ESTABLISHMENT LABS HOLDINGS INC., 10-K filed on 2/27/2026
Annual Report
v3.25.4
Cover Page - USD ($)
 12 Months Ended
Dec. 31, 2025
Feb. 26, 2026
Jun. 30, 2025
Cover [Abstract]      
Document Type 10-K    
Document Annual Report true    
Document Period End Date Dec. 31, 2025    
Current Fiscal Year End Date --12-31    
Document Transition Report false    
Entity File Number 001-38593    
Entity Registrant Name Establishment Labs Holdings Inc.    
Entity Incorporation, State or Country Code D8    
Entity Tax Identification Number 98-1436377    
Entity Address, Address Line One 11401 Century Oaks Terrace    
Entity Address, Address Line Two Suite 400    
Entity Address, City or Town Austin    
Entity Address, State or Province TX    
Entity Address, Postal Zip Code 78758    
Country Region 1    
City Area Code 800    
Local Phone Number 924-5072    
Title of 12(b) Security Common Shares, No Par Value    
Trading Symbol ESTA    
Security Exchange Name NASDAQ    
Entity Well-known Seasoned Issuer Yes    
Entity Voluntary Filers No    
Entity Current Reporting Status Yes    
Entity Interactive Data Current Yes    
Entity Filer Category Large Accelerated Filer    
Entity Small Business false    
Entity Emerging Growth Company false    
ICFR Auditor Attestation Flag true    
Document Financial Statement Error Correction false    
Entity Shell Company false    
Entity Public Float     $ 975,097,617
Entity Common Stock, Shares Outstanding   29,320,846  
Documents Incorporated by Reference
Portions of the registrant’s definitive proxy statement relating to its 2026 annual meeting of shareholders (the “2026 Proxy Statement”) are incorporated by reference into Part III of this Annual Report on Form 10-K where indicated. The 2026 Proxy Statement will be filed with the U.S. Securities and Exchange Commission within 120 days after the end of the fiscal year to which this report relates.
    
Amendment Flag false    
Entity Central Index Key 0001688757    
Document Fiscal Year Focus 2025    
Document Fiscal Period Focus FY    
v3.25.4
Audit Information
 12 Months Ended
Dec. 31, 2025
Audit Information [Abstract]  
Auditor Name CBIZ CPAs P.C.
Auditor Firm ID 199
Auditor Location Los Angeles, California
v3.25.4
Consolidated Balance Sheets - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Current assets:    
Cash and cash equivalents $ 75,572 $ 90,347
Accounts receivable, net of allowance for credit losses of $6,835 and $3,088 at December 31, 2025 and 2024, respectively 77,497 65,002
Inventory, net 85,611 78,766
Prepaid expenses and other current assets 11,260 8,922
Total current assets 249,940 243,037
Long-term assets:    
Property and equipment, net 75,615 78,028
Goodwill 1,209 1,209
Intangible assets, net of accumulated amortization 9,942 11,683
Right-of-use operating lease assets, net 4,339 5,561
Other non-current assets 16,122 7,313
Total assets 357,167 346,831
Current liabilities:    
Accounts payable 43,109 44,760
Accrued liabilities 18,856 16,536
Other liabilities, short-term 20,177 6,982
Total current liabilities 82,142 68,278
Long-term liabilities:    
Note payable, Oaktree, net of debt discount and issuance costs 247,522 219,577
Operating lease liabilities, non-current 2,820 4,203
Other liabilities, long-term 1,136 1,678
Total liabilities 333,620 293,736
Commitments and contingencies (Note 16)
Shareholders’ equity:    
Common shares – zero par value, unlimited amount of shares authorized at December 31, 2025 and 2024; 29,713,024 and 29,195,439 shares issued at December 31, 2025 and 2024, respectively; 29,304,954 and 28,787,369 shares outstanding at December 31, 2025 and 2024, respectively 433,378 420,364
Additional paid-in-capital 87,624 76,992
Treasury shares, at cost, 408,070 shares held at December 31, 2025 and 2024 (2,854) (2,854)
Accumulated deficit (495,756) (444,692)
Accumulated other comprehensive income 1,155 3,285
Total shareholders’ equity 23,547 53,095
Total liabilities and shareholders’ equity $ 357,167 $ 346,831
v3.25.4
Consolidated Balance Sheets (Parenthetical) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Statement of Financial Position [Abstract]    
Allowance for doubtful accounts $ 6,835 $ 3,088
Common stock, shares issued (in shares) 29,713,024 29,195,439
Common stock, shares outstanding (in shares) 29,304,954 28,787,369
Treasury stock, shares held (in shares) 408,070 408,070
Common Stock, Shares Authorized, Unlimited [Fixed List] Unlimited Unlimited
v3.25.4
Consolidated Statements of Operations - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Income Statement [Abstract]      
Revenue $ 211,076 $ 166,025 $ 165,151
Cost of revenue 64,768 56,500 58,174
Gross profit 146,308 109,525 106,977
Operating expenses:      
Sales, general and administrative 165,069 139,806 145,575
Research and development 20,247 19,706 26,428
Total operating expenses 185,316 159,512 172,003
Loss from operations (39,008) (49,987) (65,026)
Interest income 423 1,477 1,020
Interest expense (25,256) (20,829) (15,393)
Other income (expense), net 5,819 (15,289) 816
Loss before income taxes (58,022) (84,628) (78,583)
Benefit (provision) for income taxes 6,958 32 81
Net loss $ (51,064) $ (84,596) $ (78,502)
Basic net loss per share (in dollars per share) $ (1.72) $ (3.00) $ (3.07)
Diluted net loss per share (in dollars per share) $ (1.72) $ (3.00) $ (3.07)
Weighted average outstanding shares used for basic net loss per share (in shares) 29,620,022 28,161,761 25,600,029
Weighted average outstanding shares used for diluted net loss per share (in shares) 29,620,022 28,161,761 25,600,029
v3.25.4
Consolidated Statements of Comprehensive Loss - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Statement of Comprehensive Income [Abstract]      
Net loss $ (51,064) $ (84,596) $ (78,502)
Other comprehensive income:      
Foreign currency translation gain (loss) (2,130) 1,322 (752)
Other comprehensive income (loss) (2,130) 1,322 (752)
Comprehensive loss $ (53,194) $ (83,274) $ (79,254)
v3.25.4
Consolidated Statements of Shareholders’ Equity - USD ($)
$ in Thousands
Total
Common Shares
Treasury Shares
Additional Paid-In Capital
Accumulated Deficit
Accumulated Other Comprehensive Income
Beginning balance (in shares) at Dec. 31, 2022   24,815,908        
Beginning balance at Dec. 31, 2022 $ (8,185) $ 223,637 $ (2,854) $ 49,911 $ (281,594) $ 2,715
Beginning balance (in shares) at Dec. 31, 2022     (408,070)      
Increase (Decrease) in Stockholders' Equity [Roll Forward]            
Issuance of common shares, net of underwriters' discount and issuance costs (in shares)   1,265,000        
Issuance of common shares, net of underwriters’ discount and issuance costs 84,538 $ 84,538        
Issuance of common shares in lieu of cash compensation (in shares)   23,041        
Issuance of common shares in lieu of cash compensation 745 $ 745        
Stock option exercises (in shares)   349,967        
Stock option exercises 6,673 $ 6,673   0    
Share-based compensation (in shares)   49,351        
Share-based compensation 14,362 $ 49   14,313    
Shares withheld to cover income tax obligation upon vesting of restricted stock (in shares)   (8,017)        
Shares withheld to cover income tax obligation upon vesting of restricted stock (484) $ (8)   (476)    
Foreign currency translation gain (loss) (752)         (752)
Net loss (78,502)       (78,502)  
Ending balance (in shares) at Dec. 31, 2023   26,495,250        
Ending balance at Dec. 31, 2023 18,395 $ 315,634 $ (2,854) 63,748 (360,096) 1,963
Ending balance (in shares) at Dec. 31, 2023     (408,070)      
Increase (Decrease) in Stockholders' Equity [Roll Forward]            
Issuance of common shares, net of underwriters' discount and issuance costs (in shares)   1,867,261        
Issuance of common shares, net of underwriters’ discount and issuance costs 99,484 $ 99,484        
Issuance of common shares in lieu of cash compensation (in shares)   48,167        
Issuance of common shares in lieu of cash compensation 2,142 $ 2,142        
Warrant exercises (in shares)   599,991        
Warrant exercises 0 $ 600   (600)    
Stock option exercises (in shares)   134,226        
Stock option exercises 2,454 $ 2,454        
Share-based compensation (in shares)   61,382        
Share-based compensation 14,404 $ 61   14,343    
Shares withheld to cover income tax obligation upon vesting of restricted stock (in shares)   (10,838)        
Shares withheld to cover income tax obligation upon vesting of restricted stock (510) $ (11)   (499)    
Foreign currency translation gain (loss) 1,322         1,322
Net loss $ (84,596)       (84,596)  
Ending balance (in shares) at Dec. 31, 2024 28,787,369 29,195,439        
Ending balance at Dec. 31, 2024 $ 53,095 $ 420,364 $ (2,854) 76,992 (444,692) 3,285
Ending balance (in shares) at Dec. 31, 2024 (408,070)   (408,070)      
Increase (Decrease) in Stockholders' Equity [Roll Forward]            
Issuance of common shares, net of underwriters' discount and issuance costs (in shares)   76,569        
Issuance of common shares, net of underwriters’ discount and issuance costs $ 0 $ 77   (77)    
Issuance of common shares in lieu of cash compensation (in shares)   115,429        
Issuance of common shares in lieu of cash compensation $ 5,279 $ 5,279        
Stock option exercises (in shares) 256,696 256,696        
Stock option exercises $ 7,589 $ 7,589        
Share-based compensation (in shares)   84,194        
Share-based compensation 11,415 $ 84   11,331    
Shares withheld to cover income tax obligation upon vesting of restricted stock (in shares)   (15,303)        
Shares withheld to cover income tax obligation upon vesting of restricted stock (637) $ (15)   (622)    
Foreign currency translation gain (loss) (2,130)         (2,130)
Net loss $ (51,064)       (51,064)  
Ending balance (in shares) at Dec. 31, 2025 29,304,954 29,713,024        
Ending balance at Dec. 31, 2025 $ 23,547 $ 433,378 $ (2,854) $ 87,624 $ (495,756) $ 1,155
Ending balance (in shares) at Dec. 31, 2025 (408,070)   (408,070)      
v3.25.4
Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Cash flows from operating activities:      
Net loss $ (51,064) $ (84,596) $ (78,502)
Adjustments to reconcile net loss to net cash used in operating activities:      
Depreciation and amortization 9,563 6,834 4,166
Provision for credit losses 3,352 1,722 1,223
Provision for inventory obsolescence 2,646 1,805 1,392
Change in reserve for PP&E impairment 0 0 (341)
Provision for deferred income taxes (9,130) (2,178) (3,706)
Share-based compensation 11,415 14,404 14,362
Loss from disposal of property and equipment 153 163 280
Unrealized foreign currency (gain)/loss, net (9,956) 5,302 (4,181)
Amortization of right-to-use asset 911 743 717
Non-cash loss on contract termination 543 6,004 0
Stock compensation in lieu of cash fees 403 964 495
Interest capitalized for construction in progress 0 (555) (3,567)
Non-cash interest expense and amortization of debt discount 3,445 6,371 13,278
Changes in operating assets and liabilities:      
Accounts receivable (11,469) (26,278) (11,557)
Inventory (7,060) (471) (42,230)
Prepaid expenses and other current assets 1,847 86 2,637
Other assets 454 (483) 318
Accounts payable (2,296) 6,671 18,957
Accrued liabilities 1,847 4,395 (1,662)
Operating lease liabilities (887) (646) (689)
Other liabilities 4,393 1,227 97
Net cash used in operating activities (50,890) (58,516) (88,513)
Cash flows from investing activities:      
Purchases of property and equipment (6,049) (6,114) (7,908)
Cash used in business acquisitions, net of cash acquired (307) (50) 0
Cost incurred for intangible assets (672) (7,033) (1,328)
Capital expenditures on construction in progress 0 (2,414) (15,311)
Net cash used in investing activities (7,028) (15,611) (24,547)
Cash flows from financing activities:      
Issuance of common stock, net of underwriters’ discount and issuance costs 0 99,484 84,538
Borrowings under Oaktree credit agreement, net of debt discount and issuance costs 24,500 24,467 0
Borrowings on short term notes payable 10,000 0 0
Repayments of short term notes payable for insurance premium financing (1,018) 0 0
Proceeds from stock option exercises 7,589 2,454 2,173
Tax payments related to shares withheld upon vesting of restricted stock (637) (510) (484)
Net cash provided by financing activities 40,434 125,895 86,227
Effect of exchange rate changes on cash and cash equivalents 2,709 (1,456) 513
Net (decrease)/increase in cash and cash equivalents (14,775) 50,312 (26,320)
Cash and cash equivalents at beginning of period 90,347 40,035 66,355
Cash and cash equivalents at end of period 75,572 90,347 40,035
Supplemental disclosures:      
Cash paid for interest 20,539 9,806 5,689
Cash paid for income taxes 420 1,735 2,165
Supplemental disclosures of non-cash investing and financing activities:      
Unpaid balance for property and equipment 144 240 2,847
Unpaid balance for intangible assets 581 592 2,907
Equity consideration in an asset acquisition 0 0 250
Equity consideration issued in a business acquisition 3,556 1,177 0
Contingent consideration payable related to a business acquisition 4,474 973 0
Consideration payable related to a business acquisition 315 3,262 0
Cashless option exercises 0 0 4,500
Cashless warrant exercises 0 600 0
Cash payable to settle contract termination 0 214 0
Liability to issue shares to settle contract termination 0 1,320 0
Borrowings of short term notes payable for insurance premium financing $ 3,382 $ 0 $ 0
v3.25.4
Formation and Business of the Company
 12 Months Ended
Dec. 31, 2025
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
Formation and Business of the Company Formation and Business of the Company
Formation and Business of the Company
Establishment Labs Holdings Inc. along with its wholly owned subsidiaries, or the Company, is a global company that manufactures and markets innovative medical devices for aesthetic and reconstructive plastic surgery. The Company was established in the British Virgin Islands on October 9, 2013, at which time Establishment Labs, S.A., the Costa Rican manufacturing company, was reincorporated as a wholly-owned subsidiary. As of December 31, 2025, the Company also has wholly-owned subsidiaries in the United States (JAMM Technologies, Inc. and Motiva USA LLC), Brazil (Establishment Labs Produtos para Saude Ltda), Belgium (European Distribution Center Motiva BV and Motiva Benelux BV), the Netherlands (Motiva NL BV), France (Motiva Implants France SAS), Sweden (Motiva Nordica AB), Switzerland (JEN-Vault AG), the United Kingdom (Motiva Implants UK Limited), Italy (Motiva Italy S.R.L), Spain (Motiva Implants Spain, S.L.), Austria (Motiva Austria GmbH), Germany (Motiva Germany GmbH) and Argentina (Motiva Argentina S.R.L). Substantially all of the Company’s revenues are derived from the sale of silicone gel-filled breast implants, branded as Motiva Implants.
