Establishment Labs Holdings Inc. (ESTA) — RQD Stock Rating Cockpit

Per the Roarable RQD rating, ESTA carries an RQD Score of 30 with a letter grade of E, labeled "Roarable Strong Sell — Forensic Risk / Avoid." The score is the sum of five pillars, each scored out of 20:

• Fundamental Cash Engine: 5 / 20. Per the same rating, this pillar reflects ROIC of -15.8% and FCF yield of -2.79%. For a prospective investor, the core operating economics are currently not generating returns on capital or positive free cash flow, which removes the most durable source of intrinsic support.
• Whale 13F Flow: 11 / 20. This is the strongest pillar, reflecting institutional accumulation and options positioning. It is a supportive signal, but it describes positioning rather than earnings quality, and it does not offset the cash-generation weakness.
• Insider Conviction: 3 / 20. Per the rating, SEC Form 4 and Congressional PTR cluster flow scored low. For an investor, this indicates limited insider-level confidence signaled through the tracked flow data.
• Macro Regime Fit: 3 / 20. Per the rating, beta is 1.0 with sector sensitivity. Per the Butterfly graph, the stock shows a 1.88x Net Liquidity elasticity, meaning its price is likely to amplify changes in liquidity conditions. Tightening liquidity is therefore a headwind.
• Forensic Balance Sheet: 8 / 20. Per the rating, Altman Z is 2.52, Piotroski F is 5/9, and Debt/Equity is 8.5. These metrics are mid-range rather than distressed, but the leverage level is high relative to cash generation.

Taken together, the valuation tradeoff is that the market cap of $2.04B is supported largely by positioning and growth narrative rather than cash earnings. Upside drivers would require sustained revenue growth converting into improved operating margins and positive FCF. The 2nd-order risk is that a liquidity-sensitive stock with negative FCF and elevated leverage is vulnerable to funding-cost tightening. This is an analytical framing, not personalized advice.

Per the SEC financials, revenue grew from $165.2M in FY 2023 to $211.1M in FY 2025 while operating losses narrowed from $-65.0M to $-39.0M. Per the market data, operating margin is -18.5% and net margin is -24.2%. ROIC is -15.8% per the market data. Per the Roarable RQD rating, the Altman Z-Score is 2.52 and the Piotroski F-Score is 5/9. Debt of $247.5M exceeds cash of $75.6M in FY 2025, and the rating reports Debt/Equity of 8.5.

Per the recent news section, catalysts include an FDA clearance headline described as an expanded clearance, a price target reduction to $93 by BTIG on estimates, and a Mizuho rating reiteration citing strong sales. Several items are flagged YELLOW (market wire), and one GREEN catalyst item relates to the FDA clearance. Per the Butterfly graph, the proprietary LIQUIDITY_TAILWIND signal is BEARISH with severity 80 and a Macro Tailwind Score of 30/100, driven by a 1.88x True Net Liquidity elasticity and a Net Liquidity reading of $5,745.73B with a -0.64% 4-week rate of change. Risk watch items are the bearish liquidity signal and the BTIG target reduction.

• What are the trailing and forward earnings per share and the P/E multiples, given that these fields are absent from the source data?
• What is the EV/EBITDA valuation, and how does it compare with the revenue growth trajectory?
• What is the composition of the reported Debt of $247.5M, including maturity schedule and interest cost?
• Which specific institutions hold the stock, and what is the trend in 13F ownership?
• What is the product and customer breakdown behind the $211.1M revenue figure?