Establishment Labs Holdings Inc. (ESTA): Business Model Canvas [Dec-2025 Updated]

You're looking at a med-tech firm, Establishment Labs Holdings Inc., making a critical pivot from pure growth to solid profitability, and that shift is visible right in their business model. Honestly, seeing their Q3 2025 gross margin hit 70.1% while expecting 2025 revenue over $210 million tells you the premium Motiva product strategy is working, especially with US sales set to meaningfully exceed $40 million. Still, you have to watch the $45 million to $46 million quarterly operating expenses against that $70.6 million cash balance as of September 30, 2025, because scaling up in the US is expensive. Dive below to see exactly how their key partnerships and proprietary tech are fueling this transition from challenger to global player.

Establishment Labs Holdings Inc. (ESTA) - Canvas Business Model: Key Partnerships

You're looking at the core relationships that fuel Establishment Labs Holdings Inc.'s growth, especially as they push hard into the U.S. market. These aren't just vendors; they're strategic enablers, particularly the financial backing that keeps the lights on while scaling.

Global network of medical device distributors

The distribution backbone for Establishment Labs Holdings Inc. remains critical outside of the direct sales push, which is gaining traction in the U.S. Globally, the company has secured approval for commercial distribution in over 70 countries, and as of late 2025, they offer solutions in over 90 countries. To give you a sense of the channel mix shift, back in Q3 2023, distributors accounted for approximately 46% of implant sales, with direct sales making up the rest, though the U.S. focus is clearly shifting that dynamic now. The company segments its international presence across Europe, Latin America, and Asia-Pacific/Middle East.

Here's a quick look at the scale of their global reach:

Metric	Value (as of late 2025)
Countries with Distribution Approval	Over 70
Countries with Solutions Offered	Over 90
Approximate Distributor Sales Share (Q3 2023)	46%

Key opinion leader (KOL) plastic surgeons for training

Building trust with surgeons is non-negotiable in this space, and Establishment Labs Holdings Inc. leans heavily on Key Opinion Leaders (KOLs) to drive adoption and provide feedback. While I don't have a hard count for the total KOL network as of late 2025, the partnership is evident in their clinical activity. For instance, leadership and invited plastic surgeons presented updates at the June 12, 2025, analyst and investor event. This engagement supports the ongoing clinical validation of their portfolio.

The depth of their scientific engagement is shown by:

• Over 100 scientific and clinical studies and publications in peer-reviewed journals.
• Presentation of 5-year results from the Motiva U.S. IDE Study at The Aesthetic MEET 2025.

Clinical research organizations for pivotal studies (e.g., GEM)

The credibility of Motiva Implants® is built on rigorous data, which requires partnership with Clinical Research Organizations (CROs) for pivotal studies. Establishment Labs Holdings Inc. has two key products currently in IRB approved pivotal studies. The GEM® system, a next-generation minimally invasive system for gluteal ergonomic modeling, is one such study. The Zensor™ RFID technology platform, which includes the Zenº™ biosensor, is also part of an IRB approved pivotal study measuring core breast temperature. This commitment to data generation is a core partnership function.

Regulatory bodies (FDA, CE Mark) for product clearance

Regulatory partnership is the gateway to the market, and Establishment Labs Holdings Inc. maintains compliance with two key manufacturing standards at its Costa Rica facilities: ISO13485:2016 and FDA 21 CFR 820. The U.S. market entry was a major milestone, supported by the earlier FDA clearance for the Motiva Flora SmoothSilk Tissue Expander. Furthermore, the company protects its innovation through a substantial intellectual property portfolio, which involves ongoing partnership with patent offices worldwide, evidenced by over 200 patent applications across 20 separate patent families.

Financial institutions for the Oaktree term loan facility

The relationship with Oaktree Capital Management, L.P. is a defining financial partnership, providing non-dilutive capital. The total facility size is $225 million. As of September 30, 2025, the company's cash balance stood at $70.6 million, which included borrowing under this existing term loan. You should note the recent amendment activity, which is defintely important.