The main manufacturing activities are conducted at manufacturing facilities in Costa Rica. In 2024, the Company completed construction of its newest facility. In 2010, the Company began operating under the Costa Rica free zone regime (Régimen de Zona Franca), which provides for reduced income tax and other tax obligations pursuant to an agreement with the Costa Rican authorities.
The Company’s products are approved for sale in Europe, the Middle East, Latin America, Asia and the United States. The Company sells its products internationally through a combination of distributors and direct sales to customers. In October 2024, the Company began selling Motiva Implants for use in breast augmentation for patients in the United States.
v3.25.4
Summary of Significant Accounting Policies
 12 Months Ended
Dec. 31, 2025
Accounting Policies [Abstract]  
Summary of Significant Accounting Policies Summary of Significant Accounting Policies
Basis of Presentation and Consolidation
The accompanying consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America, or GAAP, and the applicable rules and regulations of the Securities and Exchange Commission, or SEC.
The consolidated financial statements include the Company’s accounts and those of its wholly owned subsidiaries as of December 31, 2025 as follows:
SubsidiaryIncorporation/Acquisition Date
Establishment Labs, S.A. (Costa Rica)January 18, 2004
Motiva USA, LLC (USA)February 20, 2014
JAMM Technologies, Inc. (USA)October 27, 2015
Establishment Labs Produtos par Saude Ltda (Brazil)January 4, 2016
European Distribution Center Motiva BV (Belgium)March 4, 2016
Motiva Implants France SAS (France)September 12, 2016
JEN-Vault AG (Switzerland)November 22, 2016
Motiva Nordica AB (Sweden)November 2, 2017
Motiva Implants UK Limited (the United Kingdom)July 31, 2018
Motiva Italy S.R.L (Italy)July 31, 2018
Motiva Implants Spain, S.L. (Spain)January 3, 2019
Motiva Austria GmbH (Austria)January 14, 2019
Motiva Germany GmbH (Germany)August 1, 2019
Motiva Argentina S.R.L. (Argentina)February 7, 2020
Motiva Benelux BV (Belgium)
October 1, 2024
Motiva NL BV (Netherlands)October 1, 2024
All intercompany accounts and transactions have been eliminated in consolidation.
Segments
The chief operating decision maker, or CODM, for the Company is the Chief Executive Officer. The Chief Executive Officer reviews financial information presented on a consolidated basis, accompanied by information about revenue by geographic region, for purposes of allocating resources and evaluating financial performance. The Company has one business activity, and there are no segment managers who are held accountable for operations, operating results or plans for levels or components below the consolidated unit level. Accordingly, the Company has determined that it has one single reportable and operating segment structure. The Company and its Chief Executive Officer evaluate performance based primarily on revenue in the geographic regions in which the Company operates. See the consolidated statements of operations for the consolidated financial information and “Revenue Recognition” for revenue by geographic region used in evaluating financial performance. The level of disaggregation and amounts of significant segment expenses that are regularly provided to the CODM are the same as those presented in the consolidated statements of operations. Likewise, the measure of segment assets is reported on the consolidated balance sheets as total assets.
Geographic Concentrations
The Company derives substantially all of its revenues from sales to customers in the United States, Europe, the Middle East, Latin America, and Asia. The Company received approval to sell its Motiva Implants in the United States in September 2024 and Motiva Flora Tissue Expanded in October 2023. The revenue derived in the United States prior to the FDA approvals consisted of microtransponder sales.
For the year ended December 31, 2025, the United States accounted for 21.6% of consolidated revenue, and no other individual country exceeded 10% of consolidated revenue, on a ship-to-destination basis. For the year ended December 31, 2024, no individual country exceeded 10% of consolidated revenue, on a ship-to-destination basis. For the year ended December 31, 2023, Brazil accounted for 13.3%, respectively, of consolidated revenue
and no other individual country exceeded 10% of consolidated revenue, on a ship-to destination basis.
The majority of the Company’s consolidated total assets, including cash and tangible assets, is held in the United States. The Company’s long-lived assets, which primarily consist of property and equipment and intangible assets located in Costa Rica represented 73% and 78% of the total long-lived assets as of December 31, 2025 and 2024, respectively.
Use of Estimates
The preparation of financial statements in accordance with GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Significant accounting estimates and management judgments reflected in the consolidated financial statements include items such as accounts receivable valuation and allowances, inventory valuation and allowances, valuation of acquired intangible assets, valuation of long-lived assets, valuation of stock grants and valuation of deferred income tax assets, including tax valuation allowances. Estimates are based on historical experience, where applicable, and other assumptions believed to be reasonable by management. Actual results may differ from those estimates under different assumptions or conditions.
Concentration of Credit Risk and Other Risks and Uncertainties
Financial instruments that potentially subject the Company to a concentration of credit risk consist principally of cash and accounts receivable. The majority of the Company’s cash is held at two financial institutions in the United States. Balances in the Company’s cash accounts exceed the Federal Deposit Insurance Corporation, or FDIC, limit of $250,000. The Company has not experienced any losses to its deposits of cash.
Substantially all of the Company’s revenue has been derived from sales of its products in international markets, principally Europe, the Middle East, Latin America, and Asia. In the international markets in which the Company operates, the Company uses a combination of distributors and direct sales to customers. The Company performs ongoing credit evaluations of its distributors and customers, does not require collateral, and maintains allowances for potential credit losses on customer accounts when deemed necessary.
Substantially all of the Company’s revenues were derived from the sale of Motiva Implants. During the years ended December 31, 2025, 2024 and 2023, no customer accounted for more than 10% of the Company’s revenue. One customer accounted for 14.1% of the Company’s trade accounts receivable balance as of December 31, 2025. One customer accounted for 17.0% of the Company’s trade accounts receivable balance as of December 31, 2024.
The Company relies on Avantor, Inc. (formerly NuSil Technology, LLC), or Avantor, as the sole supplier of medical-grade silicone used in Motiva Implants. During the years ended December 31, 2025, 2024 and 2023, the Company had purchases of $31.6 million, or 55.8% of total purchases, $29.2 million, or 44.7% of total purchases, and $53.7 million, or 68.4% of total purchases, respectively, from Avantor. As of December 31, 2025 and 2024, the Company had an outstanding balance owed to this vendor of $8.9 million and $15.0 million, respectively.
The Company’s financial condition and future results of operations involve a number of risks and uncertainties. Factors that could affect the Company’s future operating results and cause actual results to vary materially from expectations include, but are not limited to, unfavorable economic conditions, uncertainty of continued or new regulatory approval for the Company’s current and potential future products, uncertainty of market acceptance of the Company’s products, competition from substitute products and larger companies, securing and protecting proprietary technology, access to capital, strategic relationships and dependence on key individuals and sole source suppliers.
Products developed by the Company require clearance from the FDA or other international regulatory agencies prior to commercial sales. There can be no assurance that the products will receive the necessary clearances. If the Company is denied clearance, clearance is delayed, or if the Company is unable to maintain its existing clearances, these developments could have a material adverse impact on the Company.
Cash and Cash Equivalents
The Company’s cash consists of cash maintained in checking and interest-bearing accounts. The majority of the Company’s cash is held at two financial institutions in the United States, with balances in excess of FDIC
insurance limits. The Company accounts for financial instruments with original maturities of three months or less at the date of purchase as cash equivalents. The Company held no cash equivalents as of December 31, 2025. The Company held $3.0 million cash equivalents as of December 31, 2024.
Accounts Receivable and Allowance for Credit Losses
Accounts receivable balance is stated at invoice value less estimated allowances for returns and credit losses. The Company continually monitors customer payments and maintains an allowance for estimated losses resulting from customers’ inability to make required payments. In evaluating the Company’s ability to collect outstanding receivable balances, the Company considers various factors including the age of the balance, the creditworthiness of the customer, which is assessed based on ongoing credit evaluations and payment history, and the customer’s current financial condition. In cases where there are circumstances that may impair a specific customer’s ability to meet its financial obligations, an allowance is recorded against amounts due, which reduces the net recognized receivable to the amount reasonably believed to be collectible.
A roll-forward of the allowance for credit losses is as follows:
Year Ended December 31,
2025
2024
2023
(in thousands)
Beginning balance$3,088 $1,841 $741 
Provision for credit losses3,352 1,722 1,223 
Recoveries (write-offs)
395 (475)(123)
Ending balance$6,835 $3,088 $1,841 
Inventory and Cost of Revenue
Inventory is stated at the lower of cost to purchase or manufacture the inventory or the net realizable value of such inventory. Cost is determined using the standard cost method which approximates actual costs using the first-in, first-out basis. The Company regularly reviews inventory quantities, actual losses, projected future demand, and remaining shelf life to record a provision for obsolete and/or damaged inventory.
