Establishment Labs Holdings Inc. Q4 FY2025 earnings call

2025 Q4 was standout with revenue growth. Motiva in U.S. had strong performance in 2025 with $45.6M revenue, ~20% augmentation market share. R&D investment continues to drive differentiated products. Preserve introduced in 2025 with strong global demand, U.S. acceptance exceeded expectations, to launch fully in March 2026 with over 90 surgeons trained. Submitted Motiva implants to FDA for breast reconstruction in Dec 2025, Motiva Flora in over 200 facilities. International markets: Europe, Middle East, Africa had 41% of global sales in Q4 2025 with strong growth; Latin America had stable Brazil and strong Argentina; APAC had China showing improved performance with local distributor. Minimally invasive platform Preserve and Mia had strong momentum globally. Raj to move into SVP Global strategy, Cassandra Harris new CFO.

Fourth quarter revenue was $64.6 million, an increase of 45.2% versus Q4 2024. 2025 total revenue was $211.1 million, an increase of 27.2% over 2024. U.S. Motiva revenue in 2025 was $45.6 million. Q4 had gross margin exceeding 70% for the second consecutive quarter. Fourth quarter net loss from operations was $3.9 million, down 79% from Q4 2024. Q4 adjusted EBITDA was positive $5.5 million, up from negative $13.1 million in Q4 2024. 2026 initial revenue guidance is $264 million to $266 million, an increase of 25.1% to 26% over 2025. U.S. is expected to exceed 30% of overall sales, up from ~22% in 2025. Gross margins are expected to increase 200 to 300 basis points. 2026 expected to be adjusted EBITDA positive every quarter and reach cash flow positive without need for additional capital.

2026 revenue guidance $264M - $266M, 25.1%-26% growth from 2025. U.S. revenue to exceed 30% of overall sales. Gross margins to increase 200-300 basis points. 2026 expected to be adjusted EBITDA positive every quarter. Cash flow positive in 2026 without further equity raises. 2027 expected to see at least same level of growth as 2026.

Q: Congrats on strong end of year and excited for Raj in new role, talk about optimism and trajectory of minimally invasive portfolio.

A: What we're seeing in OUS markets with minimally invasive platform is positive, benefits like no general anesthesia, smaller scars, faster recovery resonate with patients, expected over $30M demand in 2026.

Q: Talk about where reps for U.S. sales force expansion are pulled from and productivity ramp.

A: Focus on reps with significant industry experience, good reputation, strong track record, many see Establishment Labs as attractive opportunity.

Q: Talk about how to launch into reconstruction market in U.S., need for specialized reps.

A: Will expand sales force, look at combination of hybrid reps and dedicated reps for larger hospital networks, leverage existing sales force.

Q: International growth stronger this quarter, any one-offs?

A: Strategic focus on direct markets, allocated resources, 20% growth last 3 quarters, demand stable across markets.

Q: Macro on underlying markets, U.S. and OUS.

A: Markets healthy, U.S. growing at high rate, international distributor markets had north of 20% growth, China results turning a bit with focus.

Q: Preserve as percent of total revenues in 2027-2028 and impact on gross margin.

A: Early still, Preserve demand strong, potential for high penetration in U.S. revenues, higher ASPs and margins.

Q: Momentum in U.S. in 2026 and long-term share gains.

A: Strong momentum, continue to gain share in accounts, add accounts, launch Preserve, add sales reps, expect dominant share in U.S. market.

Q: Contribution to 2026 guide from pipeline products, reconstruction timeline.

A: Reconstruction likely 2027 and beyond story, Preserve has upside in 2026 numbers.

Q: Cadence of spending on operating side throughout 2026.

A: Spending not linear, first quarter likely below trend, pick up in back half, incremental investment for recon well below opportunity.

Q: Current accounts in U.S. high-volume and penetration.

A: Accounts span spectrum, still low penetration in many markets, 2026 focus on expanding accounts and deepening penetration.

Q: Expectations on China this year and key hurdles.

A: Big focus on China, distributor building out capabilities, expect same dominant share as rest of Asia.

Q: U.S. growth in 2026 from volume vs ASP.

A: Majority growth from continued unit growth and share taking in U.S. market