Free cash flow deteriorated to -$20.2M in 2026Q2, with a negative FCF margin of -29.8%, indicating that revenue growth is not yet translating into cash generation.
Establishment Labs Holdings Inc. (ESTA) cash flow statement — 10-year operating, investing & financing cash flows
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 | Dec'22 | Dec'21 | Dec'20 | Dec'19 | Dec'18 | Dec'17 | Dec'16 |
|---|
| Cash from Operations | -32.72M | -50.89M | -58.52M | -88.51M | -52.17M | -27.53M | -12.51M | -29.98M | -33.88M | -31.97M | -14.27M |
| Operating CF Margin % | - | -24.11% | -35.25% | -53.6% | -32.26% | -21.73% | -14.77% | -33.48% | -55.36% | -92.18% | -72.05% |
| Operating CF Growth % | 197.46% | 13.03% | 33.89% | -69.68% | -89.47% | -120.08% | 58.28% | 11.52% | -5.99% | -124.1% | - |
| Net Income | -38.89M | -51.06M | -84.6M | -78.5M | -75.21M | -41.14M | -38.12M | -38.15M | -21.1M | -34.9M | -22.16M |
| Depreciation & Amortization | 5.42M | -9.56M | 7.58M | 4.88M | 4.34M | 4.12M | 3.71M | 3.29M | 2.81M | 1.94M | 592K |
| Stock-Based Compensation | 6.33M | -11.41M | 15.37M | 14.86M | 13.36M | 10.41M | 5.72M | 6.53M | 7.32M | 3.3M | 3.13M |
| Deferred Taxes | 9.3M | 6.96M | -2.18M | -3.71M | 86K | 7K | 2.48M | 0 | -13.94M | 4.96M | 2.9M |
| Other Non-Cash Items | 4.88M | 27.36M | 20.81M | 8.08M | 26.8M | 5.51M | 1.39M | 2.95M | 5.04M | 7.05M | 3.12M |
| Working Capital Changes | -19.75M | -13.17M | -15.5M | -34.13M | -21.54M | -6.44M | 12.31M | -4.6M | -14.02M | -14.32M | -1.84M |
| Change in Receivables | -6.05M | -11.47M | -26.28M | -11.56M | -12.33M | -6.7M | 3.81M | -5.51M | -4.67M | -6.91M | -4.72M |
| Change in Inventory | 9.34M | -7.06M | -471K | -42.23M | -10.9M | -7.64M | 4.79M | -3.37M | -6.98M | -6.44M | -1.36M |
| Change in Payables | -23.94M | -2.3M | 6.67M | 18.96M | 4.38M | 4.96M | -910K | 1.83M | -3.9M | -878K | 3.94M |
| Cash from Investing | -9.29M | -7.03M | -15.61M | -24.55M | -34.79M | -7.16M | -5.56M | -7.77M | -5.73M | -845K | -10.76M |
| Capital Expenditures | -9.07M | -6.05M | -6.11M | -7.91M | -34.27M | -6.73M | -3.91M | -6.29M | -1.77M | -941K | -10.55M |
| CapEx % of Revenue | 3.69% | 2.87% | 3.68% | 4.79% | 21.19% | 5.31% | 4.61% | 7.02% | 2.9% | 2.71% | 53.3% |
| Acquisitions | -3.75M | -307K | -50K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -147K |
| Investments | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | 3.54M | -672K | -9.45M | -16.64M | -525K | -434K | -1.65M | -1.48M | -3.96M | 96K | -55K |
| Cash from Financing | 58.42M | 40.43M | 125.89M | 86.23M | 100.25M | 4.05M | 64.67M | 22.79M | 81.53M | 42.99M | 20.21M |
| Debt Issued (Net) | 45.39M | 33.48M | 24.47M | 0 | 96.39M | -175K | -277K | 24.51M | -311K | 22.97M | 14.29M |
| Equity Issued (Net) | 24.23M | 7.59M | 99.48M | 84.54M | 3.87M | 4.58M | 63.85M | 0 | 0 | -4.51M | -2M |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Share Repurchases | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -4.51M | -2M |
| Other Financing | -11.2M | -637K | 1.94M | 1.69M | -4K | -356K | 1.09M | -1.72M | 81.84M | 24.53M | 7.92M |
| Net Change in Cash | 16.52M | -14.78M | 50.31M | -26.32M | 12.94M | -31.11M | 46.87M | -14.98M | 41.77M | 10.38M | -4.81M |
| Free Cash Flow | -42.06M | -57.61M | -74.08M | -113.06M | -86.43M | -34.26M | -16.42M | -36.98M | -35.66M | -32.91M | -24.82M |
| FCF Margin % | -17.11% | -27.29% | -44.62% | -68.46% | -53.45% | -27.04% | -19.39% | -41.29% | -58.26% | -94.9% | -125.35% |
| FCF Growth % | 46.36% | 22.23% | 34.48% | -30.81% | -152.28% | -108.69% | 55.61% | -3.72% | -8.34% | -32.6% | - |
| FCF per Share | -1.40 | -1.94 | -2.63 | -4.42 | -3.53 | -1.43 | -0.70 | -1.80 | -2.06 | -1.78 | -1.34 |
| FCF Conversion (FCF/Net Income) | 1.08x | 1.00x | 0.69x | 1.13x | 0.69x | 0.67x | 0.33x | 0.79x | 1.61x | 0.92x | 0.64x |
| Interest Paid | 5.14M | 20.54M | 9.81M | 5.69M | 5.36M | 6.93M | 6.96M | 5.95M | 5.38M | 2.86M | 0 |
| Taxes Paid | 154K | 420K | 1.74M | 2.17M | 2.13M | 652K | 316K | 649K | 136K | 147K | 0 |
Quick answers to the most common questions about buying ESTA stock.