A roll-forward of the inventory reserve is as follows:
Year Ended December 31,
2025
2024
2023
(in thousands)
Beginning balance$4,177 $3,930 $2,649 
Provision for inventory obsolescence2,646 1,805 1,392 
Write-offs(2,915)(1,558)(111)
Ending balance$3,908 $4,177 $3,930 
The Company recognizes the cost of inventory transferred to the customer in cost of revenue when revenue is recognized.
Leases
The Company determines if an arrangement is, or contains, a lease at the inception date of the contract. The Company has elected an expedient to account for each separate lease component and its associated non-lease components as a single lease component for the majority of its asset classes.
The lease term may include periods covered by options to extend or terminate the lease when it is reasonably certain that the Company will exercise a renewal option, or reasonably certain it will not exercise an early termination option. The Company recognizes lease liabilities and right-of-use, or ROU, assets upon commencement for all material leases with a term greater than 12 months. The Company has elected an expedient not to recognize leases with a lease term of 12 months or less on the balance sheet. These short-term leases are expensed on a straight-line basis over the lease term.
Shipping and Handling Costs
Shipping and handling costs are expensed as incurred and are included in selling, general and administrative, or SG&A, expenses. For the years ended December 31, 2025, 2024 and 2023, shipping and handling costs were $13.0 million, $7.2 million and $11.8 million, respectively.
Revenue Recognition
The Company recognizes revenue related to sales of products to distributors or directly to customers in markets where it has regulatory approval, net of discounts and allowances. The Company recognizes revenue in accordance with Accounting Standards Codification, or ASC, Revenue from Contracts with Customers (Topic 606). ASC 606 requires the Company to recognize revenue to depict the transfer of goods or services to a customer at an amount that reflects the consideration it expects to receive in exchange for those goods or services.
The Company recognizes revenue related to the sales of products to distributors at the time of shipment of the product, which represents the point in time when the distributor has taken ownership and assumed the risk of loss, and the required revenue recognition criteria are satisfied. The Company’s distributors are obligated to pay within specified terms regardless of when, or if, they sell the products. The Company’s contracts with distributors typically do not contain right of return or price protection and have no post-delivery obligations.
The Company recognizes revenue when title to the product and risk of loss transfer to customers, provided there are no remaining performance obligations required of the Company or any written matters requiring customer acceptance. The Company allows for the return of products from direct customers in certain regions in limited instances within 15 to 60 days after the original sale and records estimated sales returns as a reduction of sales in the same period revenue is recognized. Appropriate reserves are established for anticipated sales returns based on historical experience, recent gross sales and any notification of pending returns. Actual sales returns in any future period are inherently uncertain and thus may differ from the estimates. If actual sales returns differ significantly from the estimates, an adjustment to revenue in the current or subsequent period is recorded. As of December 31, 2025 and 2024, an allowance of $1.9 million and $0.4 million was recorded for product returns, respectively. Taxes collected from customers for remittance to governmental authorities are excluded from net sales.
A portion of the Company’s revenue is generated from the sale of consigned inventory maintained at physician, hospital, or clinic locations. For these products, revenue is recognized at the time the Company is notified by the consignee that the product has been implanted, not when the consigned products are delivered to the consignee’s warehouse.
Revenue was generated in these primary geographic markets:
Year Ended December 31,
202520242023
(in thousands)
EMEA (Europe / Middle East / Africa)$91,052 $78,209 $80,150 
Latin America39,926 34,998 48,891 
Asia-Pacific34,541 48,408 33,953 
North America45,557 4,410 2,157 
Total revenue$211,076 $166,025 $165,151 
The Company has a limited warranty for the shelf life of breast implants, which is five years from the time of manufacture. Estimated warranty obligations are recorded at the time of sale. The Company also offers a warranty to patients in the event of rupture and a replacement program for capsular contracture events, provided certain registration requirements are met. Revenue for extended warranties is recognized ratably over the term of the agreement. To date, these warranty and program costs have been de minimis. The Company will continue to evaluate the warranty reserve policies for adequacy considering claims history.
Deferred revenue primarily consists of payments received in advance of meeting revenue recognition criteria. The Company has received payments from distributors to provide distribution exclusivity within a geographic area and recognizes revenue on a ratable basis over the term of such contractual distribution relationship. Additionally, the Company has received payments from customers in direct markets prior to surgical implantation and recognizes deferred revenue at the time the Company is notified by the customer that the product has been implanted. For all arrangements, any revenue that has been deferred and is expected to be recognized beyond one year is classified as long-term deferred revenue and included in “Other liabilities, long-term” on the consolidated balance sheets (see Note 3).
Research and Development
Costs related to research and development, or R&D, activities are expensed as incurred. R&D costs primarily include personnel costs, materials, clinical expenses, regulatory expenses, product development, consulting services, and outside research activities, all of which are directly related to research and development activities.
The Company estimates IDE clinical trial expenses based on the services performed, pursuant to contracts with research institutions and clinical research organizations that conduct and manage clinical trials on its behalf. In accruing service fees, the Company estimates the time period over which services will be performed and the level of patient enrollment and activity expended in each period. If the actual timing of the performance of services or the level of effort varies from the estimate, the Company will adjust the accrual accordingly.
Selling, General and Administrative Expenses
SG&A expenses include sales and marketing costs, payroll and related benefit costs, insurance expenses, shipping and handling costs, legal and professional fees and administrative overhead.
Property and Equipment
Property and equipment are stated at cost less accumulated depreciation and amortization.
The Company depreciates owned buildings on a straight-line basis over 50 years of useful life. Depreciation of property and equipment is computed using the straight-line method over the assets’ estimated useful lives of five to ten years. Leasehold improvements are amortized on a straight-line basis over the shorter of the estimated useful life of the asset or the remaining lease term after factoring expected renewal periods. Upon retirement or disposal of assets, the costs and related accumulated depreciation are eliminated from the accounts and any gain or loss is recognized in operations. Maintenance and repairs are expensed as incurred. Substantially all of the
Company’s manufacturing operations and related property and equipment are located in Costa Rica.
Goodwill and Intangible Assets
The Company records the excess of the acquisition purchase price over the net fair value of the tangible and identifiable intangible assets acquired and liabilities assumed as goodwill. In accordance with ASC 350, Intangibles - Goodwill and Other, the Company tests goodwill for impairment annually during the fourth quarter of each year and whenever events or changes in circumstances indicate that the carrying value of the asset may not be recoverable. In connection with the annual impairment test for goodwill, the Company elected the option to perform a qualitative assessment to determine whether it is more likely than not that the fair value of the reporting unit is less than its carrying amount. If the Company determines that it was more likely than not that the fair value of the reporting unit is less than its carrying amount, then the impairment test is performed.
Consistent with the Company’s assessment that it has only one reporting segment, the Company has determined that it has only one reporting unit and tests goodwill for impairment at the entity level using the two-step process required by ASC 350. In the first step, the Company compares the carrying amount of the reporting unit to the fair value of the enterprise. If the fair value of the enterprise exceeds the carrying value, goodwill is not considered impaired and no further testing is required. If the carrying value of the enterprise exceeds the fair value, goodwill is potentially impaired, and the second step of the impairment test must be performed. In the second step, the Company compares the implied fair value of the goodwill, as defined by ASC 350, to its carrying amount to determine the impairment loss, if any.
The Company capitalizes certain costs related to intangible assets, such as patents, trademarks and software development costs. The Company follows the provisions of ASC 350-40, Internal Use Software for determining whether computer software is internal-use software and on accounting for the costs of computer software originally developed or obtained for internal use. The Company expenses all costs incurred during the preliminary project stage of software development and capitalizes the costs incurred during the application development stage. Costs incurred relating to upgrades and enhancements to the software are capitalized if it is determined that these upgrades or enhancements add additional functionality to the software. Costs incurred to improve and support products after they become available are charged to expense as incurred.
The Company records purchased intangible assets at their respective estimated fair values at the date of acquisition. Purchased finite-lived intangible assets are being amortized using the straight-line method over their remaining estimated useful lives, which range from one to ten years. The Company evaluates the remaining useful lives of intangible assets on a periodic basis to determine whether events or circumstances warrant a revision to the remaining estimated amortization period. The Company tests indefinite-lived intangible assets for impairment on at least an annual basis and whenever circumstances suggest the assets may be impaired. If indicators of impairment are present, the Company evaluates the carrying value of the intangible assets in relation to estimates of future undiscounted cash flows. The Company also evaluates the remaining useful life of an indefinite-lived intangible asset to determine whether events and circumstances continue to support an indefinite useful life.
During the years ended December 31, 2025, 2024 and 2023, there has been no impairment of goodwill or intangible assets based on the qualitative assessments performed by the Company.
Long-Lived Assets
The Company reviews long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset might not be recoverable. When such an event occurs, management determines whether there has been impairment by comparing the anticipated undiscounted future net cash flows to the related asset group’s carrying value. If an asset is considered impaired, the asset is written down to fair value, which is determined based either on discounted cash flows or appraised value, depending on the nature of the asset. There were no impairment charges, or changes in estimated useful lives recorded during the years ended December 31, 2025, 2024 and 2023.
Debt Issuance Costs and Debt Discounts
Costs incurred in connection with the issuance of new debt are capitalized. Capitalizable debt issuance costs paid to third parties and debt discounts, net of amortization, are recorded as a reduction to the long-term debt balance
on the consolidated balance sheets. Amortization expense on capitalized debt issuance costs and debt discounts related to loans are calculated using the effective interest method over the term of the loan commitment and is recorded as interest expense in the consolidated statements of operations.
Income Taxes
The Company accounts for income taxes using the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences of differences between the financial reporting and tax bases of assets and liabilities, and for operating loss and tax credit carryforwards. Deferred tax balances are measured using enacted tax laws and rates expected to apply when the related temporary differences reverse. The Company establishes a valuation allowance when it is more likely than not that some portion or all of a deferred tax asset will not be realized.
The Company operates in multiple tax jurisdictions and is subject to examination by various tax authorities. The Company recognizes uncertain tax positions using a two‑step approach: (1) a tax position is recognized only if it is more likely than not to be sustained based on its technical merits, and (2) the amount recognized is the largest amount of benefit that is more than 50% likely to be realized upon settlement. Interest and penalties related to uncertain tax positions are recorded in income tax expense. There were no material uncertain tax positions in the years ended December 31, 2025, 2024 and 2023.
Effective January 1, 2025, the Company adopted ASU 2023‑09, Improvements to Income Tax Disclosures, on a prospective basis. As a result, our income tax disclosures now include enhanced disaggregation of income taxes paid and a standardized effective tax rate reconciliation, as required by the amended guidance. The adoption did not affect our accounting for income taxes under ASC 740.
Foreign Currency
The financial statements of the Company’s foreign subsidiaries whose functional currencies are the local currencies are translated into U.S. dollars for consolidation as follows: assets and liabilities at the exchange rate as of the balance sheet date, shareholders’ equity at the historical rates of exchange, and income and expense amounts at the average exchange rate for the period. Translation adjustments resulting from the translation of the subsidiaries’ accounts are included in “Accumulated other comprehensive income” as equity in the consolidated balance sheet. Transactions denominated in currencies other than the applicable functional currency are converted to the functional currency at the exchange rate on the transaction date. At period end, monetary assets and liabilities are remeasured to the functional currency using exchange rates in effect at the balance sheet date. Non-monetary assets and liabilities are remeasured at historical exchange rates. Gains and losses resulting from foreign currency transactions are included within “Other income (expense), net” in the consolidated statement of operations. For the years ended December 31, 2025, 2024 and 2023, foreign currency transaction gain/loss amounted to a gain of $6.4 million, a loss of $8.8 million and a gain of $1.8 million, respectively.
