Establishment Labs Holdings Inc. (ESTA) Cash Flow Statement

The ratio is distorted because net losses were large in several quarters while operating cash outflows were smaller or reversed, so the gap does not reflect a stable accrual pattern. The most recent quarter shows positive operating cash flow of $7.7M against a net loss of $10.7M, which may reflect working capital timing rather than a durable improvement in earnings quality. Investors should monitor whether positive operating cash flow persists across additional quarters before treating it as evidence of cash conversion.

The swing appears driven more by working capital movements, which reached $5.4M in the latest quarter after a $16.7M outflow in the prior quarter, than by sustained operating improvement. Free cash flow has been negative in nine of the ten quarters, suggesting the business has not yet demonstrated self-funding capacity. The data does not establish whether the recent positive quarter is a turning point or a timing effect.

Low capex relative to revenue is consistent with a manufacturing model centered on a single facility, so the capital burden is limited while the operating cash burden is driven elsewhere. Depreciation and amortization of roughly $2.4M to $3.1M per quarter exceeds most quarterly capex figures, which may indicate the asset base is being maintained rather than expanded. Any step-up in capex tied to US commercial preparation would be a material change to this profile and warrants attention.

The absence of distributions is consistent with a company in an investment and cash-consumption phase, where capital is being absorbed by operations and growth. Acquisition outflows of $3.7M in 2025Q4 and $307K in 2025Q1 are small and do not appear to represent a strategic deployment program. Capital allocation is therefore best understood as funding operations rather than deploying surplus cash.

Stock-based compensation of around $2.9M to $3.7M per quarter and D&A contribute meaningfully to the gap between reported losses and cash outflows, so the cash burn is less severe than the accounting loss suggests. This divergence should not be read as evidence of profitability, since underlying operating losses persist. Investors should rely on cash flow figures for liquidity assessment while recognizing that losses continue to dilute equity value over time.