Here's the quick math on the facility structure and recent activity:

Tranche/Component	Amount	Key Status/Condition (as of late 2025)
Drawn Tranches (Initial)	$175 million	Terms unchanged from original agreement.
Tranche C	$25 million	Amended availability before December 31, 2024, upon FDA approval.
Tranche D	$25 million	Fully borrowed on September 28, 2025, via Fourth Amendment, removing the prior sales milestone of $195 million TTM sales.
Interest Rate (Tranches C & D)	Fixed 10.0% per annum	Applies to the potential $50 million in undrawn capital prior to draw.
Q3 2025 Borrowing Impact	$24.5 million (net proceeds)	Contributed to the $70.6 million cash balance on September 30, 2025.

The company achieved its goal of positive Adjusted EBITDA in Q3 2025 at $1.2 million, and the focus now shifts to cash flow positive in 2026, a plan supported by this Oaktree partnership. Finance: review the covenant compliance schedule for the Oaktree facility against the new $30 million minimum liquidity requirement effective September 28, 2025, by next Tuesday.

Establishment Labs Holdings Inc. (ESTA) - Canvas Business Model: Key Activities

You're looking at the core engine driving Establishment Labs Holdings Inc.'s growth, which is heavily weighted toward high-quality product execution and aggressive market penetration, especially in the U.S. The key activities here are not just making the product; it's about proving it works better, consistently, year after year.

Design, development, and manufacturing of Motiva Implants

Establishment Labs Holdings Inc. focuses its design and development on creating silicone-filled breast and body-shaping implants under the Motiva brand. The manufacturing backbone is centralized in Costa Rica, where they operate two facilities that comply with both ISO 13485:2016 and FDA 21 CFR 820 regulatory standards. This controlled environment supports the production that has seen over four million Motiva devices delivered globally since 2010. The company employs approximately 1,023 total staff to support these operations as of late 2025.

Extensive clinical research and safety data generation

A critical activity is generating and publishing data to back up the product claims. Establishment Labs Holdings Inc. released its 2025 Post-Market Surveillance (PMS) Report, which covers 15 years of data since the Motiva launch in 2010. This data consistently shows less than 1% device-related complications leading to reoperations for Motiva implants. Furthermore, the Motiva Flora tissue expander is noted as the only regulatory-approved expander globally featuring an integrated port that uses radio-frequency technology. The installed base is significant, with more than two million women worldwide currently using Motiva, and the company expects approximately 400,000 more to join them in 2026.

Direct sales and surgeon training in key markets (e.g., U.S.)

The company heavily emphasizes direct sales, particularly in the U.S. market following FDA approval. This direct engagement allows for focused surgeon training and better control over the brand experience. The momentum in the U.S. is clear from the financial results, which show a significant ramp-up in sales volume and market share focus.

Here's how the U.S. Motiva sales have progressed through the first three quarters of 2025, alongside the full-year guidance:

Metric	Q1 2025 Amount	Q2 2025 Amount	Q3 2025 Amount	Full Year 2025 Guidance/Expectation
U.S. Motiva Sales (USD)	$6.2 million	$10.3 million	$11.9 million	Exceed $40 million
Worldwide Revenue (USD)	$41.4 million	$51.3 million	$53.8 million	Exceed $210 million

Establishment Labs Holdings Inc. projects it will finish 2025 holding an approximate 20% share of the U.S. breast augmentation market.

Global supply chain and logistics management across 90+ countries

Establishment Labs Holdings Inc. manages a complex global footprint, distributing its products across over 90 countries. While the U.S. is a current growth focus, the international business remains substantial. For instance, in Q2 2025, Europe, Middle East, and Africa represented 40% of global sales. The company is also executing on specific market launches, such as the Preservé launch in Brazil as the next step in its minimally invasive portfolio rollout.

Advancing minimally invasive platforms like Mia Femtech

A key strategic activity is advancing the minimally invasive platform, headlined by Mia Femtech. Clinical validation is strong; a 3-year prospective study on Mia Femtech showed a reoperation rate of just 1% at the three-year mark. Surgeon and patient reception is high, with 90% of surgeons reporting they were 'very satisfied' with their overall experience in that study, which maintained a patient follow-up compliance rate of 93%. Management has set an aggressive revenue target for this segment, expecting the minimally invasive platform to generate at least $30 million in revenue in 2026.

The company achieved its first quarter of positive Adjusted EBITDA in Q3 2025 at $1.2 million, up from a loss of $8.5 million in Q2 2025, signaling operational leverage is beginning to take hold.

Finance: Finance needs to model the impact of the $30 million 2026 Mia Femtech revenue target on the 2026 operating expense budget by end of Q1 2026.