Contract Termination Costs
From time to time the Company may settle certain contracts with third parties. In the second quarter of 2025, the Company terminated a contract with a supplier of raw materials and recorded a $0.5 million loss on contract termination. In the fourth quarter of 2024, the Company entered into a contract termination agreement with a third-party in connection with its Mia products in Europe. In lieu of a cash settlement, the Company and the third-party agreed to settle previous amounts incurred by each respective party from separate and unrelated contracts. As of December 31, 2024, the Company recorded a $1.5 million liability for contract termination payments resulting in a total loss on contract termination of $6.0 million reported under “Other income (expense), net”. There were no such costs in the years ended December 31, 2023.
Comprehensive Loss
The Company’s comprehensive loss consists of net loss and foreign currency translation adjustments arising from the consolidation of the Company’s foreign subsidiaries.
Share-Based Compensation
The Company measures and recognizes compensation expense for all share-based awards in accordance with the provisions of ASC 718, Stock Compensation. Share-based awards granted include stock options, restricted stock units, or RSUs, and restricted stock awards, or RSAs. Share-based compensation expense for stock
options, RSUs and RSAs granted to employees is measured at the grant date based on the fair value of the awards and is recognized as an expense ratably on a straight-line basis over the requisite service period. The fair value of options to purchase shares is estimated on the grant date using the Black-Scholes option valuation model.
The calculation of share-based compensation expense requires the Company to make assumptions and judgments about the variables used in the Black-Scholes model, including the expected term, expected volatility of the underlying common shares, risk-free interest rate and dividends.
Net Income (Loss) Per Share
Basic net income (loss) per share is calculated by dividing the net income (loss) attributable to shareholders by the weighted-average number of shares outstanding during the period, without consideration for potentially dilutive securities. Diluted net income (loss) per share is computed by dividing the net income (loss) by the weighted-average number of shares and potentially dilutive securities outstanding for the period. For purposes of the diluted net loss per share calculation, any shares issuable upon exercise of warrants, stock options and non-vested RSUs or RSAs outstanding under the Company’s equity plan are potentially dilutive securities. Diluted net loss per share is the same as basic net loss per share for periods where the Company reported a net loss because including the dilutive securities would be anti-dilutive.
Recent Accounting Standards
Periodically, new accounting pronouncements are issued by the Financial Accounting Standards Board, or FASB, and adopted by the Company as of the specified effective date. Unless otherwise discussed, the impact of recently issued standards that are not yet effective will not have a material impact on the Company’s consolidated financial statements upon adoption.
Recently Adopted Accounting Standards
In December 2023, the FASB issued ASU No. 2023-09, Income Taxes (Topics 740): Improvements to Income Tax Disclosures, which enhances the disclosure requirements for income taxes, specifically related to the rate reconciliation and income taxes paid and certain other amendments to improve the effectiveness of income tax disclosures. The guidance is effective for annual periods beginning after December 15, 2024, with early adoption permitted, and may be applied either prospectively or retrospectively. The Company adopted ASU 2023-09 as of December 31, 2025 on a prospective basis. Upon adoption, the Company expanded disclosures under Note 12, “Income Taxes”.
Recently Issued Accounting Standards
In November 2024, the FASB issued ASU 2024-03, Disaggregation of Income Statement Expenses, which enhances disclosure requirements over the disaggregation of relevant expense categories within the income statement. The new guidance requires tabular presentation of prescribed expense categories such as the purchases of inventory, employee compensation, depreciation, intangible asset amortization, and other specific expense, gains and losses required by existing GAAP, that reconciles to the face of the income statement. It is effective for annual periods beginning after December 15, 2026 and interim periods beginning after December 15, 2027, with early adoption permitted, and may be applied either prospectively or retrospectively. The Company is currently evaluating the potential effect that the updated standard will have on the financial statement disclosures.
v3.25.4
Balance Sheet Accounts
 12 Months Ended
Dec. 31, 2025
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
Balance Sheet Accounts Balance Sheet Accounts
Inventory, Net
December 31,
20252024
(in thousands)
Raw materials$35,161 $41,310 
Work in process2,842 2,454 
Finished goods47,608 35,002 
Total inventory, net
$85,611 $78,766 
As of December 31, 2025 and 2024, $14.1 million and $9.0 million of inventory was on consignment, respectively.
Prepaid Expenses and Other Current Assets
December 31,
20252024
(in thousands)
Prepaid insurance$3,072 $2,768 
Prepaid services653 571 
Prepaid taxes1,392 458 
Prepaid assets1,629 505 
Prepaid raw materials and accessories384 1,005 
Prepaid U.S. clinical trial costs120 184 
Prepaid warranty and distribution rights379 409 
Prepaid software1,146 408 
Other
2,485 2,614 
Total prepaid expenses
$11,260 $8,922 
Property and Equipment, Net
December 31,
20252024
(in thousands)
Machinery and equipment$23,083 $22,764 
Building improvements17,361 16,902 
Furniture and fixtures17,645 14,772 
Building37,227 37,227 
Leasehold improvements2,537 2,516 
Land3,694 3,694 
Vehicles281 269 
Total101,828 98,144 
Less: Accumulated depreciation and amortization(26,213)(20,116)
Total property and equipment, net
$75,615 $78,028 
For the years ended December 31, 2025, 2024 and 2023, depreciation and amortization expense related to property and equipment was $6.2 million, $4.7 million and $2.8 million, respectively.
In August 2021, the Company entered into a contract with the Zona Franca Coyol, S.A., or ZFC, to begin construction of a new manufacturing facility in the Coyol Free Zone, or the CFZ, in Costa Rica. The construction for this facility was completed in June 2024. The Company also has the option to buy an adjacent lot of land for approximately $2.8 million and engage ZFC to construct an additional manufacturing facility.
Accrued Liabilities
Accrued liabilities consisted of the following:
December 31,
20252024
(in thousands)
Performance bonus$6,703 $6,235 
Payroll and related expenses5,129 4,832 
Operating lease liabilities - current1,712 1,514 
Commissions1,889 1,312 
Professional and legal services1,891 876 
Warranty reserve288 141 
Taxes377 153 
Other867 1,473 
Total accrued liabilities
$18,856 $16,536 
Other Liabilities, Short-Term
Other liabilities, short-term consisted of the following:
December 31,
20252024
(in thousands)
Deferred revenue$1,208 $1,749 
Borrowings of short term notes payable for purchases of silicone raw material
10,000 — 
Borrowings of short term notes payable for insurance premium financing
2,413 — 
Consideration payable for business acquisitions
315 2,774 
Contingent consideration payable for business acquisitions
4,474 737 
Other
1,767 1,722 
Total other liabilities, short-term
$20,177 $6,982 
The Company signed an Inventory Funding Agreement, or Funding Agreement, on May 23, 2025, with RTW Master Fund, LTD., RTW Innovation Master Fund, LTD., and RTW Biotech Opportunities Operating LTD, collectively referred to as the Funding Providers, and RTW Investments, LP, as the funding representative, to finance purchases of silicone raw material to support the manufacture of Motiva Implants in an aggregate amount not to exceed $10.0 million in a funding period. Under the Funding Agreement, the Funding Providers will finance, upon request, eligible invoices at a 12.0% annual interest rate for an initial four-month term, or a later date if agreed by the Funding Providers in writing in their sole discretion. The Company drew $5.0 million at each of June 20, 2025 and September 26, 2025 and recorded this liability in “Other Liabilities, Short-Term”. On September 25, 2025, the Funding Agreement was amended to extend the due date for the amount received in June 2025 to May 15, 2026.
During fiscal 2025, the Company entered into short‑term insurance premium financing arrangements to fund the payment of business insurance premiums. The aggregate financing provided under these arrangements totaled approximately $3.4 million and bears interest at rates ranging from approximately 7.7% to 8.3% per annum. The borrowings are short‑term in nature and mature within ten months of issuance.
Other Liabilities, Long-Term
Other liabilities, long-term consisted of the following:
December 31,
20252024
(in thousands)
Deferred revenue$1,136 $1,124 
Consideration payable for business acquisitions
— 278 
Contingent consideration payable for business acquisitions
— 174 
Other— 102 
Total other liabilities, long-term
$1,136 $1,678 
v3.25.4
Goodwill and Other Intangible Assets
 12 Months Ended
Dec. 31, 2025
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Other Intangible Assets Goodwill and Other Intangible Assets
Goodwill represents the excess of the purchase price over the fair value of the net tangible and identifiable intangible assets acquired in a business combination. Intangible assets resulting from the acquisitions of entities accounted for using the acquisition method of accounting are recorded at the estimated fair value of the assets acquired. Purchased intangibles include certain patents and license rights, 510(k) authorization by the FDA to sell a medical device and other intangible assets.
The Company’s goodwill and most intangibles at December 31, 2025 are the result of previous asset and business acquisitions. Finite-lived intangibles are amortized over their estimated useful lives based on expected future benefit.
In addition to the intangibles acquired, the Company capitalized certain patent and license rights as identified intangibles based on patent and license rights agreements entered into over the past several years. Additionally, the Company capitalized certain software development costs.
Changes in the carrying amount of goodwill during the year ended December 31, 2025 were as follows:
Balance as of January 1, 2025
AdditionsAccumulated Impairment Losses
Balance as of December 31, 2025
(in thousands)
Goodwill$1,209 $— $— $1,209 
The carrying amounts of these intangible assets other than goodwill as of December 31, 2025 were as follows:
Gross Carrying AmountAccumulated AmortizationNet Carrying AmountEstimated Useful Lives
(in thousands)(in years)
Patents and license rights$2,033 $(1,593)$440 
7-12
Customer relationships3,658 (2,142)1,516 
4-10
510(k) authorization567 (481)86 15
Developed technology62 (62)— 10
Capitalized software development costs14,678 (7,480)7,198 
2-5
Other183 (92)91 
2-5
Capitalized software development costs not yet amortized170 — 170 
Patents and license rights not yet amortized441 — 441 
Total intangibles other than goodwill$21,792 $(11,850)$9,942 

The carrying amounts of intangible assets other than goodwill as of December 31, 2024 were as follows:
Gross Carrying AmountAccumulated AmortizationNet Carrying AmountEstimated Useful Lives
(in thousands)(in years)
Patents and license rights$2,033 $(1,509)$524 
7-12
Customer relationships3,466 (1,997)1,469 
4-10
510(k) authorization567 (345)222 15
Developed technology62 (62)— 10
Capitalized software development costs13,559 (4,839)8,720 
2-5
Other183 (91)92 
2-5
Capitalized patents and license rights not yet amortized215 — 215 
Patents and license rights not yet amortized441 — 441 
Total intangibles other than goodwill$20,526 $(8,843)$11,683 
The amortization expense associated with intangible assets was $3.3 million, $2.1 million, $1.2 million for the years ended December 31, 2025, 2024 and 2023, respectively. Non-product related amortization is recorded in SG&A while product related amortization is recorded in cost of revenue.
As of December 31, 2025, the amortization expense related to identifiable intangible assets, with definite useful lives, in future periods is expected to be as follows:
Year Ending December 31,(in thousands)
2026
$2,877 
20272,314 
20281,951 
2029950 
2030258 
Thereafter981 
Total expected future amortization expense$9,331 
The Company evaluates the recoverability of goodwill and indefinite-lived intangible assets annually and whenever events or changes in circumstances indicate that the carrying amount may not be recoverable. During the three years ended December 31, 2025, there was no impairment of goodwill or intangible assets based on the qualitative assessments performed by the Company. As of December 31, 2025, no triggering events have occurred which would indicate that the acquired intangible asset values may not be recoverable.
v3.25.4
Fair Value Measurements
 12 Months Ended
Dec. 31, 2025
Fair Value Disclosures [Abstract]  
Fair Value Measurements Fair Value Measurements
Fair value is defined as the exchange price that would be received for an asset or an exit price paid to transfer a liability in the principal or most advantageous market for the asset or liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value must maximize the use of observable inputs and minimize the use of unobservable inputs.