Establishment Labs Holdings Inc. (ESTA) generated $-50.9M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
Establishment Labs Holdings Inc. (ESTA) reported negative free cash flow of $57.6M in 2025, indicating capital requirements exceeded cash from operations.
Establishment Labs Holdings Inc. (ESTA) spent $6.0M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.
Key Metrics
Top Statement Risk
US launch delays and cash burn
Metrics are mathematically derived from official filings.
Cash Conversion Remains Negative
In 2026Q2, operating cash flow was -$16.6M against a net loss of -$11.7M, yielding an OCF/NI ratio of 1.41, indicating cash burn exceeds accounting losses, per quarterly filings.
The negative OCF/NI ratio suggests that non-cash charges like D&A and SBC are not fully offsetting working capital outflows, which consumed $16.7M in 2026Q2. This implies that the company's earnings quality is poor, as cash generation lags behind reported losses, and the gap may widen if working capital demands persist.
FCF Burn Intensifies Despite Revenue Growth
Free cash flow deteriorated to -$20.2M in 2026Q2 from -$6.3M in 2026Q1, with FCF margin falling to -29.8%, according to recent financial statements, as revenue growth fails to translate into cash generation.
Despite a 31.7% YoY revenue increase, FCF remains deeply negative, indicating that the company is investing heavily in growth ahead of US market entry. The widening FCF deficit suggests that operating leverage is not yet visible at the cash level, and investors should monitor whether this burn rate moderates as international expansion matures.
Modest CapEx Signals Asset-Light Model
Capital expenditures averaged $1.9M per quarter over the last five quarters, representing only 3.4% of revenue, as reported in cash flow statements, indicating a relatively asset-light manufacturing model.
The low capital intensity suggests that ESTA's competitive advantage relies more on R&D and brand building than on heavy fixed assets. However, the modest CapEx may also imply that the company is underinvesting in capacity ahead of a potential US launch, which could strain operations if demand surges.
Working Capital Swings Drive Cash Volatility
Working capital changes swung from +$3.7M in 2025Q4 to -$16.7M in 2026Q2, per quarterly data, indicating significant cash absorption from inventory and receivables as revenue scales.
The negative working capital changes in recent quarters suggest that ESTA is building inventory and extending credit to distributors to support international growth. This pattern may indicate channel stuffing or genuine demand, but the volatility warrants close monitoring, as it directly impacts cash flow predictability.
No Capital Returns, All Cash to Growth
ESTA paid no dividends and repurchased no shares in the last ten quarters, with all cash directed toward operations and expansion, according to cash flow statements, reflecting a reinvestment strategy.
The absence of capital returns is consistent with a growth-stage company prioritizing market share and FDA approval. However, the lack of buybacks or dividends means shareholders rely entirely on equity appreciation, which is contingent on successful US commercialization and eventual profitability.
Cumulative Losses Exceed Cash Burn
Over the last ten quarters, cumulative net losses totaled -$161.7M while operating cash flow was -$130.7M, per reported figures, indicating that cash burn is less than accounting losses due to non-cash charges.
The $31M gap between net income and operating cash flow suggests that non-cash items like D&A and SBC are significant, but the company still consumes substantial cash. This divergence implies that while the business is not yet self-funding, the cash burn is somewhat cushioned by non-cash expenses, though the trend remains concerning.
What the Cash Flow Statement Obscures
Stock-based compensation averaged $3.1M per quarter over the last five quarters, per cash flow data, which may understate true cash costs if not fully expensed, potentially inflating reported operating losses.
While SBC is a non-cash charge, it represents real dilution to shareholders, and the company's heavy use of equity compensation may indicate a reliance on equity to fund operations. Additionally, the absence of acquisition activity in most quarters suggests organic growth, but any future M&A could significantly alter cash flow dynamics. Investors should also consider that capitalized costs, such as those related to clinical trials, may be masking the true cash burn of the commercial business.