Establishment Labs Holdings Inc. (ESTA) - Canvas Business Model: Key Resources

You're looking at the core assets Establishment Labs Holdings Inc. (ESTA) relies on to compete in the women's health space. These aren't just ideas; they are tangible, protected, and operational assets that drive their revenue growth, especially now that they've hit positive Adjusted EBITDA in Q3 2025.

Proprietary Motiva Implants and SmoothSilk technology patents

The intellectual property is a major moat here. Establishment Labs Holdings Inc. has its core technology locked down with over 200 patent applications spread across 20 separate patent families worldwide. The patented SmoothSilk® surface technology is key; it's designed for better biocompatibility and has been scientifically shown to promote low inflammation. This proprietary tech is defintely what underpins their differentiation in the market.

Two ISO13485:2016 compliant manufacturing facilities in Costa Rica

Control over manufacturing quality is non-negotiable in this sector, and Establishment Labs Holdings Inc. manages this through its two state-of-the-art facilities in Costa Rica. These sites adhere to stringent standards, specifically ISO13485:2016 and FDA 21 CFR 820. The company's capacity was planned to more than double to approximately 1,900,000 Motiva implants per year when the new facility was fully operational.

Experienced global sales force and clinical support teams

The reach of their commercial teams is substantial, supporting sales in over 90 countries. This global footprint is necessary to support the volume they move; since 2010, Establishment Labs Holdings Inc. has delivered over four million Motiva® devices to surgeons globally. The U.S. market, which started commercial procedures in late 2024, is a growing part of this, contributing $11.9 million in revenue in Q3 2025 alone.

Zensor™ RFID technology platform for device identification

The Zensor™ platform is their RFID solution for safely identifying implants from outside the body. This includes the Zenº™ biosensor, which is in a pivotal study to measure core breast temperature. The passive RFID technology, known as Qid®, has been in use since 2014, with approximately two million devices featuring it placed in the market.

You need to see the hard numbers that back up these physical and intangible assets. Here's a quick look at some of the key figures supporting the business as of late 2025:

Resource Metric	Value/Amount	As of Period End
Cash Balance	$70.6 million	September 30, 2025
Patent Applications	Over 200	2025
Patent Families	20 separate families	2025
Global Markets Served	Over 90 countries	2025
Total Devices Delivered (Since 2010)	Over 4 million	2025
Q3 2025 US Revenue	$11.9 million	September 30, 2025

Cash balance of $70.6 million as of September 30, 2025

Financially, the Company's cash position was reported at $70.6 million on September 30, 2025. This cash level followed a quarter where Establishment Labs Holdings Inc. achieved positive Adjusted EBITDA of $1.2 million. The cash balance decreased by $19.7 million from December 31, 2024, primarily due to operating losses, though this was partially offset by borrowing under the Oaktree term loan. Management's focus now is on reaching cash flow positive status next year.

Establishment Labs Holdings Inc. (ESTA) - Canvas Business Model: Value Propositions

You're looking at the core reasons why surgeons and patients choose Establishment Labs Holdings Inc. products over the competition, especially now that the US market has fully adopted the Motiva platform following its FDA approval in September 2024. The value propositions center on superior clinical performance, technological advancement, and less invasive patient experiences.

Enhanced safety profile and low complication rates (Motiva)

The data coming out of the US IDE Study and the 2025 Post-Market Surveillance Report definitely backs up the safety claims. For primary augmentation subjects in the US IDE Study at five years, the Kaplan-Meier risk rates for specific negative outcomes were remarkably low. For instance, the rate of capsular contracture (Baker Grade III/IV) was just 0.5%, and the rate for rupture, confirmed or suspected (in the MRI cohort), was 0.6%. Even looking at the broader 15 years of data in the 2025 PMS Report, device-related complications leading to reoperations for Motiva implants remain below 1%. This consistency in low rates is a huge differentiator for you when assessing long-term patient satisfaction.