The fair value hierarchy defines a three-level valuation hierarchy for disclosure of fair value measurements as follows:
•Level I    Unadjusted quoted prices in active markets for identical assets or liabilities;
•Level II    Inputs other than quoted prices included within Level I that are observable, unadjusted quoted prices in markets that are not active, or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the related assets or liabilities; and
•Level III     Unobservable inputs that are supported by little or no market activity for the related assets or liabilities.
The categorization of a financial instrument within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement.
The following table sets forth the Company’s financial instruments that were measured at fair value on a recurring basis by level within the fair value hierarchy at December 31, 2025 and 2024:
 
Fair Value Measurements at December 31, 2025
 TotalLevel 1Level 2Level 3
(in thousands)
Liabilities
Acquisition-related contingent consideration$4,474 — — $4,474 
 
Fair Value Measurements at December 31, 2024
 TotalLevel 1Level 2Level 3
(in thousands)
Liabilities
Acquisition-related contingent consideration$973 — — $973 
The fair value measurement of contingent consideration related to the business acquisition completed in fiscal 2024 represents the contingent consideration arrangement from the Company’s acquisition of Motiva Benelux BV, a distribution company in Belgium, and Motiva NL B.V., a distribution company in the Netherlands, on October 1, 2024. Under this contingent consideration arrangement, the Company is required to pay the former owners an amount equal to the total revenue for fiscal year 2024 and 2025 multiplied by a multiple based on the relevant revenue growth rate realized in that particular fiscal year versus the prior year (ratio ranges from 0.5 to 0.9). The potential undiscounted amount of all future contingent payments that the Company could be required to make is not capped.
The fair value of the contingent consideration arrangement of $4.5 million as of December 31, 2025 was calculated using these inputs: (a) 2025 actual revenue of approximately $9.5 million; (b) growth ratio of 0.9 based on average revenue growth over the last two years; and (c) the fact that operating expense targets were met. The Company retains the option to settle the outstanding liability either in cash or in the Company’s common shares.
The fair value of the contingent consideration arrangement of $1.0 million as of December 31, 2024 was estimated by applying the income approach which used significant inputs that are not observable in the market and thus represents a Level 3 measurement. Key assumptions included (a) a discount rate of 12.5 percent; (b) 2024 revenue of approximately $6.0 million (actual, assumed to be reliably forecasted as of the date of valuation); (c) 2025 revenue forecasted using a normal distribution with approximately $6.4 million as the base case and a range determined based on volatility of 10%; and (d) an assumption that operating expense targets will be met. The Company settled the outstanding liability in early fiscal 2025. See Note 11 for additional information on the business acquisition.
The estimates are based, in part, on subjective assumptions and could differ materially in the future. During the periods presented, the Company has not changed the manner in which it values liabilities that are measured at fair value using Level 3 inputs. The Company recognizes transfers between levels of the fair value hierarchy as of the end of the reporting period. There were no transfers within the hierarchy during the years ended December 31, 2025 and 2024.
The following table sets forth a summary of the changes in the fair value of the Company’s Level 3 financial instruments as follows:
Acquisition-related Contingent Consideration
(in thousands)
Balance at December 31, 2024
$973 
Settlement(787)
Additional liability
4,277 
Change in fair value
11 
Balance at December 31, 2025
$4,474 
v3.25.4
Debt
 12 Months Ended
Dec. 31, 2025
Debt Disclosure [Abstract]  
Debt Debt
Oaktree Debt
On April 26, 2022, or the Closing Date, the Company entered into a Credit Agreement and Guaranty, or the Credit Agreement, together with certain of its subsidiaries party thereto as guarantors, the lenders from time to time party thereto, or the Lenders, and Oaktree Fund Administration, LLC, as administrative agent for the Lenders, or the Administrative Agent, pursuant to which the Lenders agreed to make term loans to the Company in an aggregate principal amount of up to $225 million, or collectively, the Term Loans.
On February 21, 2024, the Company entered into a Second Amendment to the Credit Agreement, or the Second Amendment, which amends terms applicable to the two remaining available tranches during the date of agreement, Tranche C Term Loans and Tranche D Term Loans. The terms of the Tranche A Term Loans and Tranche B Term Loans were not modified.
On November 7, 2024, the Company entered into a Third Amendment to the Credit Agreement, or the Third Amendment, which amends terms applicable to the remaining available tranche during the date of agreement, Tranche D Term Loans. The terms of the Tranche A Term Loans, Tranche B Term Loans and Tranche C Term Loans were not modified.
On September 29, 2025, the Company entered into a Fourth Amendment to the Credit Agreement, or the Fourth Amendment, which provides for the availability of the Tranche D Term Loans to commence as of the effective date of the amendment, notwithstanding the revenue milestone originally set forth in the Agreement, and (ii) increases, effective September 28, 2025, the minimum liquidity that the Company and its subsidiaries are guarantors under the Agreement are required to maintain from $25 million to $30 million.
Pursuant to the terms of the Credit Agreement, the Term Loans will be advanced in four tranches:
•The first tranche, or the Tranche A Term Loan, was advanced in the amount of $150 million on the Closing Date. A portion of the first tranche was used to repay the outstanding principal and interest under the Company’s credit agreement with Madryn Health Partners, LP, as administrative agent, and a syndicate of lenders in full, including the early repayment penalty of $6.5 million.
•The second tranche, or the Tranche B Term Loan, of $25 million was advanced in December 2022 at the Company’s election upon satisfaction of specified gross sales thresholds and subject to the other terms and conditions of the Credit Agreement.
•The third tranche, or the Tranche C Term Loan, of $25 million was advanced in October 2024 at the Company’s election following the Administrative Agent’s receipt of evidence that specified FDA’s approval of Motiva Implants for augmentation use in the United States had been issued, subject to the other terms and conditions of the Credit Agreement and the Second Amendment.
•The fourth tranche, or the Tranche D Term Loan, of $25 million was advanced in September 2025 at the Company’s election following the Fourth Amendment, subject to the other terms and conditions of the Credit Agreement, as amended.
The Term Loans will mature on the 5-year anniversary of the Closing Date, or the Maturity Date. The Term Loans accrue interest at a rate equal to 9% per annum for Tranche A and Tranche B, 10% per annum for Tranche C and Tranche D, or, at any time following the Tranche C Funding Milestone and the Administrative Agent’s receipt of evidence that a gross sale threshold of $225 million in trailing twelve month gross sales have been met, 8.25% per annum. Accrued interest is due and payable in cash on the last business day of March, June, September, and December of each year; provided, however, that prior to the second anniversary of the Closing Date, the Company may pay an amount of interest on the outstanding Tranche A Term Loans and Tranche B Term Loans corresponding to 600 basis points of the interest rate in kind, or PIK, on each applicable payment date, subject to prior written notice delivered to the Administrative Agent, which has been delivered. Each of the Term Loans will be subject to the original issue discount of 2% of the principal amount thereof upon the drawing of each applicable tranche. Upon any payment or prepayment in full or in part of the Term Loans, whether voluntary or involuntary, the Company is required to pay an exit fee equal to 3% of the principal amount of the Term Loan paid, or the Exit Fee.
The Company may elect to prepay all or any portion of the amounts owed prior to the Maturity Date, provided that the Company provides notice to the Administrative Agent, the amount is not less than $5 million, and the amount is accompanied by all accrued and unpaid interest thereon through the date of prepayment, plus the applicable yield protection premium and the applicable Exit Fee. Prepayments of the Tranche A Term Loans and Tranche B Term Loans prior to the second anniversary of the Closing Date, or prepayments of the Tranche C Term Loans or Tranche D Term Loans prior to the one-year anniversary of the applicable funding date will be accompanied by a yield protection premium equal to the sum of all interest that would have accrued through such second anniversary plus 4% of the principal amount so prepaid. Prepayments of the Term Loans after the second anniversary of the Closing Date in the case of Tranche A Term Loans and Tranche B Term Loans or the one year anniversary of the applicable funding date in the case of the Tranche C Term Loans and the Tranche D Term Loans but before, in each case, the third anniversary of the Closing Date, will be accompanied by a yield protection premium equal to 4% of the principal amount so prepaid if made prior to the third anniversary of the Closing Date, 2% if made on or after the 3rd anniversary of the Closing Date but prior to the fourth anniversary of the Closing Date, and 0% if made on or after the 4th anniversary of the Closing Date. If the Term Loans are accelerated following the occurrence of an event of default, the Company shall immediately pay to Lenders the sum of all obligations for principal, accrued interest, the applicable yield maintenance premium and the applicable Exit Fee. Under the Second Amendment, Tranche D Term Loans were modified to provide for a make whole plus 4% for any prepayments of the Tranche C Term Loans and Tranche D Term Loans during the one year period after their advance. The existing prepayment premium schedule was otherwise preserved. The Third Amendment did not modify the prepayment premium schedule.
Pursuant to the Credit Agreement, the obligations of the Company are guaranteed by its subsidiaries that are party thereto as guarantors. On the Closing Date, the Company and such subsidiaries entered into a U.S. Security Agreement in favor of the Administrative Agent on behalf of Lenders, or the U.S. Security Agreement. Pursuant to the U.S. Security Agreement, the Company and its subsidiaries party thereto granted the Administrative Agent a security interest in substantially all of its personal property, rights and assets to secure the payment of all amounts owed to Lenders under the Credit Agreement.
The Credit Agreement contains customary affirmative and restrictive covenants and representations and warranties. The Company and its subsidiaries are bound by certain affirmative covenants setting forth actions that are required during the term of the Credit Agreement, including, without limitation, certain information delivery requirements, obligations to maintain certain insurance, and certain notice requirements. Additionally, the Company and its subsidiaries are bound by certain restrictive covenants setting forth actions that are not permitted to be taken during the term of the Credit Agreement without prior written consent, including, without limitation, incurring certain additional indebtedness, consummating certain mergers, acquisitions or other business combination transactions, or incurring any non-permitted lien or other encumbrance on the assets of the Company or any of its subsidiaries. The Credit Agreement also contains other customary provisions, such as confidentiality obligations and indemnification rights for the benefit of Lenders. The Credit Agreement contains financial covenants requiring (a) the Company to maintain minimum liquidity of at least $20 million from and after the Closing Date or $25 million from and after the funding of the Tranche B Term Loans, and (b) for each fiscal quarter until gross sales of the Company and its subsidiaries for any 12-consecutive month period are no less than $200 million, minimum gross sales of the Company and its subsidiaries for each consecutive 12-month period ending on the last day of each fiscal quarter in excess of 50% of specified target gross sales for such period. The Credit Agreement provides for a customary equity cure right in the event the Company fails to comply with the minimum gross sales covenant.
The effective interest rate under the Credit Agreement is 10.9%, and the weighted average interest rate is 9.2%. The Company elected to pay interest in kind on up to two-thirds of cash interest payments prior to the second anniversary of the Closing Date, resulting in a minimum initial cash interest rate of 3.0% for the Tranche A Term Loans and Tranche B Term Loans and 4.0% for the Tranche C Term Loans. The Company incurred $24.5 million, $21.1 million and $16.9 million in interest expense in connection with the Credit Agreement during the years ended December 31, 2025, 2024 and 2023, respectively. No principal payments are due on the Term Loans until the final maturity date on April 26, 2027.
As of December 31, 2025, $246.4 million was outstanding under the Credit Agreement representing the initial principal of $150 million for the Tranche A Term Loan, $25 million for the Tranche B Term Loan, $25 million for the
Tranche C Term Loan, $25 million for the Tranche D Term Loan and $21.4 million of interest accrued into the principal balance.
