Persistent negative free cash flow remains a primary concern, with the company recording a $6.2 million outflow in 2026Q1 and a historical peak outflow of $21.5 million in 2025Q1.
| Cash from Operations | -34.81M | -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 % | 154.41% | 13.03% | 33.89% | -69.68% | -89.47% | -120.08% | 58.28% | 11.52% | -5.99% | -124.1% | - |
| Net Income | -43.74M | -51.06M | -84.6M | -78.5M | -75.21M | -41.14M | -38.12M | -38.15M | -21.1M | -34.9M | -22.16M |
| Depreciation & Amortization | 5.34M | -9.56M | 7.58M | 4.88M | 4.34M | 4.12M | 3.71M | 3.29M | 2.81M | 1.94M | 592K |
| Stock-Based Compensation | 3.09M | -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 | -747.95K | 27.36M | 20.81M | 8.08M | 26.8M | 5.51M | 1.39M | 2.95M | 5.04M | 7.05M | 3.12M |
| Working Capital Changes | -8.07M | -13.17M | -15.5M | -34.13M | -21.54M | -6.44M | 12.31M | -4.6M | -14.02M | -14.32M | -1.84M |
| Change in Receivables | -12.03M | -11.47M | -26.28M | -11.56M | -12.33M | -6.7M | 3.81M | -5.51M | -4.67M | -6.91M | -4.72M |
| Change in Inventory | 2.47M | -7.06M | -471K | -42.23M | -10.9M | -7.64M | 4.79M | -3.37M | -6.98M | -6.44M | -1.36M |
| Change in Payables | -6.26M | -2.3M | 6.67M | 18.96M | 4.38M | 4.96M | -910K | 1.83M | -3.9M | -878K | 3.94M |
| Cash from Investing | -7.7M | -7.03M | -15.61M | -24.55M | -34.79M | -7.16M | -5.56M | -7.77M | -5.73M | -845K | -10.76M |
| Capital Expenditures | -7.48M | 0 | -6.11M | -7.91M | -34.27M | -6.73M | -3.91M | -6.29M | -1.77M | -941K | -10.55M |
| CapEx % of Revenue | 3.26% | 2.87% | 3.68% | 4.79% | 21.19% | 5.31% | 4.61% | 7.02% | 2.9% | 2.71% | 53.3% |
| Acquisitions | -3.75M | -4.37M | -50K | 0 | 0 | 0 | 0 | 0 | 0 | 0 | -147K |
| Investments | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | 3.53M | -2.66M | -9.45M | -16.64M | -525K | -434K | -1.65M | -1.48M | -3.96M | 96K | -55K |
| Cash from Financing | 40.08M | 40.43M | 125.89M | 86.23M | 100.25M | 4.05M | 64.67M | 22.79M | 81.53M | 42.99M | 20.21M |
| Debt Issued (Net) | 33.73M | 33.48M | 24.47M | 0 | 96.39M | -175K | -277K | 24.51M | -311K | 22.97M | 14.29M |
| Equity Issued (Net) | 7.54M | 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 | -1.19M | -637K | 1.94M | 1.69M | -4K | -356K | 1.09M | -1.72M | 81.84M | 24.53M | 7.92M |
| Net Change in Cash | -1.08M | -14.78M | 50.31M | -26.32M | 12.94M | -31.11M | 46.87M | -14.98M | 41.77M | 10.38M | -4.81M |
| Free Cash Flow | -42.12M | -56.94M | -74.08M | -113.06M | -86.43M | -34.26M | -16.42M | -36.98M | -35.66M | -32.91M | -24.82M |
| FCF Margin % | -18.35% | -26.98% | -44.62% | -68.46% | -53.45% | -27.04% | -19.39% | -41.29% | -58.26% | -94.9% | -125.35% |
| FCF Growth % | 45.05% | 23.14% | 34.48% | -30.81% | -152.28% | -108.69% | 55.61% | -3.72% | -8.34% | -32.6% | - |
| FCF per Share | -1.42 | -1.92 | -2.63 | -4.42 | -3.53 | -1.43 | -0.70 | -1.80 | -2.06 | -1.78 | -1.34 |
| FCF Conversion (FCF/Net Income) | 0.96x | 1.00x | 0.69x | 1.13x | 0.69x | 0.67x | 0.33x | 0.79x | 1.61x | 0.92x | 0.64x |
| Interest Paid | 5.14M | 0 | 9.81M | 5.69M | 5.36M | 6.93M | 6.96M | 5.95M | 5.38M | 2.86M | 0 |
| Taxes Paid | 154K | 0 | 1.74M | 2.17M | 2.13M | 652K | 316K | 649K | 136K | 147K | 0 |
US Regulatory Approval Delay
As reported in recent financial filings, Establishment Labs exhibits a consistent gap between net losses and operating cash flow, with the OCF/NI ratio fluctuating significantly, reaching a low of 0.21 in 2025Q4, which suggests that accounting accruals are not currently masking a deeper underlying cash burn.
The divergence between net income and operating cash flow indicates that the company's losses are largely cash-based rather than driven by non-cash charges. Investors should monitor this relationship closely, as the inability to bridge the gap between accounting losses and cash outflows may necessitate further external financing.
Based on the provided cash flow data, the company has sustained negative free cash flow across all ten reported quarters, with a peak outflow of $21.5 million in 2025Q1, indicating that the business model remains heavily reliant on external capital to fund its ongoing international expansion efforts.
The persistent negative FCF margins, which reached -51.9% in 2025Q1, highlight the capital-intensive nature of the firm's current growth phase. This trend suggests that the company is prioritizing market share acquisition over self-sustaining operations, leaving little room for error in its regulatory and commercial execution.
According to historical cash flow statements, Establishment Labs has maintained a disciplined approach to capital expenditures, with the CapEx/Revenue ratio peaking at 17.8% in 2024Q1 before moderating to 3.1% in 2026Q1, suggesting that the primary infrastructure for its Costa Rican manufacturing facility is largely established.
The moderation in capital intensity implies that the company has transitioned from a heavy investment phase into a period where maintenance and incremental capacity expansion are the primary drivers of spending. This shift may provide a slight tailwind to cash flow if revenue growth continues to outpace the need for additional manufacturing assets.
Analysis of the cash flow statements reveals significant volatility in working capital, with a notable $7.7 million outflow in 2025Q3, which suggests that the company's cash position is sensitive to the timing of inventory builds and the efficiency of its international accounts receivable collection cycles.
The erratic nature of working capital changes indicates potential challenges in managing the supply chain for a complex, multi-SKU product portfolio. Investors should monitor whether these outflows represent strategic inventory accumulation in anticipation of future demand or inefficiencies in the conversion of sales into actual cash receipts.
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 $56.9M in 2025, indicating capital requirements exceeded cash from operations.
Establishment Labs Holdings Inc. (ESTA) spent $0.0M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.