Here's a quick look at those five-year primary augmentation complication rates from the US IDE Study:

Complication Type	5-Year Risk Rate (N=451)
Capsular contracture (Baker Grade III/IV)	0.5%
Rupture, suspected or confirmed (MRI cohort)	0.6%
Implant removal, with or without replacement	3.1%
Any reoperation	8.8%

Premium, high-technology breast aesthetics and reconstruction solutions

Establishment Labs Holdings Inc. positions its offerings as premium, which is reflected in the financial performance, particularly the margin expansion. The company achieved a record Q3 2025 Gross Margin of 70.1%, up from 63.9% in the year-ago period, driven by the geographic mix shift toward higher-margin US sales. The US market is clearly buying into the premium value, with US Motiva sales hitting $11.9 million in Q3 2025 alone, and management expecting full-year 2025 US sales to meaningfully exceed $40 million. This focus on high-value, technology-driven products helps support the company's overall 2025 revenue guidance exceeding $210 million.

Minimally invasive procedures (Mia Femtech, Preservé) for faster recovery

The minimally invasive platform, which includes Mia Femtech and Preservé, offers a value proposition centered on speed and reduced patient downtime. For the Mia Femtech procedure, the skin-to-skin time is often described as around 15 minutes, and patients can resume daily activities within about 90 minutes post-procedure, thanks to the use of local anesthesia combined with sedation instead of general anesthesia. The clinical validation is strong; in the 3-year Mia Femtech study (N=100), the reoperation rate was only 1%. Furthermore, patient satisfaction was high, with patients reporting an 87% increase in breast satisfaction at three years.

The traction for this new market segment is building, as evidenced by the Preservé early experience in the US reaching approximately 300 cases. Management is projecting this entire minimally invasive platform will generate at least $30 million in revenue in 2026.

Integrated digital tools for surgical planning and patient experience

While specific financial metrics tied directly to digital tool adoption aren't always broken out, the success of the overall platform implies value capture from integrated technology. The high patient follow-up rates in the US IDE Study-92.4% at three years and the 93% follow-up in the Mia Femtech study- suggest a positive patient journey, which digital tools help facilitate. The high surgeon satisfaction with Mia Femtech, where 90% of surgeons reported being 'very satisfied,' often correlates with streamlined, technology-supported workflows that digital planning tools enable.

Motiva Flora tissue expander for post-mastectomy reconstruction

The Motiva Flora tissue expander provides a unique, high-tech solution in the reconstruction space. Its key differentiator is that it's the only regulatory-approved expander globally featuring an integrated port that uses radio-frequency technology and is MRI conditional. This specific feature reduces the need for additional procedures or concerns related to MRI compatibility, which is a significant value add for post-mastectomy patients.

Finance: draft 13-week cash view by Friday.

Establishment Labs Holdings Inc. (ESTA) - Canvas Business Model: Customer Relationships

You're looking at how Establishment Labs Holdings Inc. keeps its professional and patient customers engaged, which is critical in the medical device space. The focus is clearly on deep, ongoing relationships built on clinical evidence and support.

High-touch, direct engagement with plastic surgeons for training

Establishment Labs Holdings Inc. invests heavily in direct engagement with plastic surgeons. This isn't just about selling a product; it's about ensuring proper technique and adoption of their platform, including minimally invasive options like Preservé. The company held an event in Q2 2025 that brought together some of the highest volume surgeons in the United States, along with leaders from major plastic surgeon societies. The reception from these surgeons involved in the training was reported as overwhelmingly positive, with their enthusiasm already influencing the broader conversation around breast implants. The US business is a primary growth engine, with Q3 2025 revenue from Motiva sales in the United States hitting $11.9 million, which was a 16% sequential increase. Management expects to finish 2025 with an approximate 20% share of the US breast augmentation market, up from an earlier guidance of at least $40 million in US Motiva sales for the full year.

Dedicated clinical support for surgical procedures

The relationship is underpinned by a commitment to real-world performance data, which serves as the ultimate clinical support. The 2025 Post-Market Surveillance (PMS) Report, released in October 2025, reviews outcomes across 15 years of data since 2010. This continuous monitoring and data sharing is a key part of the trust built with the surgical community. The company has delivered over four million Motiva devices to plastic and reconstructive surgeons globally since 2010.

Long-term patient warranty and safety programs

The patient relationship extends far beyond the operating room through robust safety programs and warranties. The 2025 PMS Report incorporates the company's warranty and claims data. A major statistical point Establishment Labs Holdings Inc. highlights is that device-related complications leading to reoperations remain below 1% based on the latest data review. This commitment to long-term safety is central to the value proposition offered to both the surgeon and the end-consumer.