The Company recorded Oaktree debt on the consolidated balance sheets as follows:
December 31,
20252024
(in thousands)
Principal$246,367 $221,367 
Net unamortized prepayment premium (debt discount and issuance costs)
1,155 (1,790)
Net carrying value of Oaktree debt$247,522 $219,577 
As of December 31, 2025, the Company was in compliance with all financial debt covenants.
v3.25.4
Leases
 12 Months Ended
Dec. 31, 2025
Leases [Abstract]  
Leases Leases
The Company recognizes lease liabilities and ROU assets upon commencement for all material leases with a term greater than 12 months. The Company has elected an expedient not to recognize leases with a lease term of 12 months or less on the balance sheet. These short-term leases are expensed on a straight-line basis over the lease term.
ROU assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. ROU assets and lease liabilities are recognized at commencement date of the lease based on the present value of lease payments over the lease term. When the rate implicit to the lease cannot be readily determined, the Company utilizes its incremental borrowing rate in determining the present value of the future lease payments. Lease liabilities are accreted each period and reduced for payments. The ROU asset also includes other adjustments, such as for the effects of escalating rents, rent abatement or initial lease costs. The lease term may include periods covered by options to extend or terminate the lease when it is reasonably certain that the Company will exercise a renewal option, or reasonably certain it will not exercise an early termination option. For operating leases, lease expense for minimum lease payments is recognized on a straight-line basis over the expected lease term. For finance leases, the ROU asset depreciates on a straight-line basis over the shorter of the lease term or useful life of the ROU asset and the lease liability accretes interest based on the interest method using the discount rate determined at lease commencement. The Company’s finance leases are not material.
The Company has operating leases for facilities and office spaces. Operating lease assets and the related lease liabilities are included within the ROU operating lease assets on the consolidated balance sheets. The determination of whether an arrangement is, or contains, a lease is performed at the inception of the arrangement. The Company has operating leases for certain facilities and office spaces to be used in its operations, with remaining lease terms ranging from monthly to 6 years. These leases require monthly lease payments that may be subject to annual increases throughout the lease term. Certain of these leases also include renewal options at the election of the Company to renew or extend the lease for additional years. These optional periods have not been considered in the determination of the ROU or lease liabilities associated with these leases as management did not consider it reasonably certain it would exercise the options.
During the years ended December 31, 2025, 2024 and 2023, the Company earned income from subleasing a warehouse facility for the remaining life of an existing master lease. The sublease agreement did not release the Company from its obligations under the master lease, and no modifications were made to the lease agreement. Income from the sublease is recognized on a straight-line basis over the term of the agreement.
The Company’s lease and sublease agreements do not contain any termination options, material residual value guarantees, material bargain purchase options or material restrictive covenants. The Company does not have any lease transactions with related parties.
Total lease cost includes the following components for the years ended December 31, 2025, 2024 and 2023:
202520242023
(in thousands)
Operating lease expense cost$2,113 $1,481 $1,079 
Sublease income(311)(311)(233)
Total lease cost, net of sublease income$1,802 $1,170 $846 
December 31,
2025
2024
(in thousands)
Supplemental balance sheet information
Operating lease right-of-use assets$4,339 $5,561 
Operating lease liabilities - short-term1,712 1,514 
Operating lease liabilities - long-term2,820 4,203 
Total operating lease liabilities$4,532 $5,717 
Weighted-average remaining lease term (years)
Operating leases
2.73.4
Weighted-average discount rate (%)
Operating leases11.2 %11.1 %
Year Ended December 31,
2025
2024
2023
(in thousands)
Cash paid for amounts included in the measurement of lease liabilities
Operating cash outflows from operating leases$2,117 $1,384 $1,052 
Operating cash inflows from subleases(332)(320)(214)
Operating cash outflows from operating leases, net of sublease income$1,785 $1,064 $838 
ROU assets obtained in exchange for new lease liabilities
Operating leases$335 $3,115 $478 
Maturities of lease liabilities as of December 31, 2025 were as follows:
Years Ending December 31,Operating Leases
(in thousands)
2026
$2,097 
20271,807 
2028948 
2029459 
203086 
Thereafter37 
Total future minimum lease payments5,434 
Less: Amount of lease payments representing interest(902)
Present value of future minimum lease payments$4,532 
The undiscounted future cash receipts from the Company’s sublease as of December 31, 2025 were as follows:
Years Ending December 31,
Sublease
(in thousands)
2026
$343 
2027355 
2028368 
2029316 
Thereafter— 
Total undiscounted future sublease cash receipts
$1,382 
v3.25.4
Shareholders’ Equity
 12 Months Ended
Dec. 31, 2025
Equity [Abstract]  
Shareholders’ Equity Shareholders’ Equity
Under the Company’s Amended and Restated Memorandum of Association and Articles of Association, or Articles, the Company has authorized an unlimited number of common shares with no par value.
As of December 31, 2025 and 2024, 29,713,024 and 29,195,439 common shares, respectively, were issued and 29,304,954 and 28,787,369 common shares, respectively, were outstanding.
During the year ended December 31, 2025, the Company granted stock options and restricted stock to employees and contractors (see Note 10).
On November 7, 2024, the Company entered into a securities purchase agreement with a limited number of purchasers in connection with a registered direct offering of 765,696 common shares of the Company at a purchase price of $45.71 per share and pre-funded warrants to purchase up to 328,154 common shares at a price of $45.709 per share. On August 31, 2025, the Company issued 76,569 additional common shares and additional pre-funded warrants to purchase up to 32,814 common shares. These additional securities were issued in accordance with the securities purchase agreement for no additional consideration since the average closing price of the Company’s common shares on The Nasdaq Capital Market during the period from January 1, 2025 to August 31, 2025 did not exceed $45.71, which is the price per common share sold in the offering. The pre-funded warrants issued in the offering may be exercised immediately at a price of $0.001 per share until exercised in full. Net proceeds to the Company from the offering, after deducting offering expenses, were approximately $49.7 million.
On January 9, 2024, the Company entered into a securities purchase agreement with select institutional accredited investors pursuant to which it agreed to sell to the investors in a private placement 1,101,565 common shares at a price of $25.00 per share and pre-funded warrants to purchase up to 898,435 common shares at a price of $24.999 per share. The pre-funded warrants were able to be exercised immediately at a price of $0.001 per share until exercised in full. Net proceeds to the Company from the offering, after deducting offering expenses, were approximately $49.7 million.
The Company had reserved common shares for future issuances at December 31:
20252024
Warrants to purchase common shares659,403 626,589 
Options to purchase common shares1,428,878 1,413,948 
Remaining shares available under the 2018 Equity Incentive Plan2,230,340 2,068,033 
Shares issuable on vesting of grants of RSUs331,295 295,705 
Remaining shares available under the 2018 ESPP1,409,000 1,222,000 
Total common shares reserved for future issuances
6,058,916 5,626,275 
Warrants
In January 2024, the Company issued pre-funded warrants for the purchase of up to 898,435 common shares to select institutional accredited investors at a fixed exercise price of $0.001 per share. In November 2024, the Company issued pre-funded warrants for the purchase of up to 360,968 common shares to a limited number of purchasers at a fixed exercise price of $0.001 per share.
In September 2025, the Company issued pre-funded warrants for the purchase of up to 32,814 common shares to a select investors at a fixed exercise price of $0.001 per share as part of a price protection stipulation within the securities purchase agreement entered into in November 2024.
During the year ended December 31, 2025, zero warrants were exercised. During the year ended December 31, 2024, warrants to purchase net 600,000 shares were exercised to obtain 599,991 shares.
As of December 31, 2025, warrants to purchase up to 659,403 common shares were outstanding and exercisable, as set forth in the table below. As of December 31, 2024, 626,589 warrants were outstanding and exercisable.
Warrant HolderIssue DateSharesExercise PriceExpiration Date
RTW Master Fund, Ltd.1/9/2024164,367$0.001 *
RTW Innovation Master Fund, Ltd.1/9/2024134,068$0.001 *
RTW Master Fund, Ltd.11/7/2024164,077$0.001 *
RTW Innovation Master Fund, Ltd.11/7/2024134,543$0.001 *
RTW Biotech Opportunities Operating Ltd.
11/7/202429,534$0.001 *
RTW Master Fund, Ltd.9/5/202516,407$0.001 *
RTW Innovation Master Fund, Ltd.9/5/202513,454$0.001 *
RTW Biotech Opportunities Operating Ltd.9/5/20252,953$0.001 *
* The warrants are exercisable immediately and until exercised in full.
v3.25.4
Warrants
 12 Months Ended
Dec. 31, 2025
Equity [Abstract]  
Warrants Shareholders’ Equity
Under the Company’s Amended and Restated Memorandum of Association and Articles of Association, or Articles, the Company has authorized an unlimited number of common shares with no par value.
As of December 31, 2025 and 2024, 29,713,024 and 29,195,439 common shares, respectively, were issued and 29,304,954 and 28,787,369 common shares, respectively, were outstanding.
During the year ended December 31, 2025, the Company granted stock options and restricted stock to employees and contractors (see Note 10).
On November 7, 2024, the Company entered into a securities purchase agreement with a limited number of purchasers in connection with a registered direct offering of 765,696 common shares of the Company at a purchase price of $45.71 per share and pre-funded warrants to purchase up to 328,154 common shares at a price of $45.709 per share. On August 31, 2025, the Company issued 76,569 additional common shares and additional pre-funded warrants to purchase up to 32,814 common shares. These additional securities were issued in accordance with the securities purchase agreement for no additional consideration since the average closing price of the Company’s common shares on The Nasdaq Capital Market during the period from January 1, 2025 to August 31, 2025 did not exceed $45.71, which is the price per common share sold in the offering. The pre-funded warrants issued in the offering may be exercised immediately at a price of $0.001 per share until exercised in full. Net proceeds to the Company from the offering, after deducting offering expenses, were approximately $49.7 million.
On January 9, 2024, the Company entered into a securities purchase agreement with select institutional accredited investors pursuant to which it agreed to sell to the investors in a private placement 1,101,565 common shares at a price of $25.00 per share and pre-funded warrants to purchase up to 898,435 common shares at a price of $24.999 per share. The pre-funded warrants were able to be exercised immediately at a price of $0.001 per share until exercised in full. Net proceeds to the Company from the offering, after deducting offering expenses, were approximately $49.7 million.
The Company had reserved common shares for future issuances at December 31:
20252024
Warrants to purchase common shares659,403 626,589 
Options to purchase common shares1,428,878 1,413,948 
Remaining shares available under the 2018 Equity Incentive Plan2,230,340 2,068,033 
Shares issuable on vesting of grants of RSUs331,295 295,705 
Remaining shares available under the 2018 ESPP1,409,000 1,222,000 
Total common shares reserved for future issuances
6,058,916 5,626,275 
Warrants
In January 2024, the Company issued pre-funded warrants for the purchase of up to 898,435 common shares to select institutional accredited investors at a fixed exercise price of $0.001 per share. In November 2024, the Company issued pre-funded warrants for the purchase of up to 360,968 common shares to a limited number of purchasers at a fixed exercise price of $0.001 per share.
In September 2025, the Company issued pre-funded warrants for the purchase of up to 32,814 common shares to a select investors at a fixed exercise price of $0.001 per share as part of a price protection stipulation within the securities purchase agreement entered into in November 2024.
During the year ended December 31, 2025, zero warrants were exercised. During the year ended December 31, 2024, warrants to purchase net 600,000 shares were exercised to obtain 599,991 shares.
As of December 31, 2025, warrants to purchase up to 659,403 common shares were outstanding and exercisable, as set forth in the table below. As of December 31, 2024, 626,589 warrants were outstanding and exercisable.
Warrant HolderIssue DateSharesExercise PriceExpiration Date
RTW Master Fund, Ltd.1/9/2024164,367$0.001 *
RTW Innovation Master Fund, Ltd.1/9/2024134,068$0.001 *
RTW Master Fund, Ltd.11/7/2024164,077$0.001 *
RTW Innovation Master Fund, Ltd.11/7/2024134,543$0.001 *
RTW Biotech Opportunities Operating Ltd.
