentum that we've experienced in the first half, especially with the US, but also in terms of how we're driving growth in our direct markets; we expect that momentum to continue in the back half of the year. And, you know, I think there's significant, you know, continued growth opportunities with our platforms and the different initiatives that we're driving.

We haven't really set any guidance as it relates to 2027, but I'll pass that over to Sandra. Sandra Harris (Chief Financial Officer) Yeah, just as it relates to this year, I'll just remind you of our seasonality, and we do anticipate that our fourth quarter is always the strongest quarter of the year, with the third quarter being impacted by some seasonal impact around the summer and vacation periods. In both our OUS business and our US business, what we did is we have raised our guidance to 269 to 271. And then in regard to 2027, the only information we have provided to date is that we do expect that revenue next year would be around the 25% growth.

OPERATOR Your next question comes from the line of Anthony Petrone from Mizuho Financial Group. Please go ahead. Anthony Petrone, Analyst at Mizuho Financial Group Thanks, and congrats on the strong print here. Maybe one on Preserve, competitive dynamics, and then pricing.

Just on Preserve, when you think about site adoption in the US specifically, one of the medtech phenomenons, for instance, with Da Vinci Surgical, you sort of have Da Vinci in your practice in the early days and it represents a competitive advantage for that site. That site then gained share from its competitors.