Educational content and awareness campaigns for end-consumers

While the primary customer is the surgeon, Establishment Labs Holdings Inc. drives demand through consumer awareness, often leveraging the positive sentiment from their surgeon partners. The company's minimally invasive platform is noted for changing the narrative and attracting new patients to the category. The enthusiasm shared by key surgeons on social media following training events is part of this strategy to shape consumer conversation.

Building a community around women's health and wellness

Establishment Labs Holdings Inc. positions itself as dedicated to improving women's health and wellness overall, not just aesthetics. This broader mission helps build a community around the brand. The company offers a portfolio of solutions for breast health, aesthetics, and reconstruction, operating in over 90 countries.

Here's a quick look at the scale of the relationship metrics as of late 2025:

Metric Category	Key Data Point (Latest Available)	Timeframe/Context
Total Devices Delivered	Over 4 million	Since 2010
Device-Related Reoperation Rate	Less than 1%	As per 2025 PMS Report
US Market Share Goal	Approximate 20%	Expected by end of 2025
Q3 2025 US Motiva Sales	$11.9 million	Quarter ended September 30, 2025
2025 Full Year US Sales Guidance	At least $40 million	Full Year 2025 Outlook

The focus on the US market shows a clear strategy to deepen relationships where growth is most immediate, evidenced by the 16% sequential revenue increase in that segment for Q3 2025. The gross margin improvement to 70.1% in Q3 2025, primarily driven by higher margin sales in the US, shows that these high-touch, direct relationships are also financially accretive.

The company's trajectory is clear: they are managing expenses and driving adoption through surgeon education to hit positive EBITDA in 2025 and cash flow positive in 2026. Finance: finalize the Q4 2025 sales forecast against the raised full-year guidance of exceeding $210 million by next Tuesday.

Establishment Labs Holdings Inc. (ESTA) - Canvas Business Model: Channels

You're looking at how Establishment Labs Holdings Inc. gets its products, like Motiva implants, into the hands of surgeons and clinics as of late 2025. It's a mix of direct selling in key markets and leveraging established partners elsewhere.

Direct Sales Force to Surgeons, Hospitals, and Clinics (U.S. Focus)

The United States is a major focus area for Establishment Labs Holdings Inc., utilizing a direct sales approach to reach surgeons, hospitals, and clinics. This channel appears to carry higher margins, as evidenced by margin improvements correlating with U.S. sales growth.

The financial contribution from this channel for the third quarter of 2025 was significant:

• Motiva sales in the United States for Q3 2025 totaled $11.9 million.
• Management projects finishing 2025 with approximately 20% share in the U.S. breast augmentation market.
• The company expected U.S. Motiva sales for the full year 2025 to be at least $40 million, based on guidance from Q2 2025.
• For context on the direct market build-up, Q1 2025 U.S. revenue was anticipated to be around $5.5 million.

Established Network of Medical Distributors in International Markets

Establishment Labs Holdings Inc. supports its global reach, which spans over 90 countries, through a network of established medical distributors in many international territories. While direct markets are strong, distributor orders play a key role in the overall international revenue mix.

Here is the geographic revenue breakdown for the third quarter of 2025, illustrating the mix between direct and distributor-led markets:

Geographic Segment	Percentage of Global Total (Q3 2025)	Notes
Europe, Middle East and Africa	35.6%	Saw strong sales in direct markets; distributor orders timing impacted the total.
United States	22.1%	Primarily direct sales force focus.
Latin America	21.7%	Relies on established distribution channels.
Asia-Pacific	20.6%	Experienced sequential growth of 46% in Q3 2025.

Digital Platforms for Surgeon Education and Product Ordering

While specific revenue figures tied directly to digital ordering platforms aren't broken out, the company emphasizes surgeon training and the minimally invasive portfolio, which relies on digital support and education.

The minimally invasive platform, which includes Mia Femtech and Preservé, is a key area for future channel growth, with management projecting it will generate at least $30 million in revenue in 2026.

• The Mia Femtech Clinical Study showed a high level of surgeon satisfaction, with 90% of surgeons reporting they were 'very satisfied' with their overall experience.
• Patient follow-up compliance in the three-year Mia Femtech study reached 93%.

Mia Femtech Clinics for the Minimally Invasive Procedure

The Mia Femtech procedure is positioned as a unique, minimally invasive experience for breast harmonization. The channel here is the adoption of this specific procedure by clinics, often without the need for general anesthesia.