11/7/202429,534$0.001 *
RTW Master Fund, Ltd.9/5/202516,407$0.001 *
RTW Innovation Master Fund, Ltd.9/5/202513,454$0.001 *
RTW Biotech Opportunities Operating Ltd.9/5/20252,953$0.001 *
* The warrants are exercisable immediately and until exercised in full.
v3.25.4
Share-Based Compensation
 12 Months Ended
Dec. 31, 2025
Share-Based Payment Arrangement [Abstract]  
Share-Based Compensation Share-Based Compensation
In 2015, the Board of Directors approved and adopted the 2015 Equity Incentive Plan, or 2015 Plan. Pursuant to the 2015 Plan, the Company granted RSAs and stock options to members of the Board of Directors, employees and consultants.
In 2018, the Board of Directors terminated the 2015 Plan and approved the 2018 Equity Incentive Plan, or the 2018 Plan, with an initial reserve of 1,500,000 common shares. Under the 2018 Plan, the Company may grant stock options, equity appreciation rights, RSUs and RSAs. If an award granted under the 2018 Plan expires, terminates, is unexercised, or is forfeited, or if any shares are surrendered in connection with an incentive award, the shares subject to such award and the surrendered shares become available for further awards under the 2018 Plan.
Pursuant to the “evergreen” provision contained in the 2018 Plan, the number of common shares reserved for issuance under the 2018 Plan automatically increases on first day of each fiscal year, commencing on January 1, 2019, in an amount equal to the least of (1) 750,000 shares, (2) 4% of the total number of the Company’s common shares outstanding on the last day of the preceding fiscal year, or (3) a number of common shares as may be determined by the Company’s Board of Directors prior to any such increase date. On each of January 1, 2019 through 2025 the number of common shares authorized for issuance increased automatically by 750,000 shares in accordance with the “evergreen” provision, increasing the maximum number of common shares reserved under the 2018 Plan to 6,750,000 as of December 31, 2025.
During the periods presented, the Company recorded the following share-based compensation expense for stock options, RSUs and RSAs:
Year Ended December 31,
202520242023
(in thousands)
Sales, general and administrative $9,844$12,073$12,101
Research and development1,5712,3312,261
Total stock compensation expense
$11,415$14,404$14,362
Stock Options
 Number of Options OutstandingWeighted-Average Exercise PriceWeighted-Average Remaining Contractual Term (in years)Aggregate Intrinsic Value (in thousands)
Balance at December 31, 2024
1,413,948 $47.96 6.30$14,010 
Granted (weighted-average fair value of $21.26 per share)
327,392 35.84 
Exercised(256,696)29.57 
Forfeited/canceled(56,397)52.24 
Balance at December 31, 2025
1,428,247 $48.16 6.16$35,902 
As of December 31, 2025, 902,758 options were vested and exercisable with a weighted-average exercise price of $51.00 per share and a total aggregate intrinsic value of $20.3 million.
During the year ended December 31, 2025, 256,696 options were exercised at a weighted-average price of $29.57 per share. The intrinsic value of the options exercised during the years ended December 31, 2025, 2024,
and 2023 was $9.3 million, $4.1 million, and $5.1 million, respectively. Upon the exercise of stock options, the Company issued new shares from its authorized shares.
At December 31, 2025, unrecognized compensation expense was $8.5 million related to stock options granted to employees and members of the Board of Directors and $1.8 million related to stock options granted to consultants. The weighted-average period over which such compensation expense will be recognized is 2.6 years.
Stock Options Granted to Employees
Share-based compensation expense for employees is based on the grant date fair value. The Company recognizes compensation expense for all share-based awards ratably on a straight-line basis over the requisite service period of the awards, which is generally the vesting term of four years. During the year ended December 31, 2025, 2024 and 2023, the Company recognized $5.4 million, $7.4 million and $8.7 million, respectively, of share-based compensation expense for stock options granted to employees.
The Company uses the Black-Scholes option valuation model to value options granted to employees and consultants, which requires the use of highly subjective assumptions to determine the fair value of share-based awards. The assumptions used in the Company’s option-pricing model represent management’s best estimates. These estimates are complex, involve a number of variables, uncertainties and assumptions and the application of management’s judgment. If factors change and different assumptions are used, the Company’s share-based compensation expense could be materially different in the future. The assumptions and estimates that the Company uses in the Black-Scholes model are as follows:
•Fair Value of Common Shares. The closing price of the Company’s publicly-traded common shares on the date of grant is used as the fair value of the shares. The Board of Directors intended all options granted to be exercisable at a price per share not less than the estimated per share fair value of the shares underlying those options on the date of grant.
•Risk-Free Interest Rate. The Company bases the risk-free interest rate used in the Black-Scholes valuation model on the implied yield available on U.S. Treasury zero-coupon issues with a term equivalent to that of the term of the options for each option group on the measurement date.
•Term. For employee stock options, the expected term represents the period that the Company’s share-based awards are expected to be outstanding. Because of the limitations on the sale or transfer of the Company’s shares during the period the Company was a privately held company, the Company does not believe its historical exercise pattern is indicative of the pattern it experiences as a publicly traded company. The Company consequently uses the Staff Accounting Bulletin 110, or SAB 110, simplified method to calculate the expected term of employee stock options, which is the average of the contractual term and vesting period. The Company plans to continue to use the SAB 110 simplified method until it has sufficient trading history as a publicly traded company. For consultant stock options, the term used is equal to the remaining contractual term on the measurement date.
•Volatility. The Company determines the price volatility based on the historical volatilities of industry peers as it does not have sufficient trading history for its shares. Industry peers consist of several public companies in the medical device industry with comparable characteristics, including revenue growth, operating model and working capital requirements. The Company intends to continue to consistently apply this process using the same or a similar peer group of public companies until a sufficient amount of historical information regarding the volatility of its own shares becomes available, or unless circumstances change such that the identified peer companies are no longer similar, in which case other suitable peer companies whose common share prices are publicly available would be utilized in the calculation. The volatility is calculated based on the term on the measurement date.
•Dividend Yield. The expected dividend assumption is based on the Company’s current expectations about its anticipated dividend policy. The Company has no expectation that it will declare dividends on its common shares, and therefore has used an expected dividend yield of zero.
The fair value of stock options granted to employees was estimated using the following assumptions:
Year Ended December 31,
202520242023
Volatility
55% - 56%
63% - 122%
62% - 71%
Risk-free interest rate
3.8% - 4.3%
3.7% - 4.8%
3.4% - 4.4%
Term (in years)6.25
6.25
6.25
Dividend yield———
Stock Options Granted to Non-Employees
Share-based compensation expense related to stock options granted to non-employees is recognized as the stock options are earned using an accelerated attribution method. The Company believes that the estimated fair value of the stock options is more readily measurable than the fair value of the services rendered. For the years ended December 31, 2025, 2024 and 2023, the Company recognized expense of $0.8 million, $0.7 million and $0.9 million, respectively, for stock options granted to consultants.
The fair value of stock options granted to consultants was estimated using the following assumptions during the following periods presented:
Year Ended December 31,
202520242023
Volatility
54% - 55%
57% - 102%
60% - 65%
Risk-free interest rate
4.1% - 4.5%
4.2% - 4.5%
4.0% - 4.1%
Term (in years)101010
Dividend yield———
Restricted Stock
Each vested RSU entitles the holder to be issued one common share. These awards vest according to a vesting schedule determined by the Board of Directors or the Compensation Committee of the Company’s Board of Directors, generally over a one to four year period.
The following table represents RSU activity for fiscal 2025:
 Restricted Stock 
Weighted-Average Grant Date Fair Value
Outstanding unvested at December 31, 2024
295,705 $48.53 
Granted185,170 36.10 
Vested(84,194)55.86 
Forfeited/canceled(65,744)47.83 
Outstanding unvested at December 31, 2025
330,937 $39.85 
The fair value of RSUs is the grant date market value of common shares. The Company recognizes share-based compensation expense related to RSUs using a straight-line method over the vesting term of the awards. The share-based compensation expense for RSUs that vested during the years ended December 31, 2025, 2024 and 2023 was $5.3 million, $6.4 million and $4.8 million, respectively, which was calculated based on the market value of the Company’s common shares on the applicable grant date.
As of December 31, 2025, the Company had unrecognized share-based compensation cost of approximately $9.6 million associated with unvested awards of RSUs. This cost is expected to be recognized over a weighted-average period of approximately 2.4 years.
v3.25.4
Business Combinations
 12 Months Ended
Dec. 31, 2025
Business Combination, Asset Acquisition, Transaction between Entities under Common Control, and Joint Venture Formation [Abstract]  
Business Combinations Business Combinations
On October 1, 2024, European Distribution Center Motiva BV, or EDC, a wholly owned subsidiary of the Company, acquired 100% of the outstanding common shares of both Motiva Benelux BV, a distribution company in Belgium, and Motiva NL B.V., a distribution company in the Netherlands. The acquisition will allow the Company to expand its market in Europe and achieve synergies and cost reductions by removing redundant processes.
The acquisition’s total consideration was valued at approximately $7.8 million and consisted of the following: (1) an initial payment of approximately $0.2 million in cash made on October 1, 2024, (2) a payment of $1.2 million in the Company’s common shares made in October 2024; (2) a payment of $0.3 million in cash and $2.6 million in the Company’s common shares made in January 2025; (3) a payment of $0.8 million due in April 2025; (4) a true-up amount payable or receivable in March 2026, based on meeting revenue and operational expense targets for fiscal 2025 currently estimated to be approximately $0.5 million; and (5) $2.2 million receivable settled on the acquisition date. The Company retains the option to settle the outstanding payments either in cash or in the Company’s common shares.
The Company had an established relationship with Motiva Benelux prior to the acquisition, with Motiva Benelux distributing the Company’s products in certain European markets. On the acquisition date, the Company had receivables totaling around $2.2 million from Motiva Benelux. Due to the acquisition, this amount was considered settled at its fair value, which the Company assessed to be equal to the book value.
The contingent consideration arrangement requires the Company to pay the former owners an amount equal to the total revenue for fiscal year 2024 and 2025 multiplied by a multiple based on the relevant revenue growth rate realized in that particular fiscal year versus the prior year (ratio ranges from 0.5 to 0.9). The amount will be decreased if the operational expense targets for fiscal 2025 are not met.
The potential undiscounted amount of all future contingent payments that the Company could be required to make is not capped. The fair value of the contingent consideration arrangement of $1.0 million on the acquisition date was estimated by applying the income approach which used significant inputs that are not observable in the market (Level 3 inputs). Key assumptions included (a) a discount rate of 12.5%; (b) 2024 revenue of approximately $6.0 million (actual, assumed to be reliably forecasted as of the date of valuation); (c) 2025 revenue of approximately $9.5 million; and (d) that operating expense targets were met. As of December 31, 2024, the consideration payable related to the 2024 revenue milestone of $1.0 million has been settled.
As of December 31, 2025, the amount recognized for the contingent consideration arrangement, the range of outcomes, and the assumptions used to develop the estimates had changed. The fair value of the contingent consideration arrangement of $4.5 million as of December 31, 2025 was calculated using these inputs: (a) 2025 actual revenue of approximately $9.5 million; (b) growth ratio of 0.9 based on average revenue growth over the last two years; and (c) the fact that operating expense targets were met. The Company retains the option to settle the outstanding liability either in cash or in the Company’s common shares. As of December 31, 2025, the Company recognized an expense of $4.3 million in SG&A expenses related to the changes in the fair value of the contingent consideration.