The success of this channel is tied to clinical validation; for instance, the three-year prospective study showed no instances of capsular contracture (Baker Grade III/IV) or ruptures requiring intervention.

Investor Relations Website for Financial Transparency

Establishment Labs Holdings Inc. maintains its Investor Relations section on its website, www.establishmentlabs.com, as a primary channel for disseminating financial performance data to stakeholders.

Key financial metrics reported as of the latest available data (Q3 2025) that you can find on this channel include:

• Q3 2025 Worldwide Revenue: $53.8 million.
• Projected Full Year 2025 Revenue: Expected to exceed $210 million.
• Q3 2025 Gross Margin: 70.1%, the first time crossing 70%.
• Cash Balance as of September 30, 2025: $70.6 million.

Finance: draft 13-week cash view by Friday.

Establishment Labs Holdings Inc. (ESTA) - Canvas Business Model: Customer Segments

You're looking at the core groups Establishment Labs Holdings Inc. (ESTA) serves with its Motiva portfolio. This isn't just one group; it's a layered approach targeting the medical professionals who make the decisions and the patients who seek the procedures.

The primary professional segment is the plastic and reconstructive surgeons globally. Establishment Labs Holdings Inc. has delivered over four million Motiva devices to these surgeons since 2010. As of October 2025, there are more than two million women worldwide with a Motiva implant, and the company expects approximately 400,000 more to join them in 2026.

The patient base is split between aesthetics and reconstruction. The aesthetic segment is women seeking primary breast augmentation or revision surgery. The reconstruction segment specifically uses the Motiva Flora Tissue Expander. The company's focus on premium, innovative technology attracts high-end aesthetic clinics that value their science and engineering approach.

Geographically, Establishment Labs Holdings Inc. serves patients in over 90 countries. However, the U.S. market is clearly the most important growth segment right now, especially following FDA approval in September 2024. Management expects to finish 2025 at an approximate 20% share in the U.S. breast augmentation market.

Here's a look at the revenue distribution for the first six months of 2025, which shows the current global footprint:

Geographic Market	Revenue (Six Months Ended June 30, 2025)	Notes
EMEA (Europe / Middle East / Africa)	$45.4 million	Accounted for 40% of global sales in Q2 2025
North America (Primarily U.S.)	$16.3 million	U.S. accounted for more than 17.8% of consolidated revenue for the period
Latin America	$16.6 million	Saw sequential growth in Q2 2025
Asia-Pacific	$14.3 million	Geographic segment

The focus on the U.S. is aggressive. For the third quarter of 2025, U.S. Motiva sales hit $11.9 million. This was a 16% sequential increase, even during a quarter that can typically see declines of 20%-30% due to seasonality. The initial 2025 guidance for U.S. sales was $35 million, which was later increased to expect at least $40 million.

The customer base is segmented by the procedure type and the technology they seek:

• Plastic and reconstructive surgeons globally.
• Women seeking primary breast augmentation.
• Women seeking revision surgery.
• Breast cancer patients utilizing Motiva Flora Tissue Expander.
• Clinics prioritizing premium, innovative technology.

Establishment Labs Holdings Inc. (ESTA) - Canvas Business Model: Cost Structure

You're looking at the expense side of Establishment Labs Holdings Inc. (ESTA)'s operations as they scale, especially in the U.S. market. The cost structure reflects heavy investment in commercialization alongside ongoing product development.

High cost of goods sold (COGS) due to premium manufacturing quality is better understood by looking at the resulting Gross Profit Margin. For the third quarter ended September 30, 2025, Establishment Labs Holdings Inc. achieved a gross margin of 70.1% of revenue. This compares to 68.8% in the second quarter of 2025 and 67.2% in the first quarter of 2025. This margin performance shows the company is successfully pricing its premium products to absorb manufacturing costs, even with duties on goods imported from Costa Rica to the United States. Management expects 2025 gross margins to be approximately 300 basis points higher than in 2024.

The push for U.S. market share drives significant Selling, General, and Administrative (SG&A) expenses. For the third quarter of 2025, SG&A reached $37.2 million. This was an increase of approximately $3.1 million compared to the third quarter of 2024. The primary reason for this rise is the increased investment in the United States, which includes higher sales commissions and shipping & handling costs. To give you a sense of the quarterly fluctuation in SG&A, the second quarter of 2025 saw SG&A at $44.2 million, while the first quarter was $39.7 million.

Looking at the total operating spend, the quarterly operating expenses show a pattern of high investment. The average across the first three quarters of 2025 lands right in the range you mentioned. Here's the quick math on the reported operating expenses for the first three quarters of 2025:

Period	SG&A Expense (in millions)	R&D Expense (in millions)	Total Operating Expenses (in millions)
Q1 2025	$39.7	$5.1	$44.8
Q2 2025	$44.2	$5.2	$49.4
Q3 2025	$37.2	$4.6	$41.7

The average total operating expense across these three quarters is $45.3 million.

Ongoing Research and Development (R&D) investment remains a key cost component, though it can fluctuate based on project milestones. For the third quarter of 2025, R&D expenses were $4.6 million. This was slightly lower than the $5.2 million reported in the second quarter of 2025 and the $5.1 million in the first quarter of 2025.

The variability in R&D spend is directly tied to clinical trial costs for new products like GEM and Zensor. For instance, the R&D expense in the third quarter of 2025 decreased by approximately $0.2 million compared to the third quarter of 2024, primarily due to the timing of clinical trial expenses. Similarly, the second quarter of 2025 R&D expense decreased compared to the prior year period due to a decrease in clinical trial expenses. The GEM system, a next-generation minimally invasive system for gluteal ergonomic modeling, is currently undergoing an IRB approved pivotal study. The Zensor technology platform, which includes the Zenº biosensor, is also part of an IRB approved pivotal study.

You can see the breakdown of the operating expenses for the most recent quarter:

• Total Operating Expenses (Q3 2025): $41.7 million.
• SG&A Expenses (Q3 2025): $37.2 million.
• R&D Expenses (Q3 2025): $4.6 million.

Finance: draft 13-week cash view by Friday.

Establishment Labs Holdings Inc. (ESTA) - Canvas Business Model: Revenue Streams

You're looking at how Establishment Labs Holdings Inc. (ESTA) is bringing in the money as we head into the end of 2025. The revenue streams are clearly anchored in their core implant business, but the growth story is increasingly about their newer, less invasive technologies.

The primary engine remains the Sales of Motiva Implants for breast aesthetics and reconstruction. These are the flagship products, and the company has delivered impressive top-line results. For the third quarter ended September 30, 2025, worldwide revenue hit $53.8 million, which was a 33.8% increase year-over-year. This strong quarter helped push the trailing twelve-month revenue to $190.97 million as of that date.

The financial performance shows a clear trend toward better unit economics. Establishment Labs Holdings achieved a high gross margin of 70.1% in Q3 2025, a significant jump from 63.9% in the year-ago period. This margin improvement is defintely tied to the geographic mix shift, specifically the higher-margin sales coming from the United States.

Here's a quick look at the key 2025 financial markers we have as of the Q3 report:

Metric	Value	Period/Context
Full-Year 2025 Revenue Expectation	Exceed $210 million	Updated Guidance
Q3 2025 Worldwide Revenue	$53.8 million	Quarter Ended September 30, 2025
Q3 2025 Gross Margin	70.1%	Quarter Ended September 30, 2025
Q3 2025 U.S. Motiva Sales	$11.9 million	Quarter Ended September 30, 2025
2025 U.S. Motiva Sales Expectation	Meaningfully exceed $40 million	Full-Year Outlook

The Revenue from the minimally invasive Mia Femtech platform represents the future growth vector, designed to expand the total addressable market beyond standard augmentation. While the core implant business is driving current profitability, the minimally invasive portfolio is gaining traction. For instance, the NEO product, part of this platform, is tracking for $8-$10 million in 2025 revenue. Looking ahead, management projects the entire minimally invasive platform will generate at least $30 million in revenue in 2026. This platform includes products like Mia Femtech® for harmonization and Preservé® for tissue preservation.

The revenue mix is clearly being shaped by the U.S. market penetration. The company expects to finish 2025 at an approximate 20% share of the U.S. breast augmentation market. This success in the U.S. is directly impacting the margin profile, as noted by the Q3 results.

The key drivers underpinning these revenue streams include:

• Sales of Motiva Implants in aesthetics and reconstruction.
• Strong sequential growth in the U.S. market, up 16% in Q3 2025.
• The expansion of the minimally invasive portfolio, including NEO.
• The Motiva Flora® tissue expander contributing to reconstruction revenue.