The following table summarizes the consideration paid and payable at the acquisition date of October 1, 2024:
(in thousands)
Consideration:
Cash paid$221 
Equity issued (26,018 common shares)
1,177 
Contingent consideration payable
973 
Consideration payable3,262 
Fair value of trade receivable considered settled2,184 
Total consideration
$7,817 
The fair value of the common shares issued as part of the consideration paid for the acquisition was determined as the volume-weighted average price of closing market price of Company’s common shares over the 30 days prior to the acquisition date.
On January 13, 2025, the Company paid approximately $0.3 million in cash and approximately $2.4 million in the Company’s common stock. On June 30, 2025, the Company paid approximately $0.9 million in the Company’s common stock.
The following table summarizes the consideration still payable at December 31, 2025 and 2024:
Year Ended December 31,
20252024
(in thousands)
Contingent consideration payable
$4,474 $973 
Consideration payable315 3,262 
Total liabilities
$4,789 $4,235 
The following table summarizes the estimated fair values of the assets acquired and liabilities assumed at the acquisition date of October 1, 2024:
(in thousands)
Recognized amounts of identifiable assets acquired and liabilities assumed:
Financial assets$904 
Inventory4,946 
Property, plant, and equipment125 
Intangible assets1,527 
Financial liabilities(482)
Total identifiable net assets$7,020 
Recognized goodwill:
Goodwill
$797 
The fair value of the inventory acquired was determined as estimated selling price of the inventory less reasonable profit allowance for the selling effort.    
Property, plant, and equipment acquired in a business combination is intended to be held and used and was recognized and measured at fair value and primarily consisted of vehicles and furniture and fixtures.    
The fair value of the acquired identifiable intangible assets of $1,527 was related to customer-related intangibles (i.e., customer lists and related customer relationships) and is amortized over the estimated useful life of 10 years. The fair value was determined using the distributor method of the income approach with significant assumptions being discount rate of 17.5% and revenue attrition rate of 25.0%.    
Financial liabilities of $0.5 million primarily consisted of accounts payable of $0.2 million, accrued liabilities primarily related to salaries and fringes of $0.2 million and a loan payable of $0.1 million. As of December 31, 2025, there has been no change since October 1, 2024, in the amount recognized for the liability or any change in the range of outcomes or assumptions used to develop the estimates.
The goodwill of $0.8 million arising from the acquisition consists largely of the synergies and economies of scale expected from combining the operations of the Company and the acquired entities. None of the goodwill recognized is expected to be deductible for income tax purposes. As of December 31, 2025, there were no changes in the recognized amounts of goodwill resulting from the acquisition.
Acquisition-related costs of $0.3 million were included in selling, general, and administrative expenses in Company’s income statement for the year ending December 31, 2024.
The Company recognized $1.8 million in revenues and $0.5 million in earnings in its consolidated income statement for the year ended December 31, 2024 from the activities of the acquired entities since the acquisition date of October 1, 2024.
v3.25.4
Income Taxes
 12 Months Ended
Dec. 31, 2025
Income Tax Disclosure [Abstract]  
Income Taxes Income Taxes
Effective January 1, 2025, the Company adopted ASU 2023‑09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures. Under the transition provisions, the amendments are applied prospectively for public business entities for annual periods beginning after December 15, 2024. Upon adoption, the Company is required to present an expanded, tabular effective tax rate reconciliation that includes both dollar amounts and percentage‑point effects and is disaggregated into specified categories, with any reconciling item equal to or exceeding 5% of expected tax presented separately by nature or jurisdiction. The Company is also required to disclose income taxes paid (net of refunds received), disaggregated into U.S. federal, U.S. state and local, and foreign amounts, with separate disclosure of any individual jurisdiction that represents 5% or more of total cash taxes paid. Consistent with the prospective transition guidance, these enhanced disclosures are presented for the year ended December 31, 2025 only, while prior periods continue to be presented under the income tax disclosure requirements that were in effect for those periods.
For the year ended December 31, loss before income tax consisted of the following:
2025
(in thousands)
Costa Rica operations$(24,542)
U.S. operations
2,792 
Other foreign operations
(36,272)
Total loss before income taxes$(58,022)
20242023
(in thousands)
Costa Rica operations$(60,665)$(13,556)
Non-Costa Rica operations(23,963)(65,027)
Total loss before income taxes$(84,628)$(78,583)
For the year ended December 31, the income tax benefit consisted of the following:
2025
(in thousands)
Current:
Costa Rica$112 
United States
270 
Other foreign
2,095 
Total current2,477 
Deferred:
Costa Rica— 
United States
(8,790)
Other foreign
(645)
Total deferred(9,435)
Total benefit for income taxes
$(6,958)
20242023
(in thousands)
Current:
Costa Rica$183 $297 
Non-Costa Rica1,963 3,328 
Total current2,146 3,625 
Deferred:
Costa Rica— — 
Non-Costa Rica(2,178)(3,706)
Total deferred(2,178)(3,706)
Total (benefit) provision for income taxes$(32)$(81)
The items accounting for the difference between income taxes computed at the Costa Rica statutory income tax
rate and the income tax benefit consisted of the following for the year ended December 31:
Year Ended December 31,
2025
(in thousands)
Tax benefit at Costa Rica statutory rate$(17,406)30.0 %
State and local income taxes, net of federal (national) tax effects
— — 
Foreign tax effects
United States
Valuation allowance release
(9,384)16.2 
Other
27 — 
BVI
Foreign tax rate differential
12,283 (21.2)
Other foreign jurisdictions
Other49 (0.1)
Effect of change in tax law or rates (Costa Rica)
— — 
Tax credits— — 
Changes in valuation allowance
— — 
Nontaxable or nondeductible items
Costa Rica tax holiday benefit
7,473 (12.9)
Total benefit for income taxes$(6,958)12.0 %
20242023
(in thousands)
Tax benefit at Costa Rica statutory rate$(25,388)30.0 %$(23,575)30.0 %
Foreign tax rate differential7,166 (8.5)18,070 (22.9)
Tax rate changes(446)0.5 (7)— 
Return to provision adjustment(561)0.7 (539)0.7 
Tax credits— — — — 
Change in valuation allowance(14,157)16.7 438 (0.6)
Tax holiday adjustment (benefit)18,373 (21.7)4,386 (5.6)
U.S. stock compensation227 (0.3)984 (1.3)
Prior year true-up
14,744 (17.4)— — 
Other10 — 162 (0.2)
Total provision (benefit) for income taxes$(32)— %$(81)0.1 %
The Company’s tax holiday benefit was related to the Company’s subsidiary in Costa Rica which enjoyed a zero percent tax rate, with the exception of certain types of income, for the years ended December 31, 2025, 2024 and 2023. The zero percent tax holiday, as extended, is effective for a period of 12 years through the year 2030.
During 2025, the Company concluded that the U.S. deferred tax assets of Motiva USA LLC are
more‑likely‑than‑not realizable based on achieving a three‑year cumulative income position and updated forecasts of future taxable income. As a result, the Company released the full U.S. valuation allowance, generating a discrete deferred tax benefit of approximately $9.4 million, which is presented above as a separate reconciling item in accordance with ASU 2023‑09.
For the year ended December 31, income taxes paid consisted of the following:
2025
(in thousands)
Costa Rica93 
Foreign – by jurisdiction ≥5%:
U.S. federal78 
U.S. state and local— 
Spain83 
Sweden
29 
Germany57 
France55 
Italy21 
Belgium— 
Foreign – all other jurisdictions4 
Total cash paid for income taxes
$420 
As of December 31, the components of the Company’s deferred tax assets and liabilities are as follows:
2025
2024
(in thousands)
Accruals and reserves$345 $563 
Fixed assets
(1,284)(1,036)
Intangibles116 105 
Stock compensation 4,613 3,763 
Net operating loss9,247 10,742 
R&D credits325 325 
Allowance for credit losses
1,653 593 
Other97 56 
Valuation allowance— (9,223)
Total net deferred tax assets (included in “Other non-current assets”)$15,112 $5,888 
As of December 31, 2025, the Company released the full valuation allowance previously recorded against the deferred tax assets of Motiva USA LLC. This determination was based on the subsidiary’s achievement of a three‑year cumulative pretax income position, sustained operating improvements, and management’s supportable forecast of future taxable income, which together provided sufficient positive evidence under ASC 740 to outweigh the negative evidence of historical losses. The release resulted in a non‑cash deferred tax benefit of
approximately $9.4 million, recognized as a discrete item within income tax expense and presented separately in the effective tax rate reconciliation. Following the release, the valuation allowance balance at December 31, 2025 was $0.
As of December 31, 2025, the Company had U.S. federal and California research and development credit carryforwards totaling approximately $0.5 million. Federal research credits begin to expire in 2037, while California research credits may be carried forward indefinitely. At December 31, 2025, the Company also had net operating loss carryforwards of approximately $21.4 million for U.S. federal purposes, $11.1 million for U.S. state purposes, $1.5 million in Argentina, and $10.6 million in Brazil. U.S. federal NOLs generated in tax years beginning after 2017 may be carried forward indefinitely, subject to an annual limitation on deductibility. Certain U.S. state NOLs generated prior to 2018 will begin to expire in 2030. Brazil NOLs may be carried forward indefinitely, subject to annual deductibility limits.
During the year ended December 31, 2024, the Company recorded an $80 million intercompany true‑up adjustment related to transfer‑pricing corrections for prior years, which reduced the U.S. federal NOL position and increased taxable income in Costa Rica. This adjustment was offset by the valuation allowance and therefore did not affect the 2024 income tax provision. Because Motiva USA had no sales prior to 2024 and therefore negligible state apportionment in most jurisdictions, the state income tax impact of this adjustment was minimal.
The utilization of U.S. federal and state NOLs and credit carryforwards may be limited under Internal Revenue Code Sections 382 and 383 in the event of an “ownership change.” An ownership change generally occurs when the percentage of the Company’s stock owned by one or more “five‑percent shareholders” increases by more than 50 percentage points over a rolling three‑year testing period. Based on the Company’s evaluation to date, management does not believe an ownership change has occurred that would materially limit the Company’s ability to utilize its tax attributes; however, the Company has not completed a formal Section 382/383 analysis. Future changes in ownership, some of which may be outside the Company’s control, could result in such limitations, and the Company cannot provide assurance that all existing tax attributes will be fully available for use.
The Company continues to benefit from a tax holiday in Costa Rica, under which qualifying income is taxed at a 0% rate through December 31, 2030, subject to ongoing compliance with the regime’s requirements. As a result of the tax holiday, income that would otherwise have been taxed at the Costa Rica statutory rate generates no current tax expense. The tax holiday reduced income tax expense by approximately $7.5 million in 2025 and $18.4 million in 2024. If the Company fails to maintain eligibility, income generated in Costa Rica could become subject to the statutory rate, which could materially increase the Company’s tax expense.
The Company operates in multiple jurisdictions and is subject to examination by U.S. and foreign tax authorities. Tax authorities may challenge the Company’s tax positions, including the characterization of intercompany transactions, transfer‑pricing policies, and other positions involving judgment under applicable tax laws. An adverse resolution of any examination could result in additional tax liabilities, interest and penalties, and could materially affect the Company’s results of operations. The Company’s determination of its worldwide provision for income taxes requires significant judgment, and the ultimate tax determination for many transactions may be uncertain.
Accounting for Uncertainty in Income Taxes
The Company recognizes uncertain tax positions in accordance with ASC 740‑10. As of December 31, 2025 and 2024, the Company had no unrecognized tax benefits. No interest or penalties were accrued or recognized during the periods presented, and no material changes to unrecognized tax positions are expected within the next 12 months.
As of December 31, 2025, the Company is subject to taxation in Costa Rica, Belgium, France, Brazil, the United Kingdom, Sweden, Italy, Germany, Austria, Spain, Argentina, Switzerland, the Netherlands, and the United States. Fiscal years 2019 through 2025 remain open to examination in these jurisdictions.
v3.25.4
Net Loss Per Share
 12 Months Ended
Dec. 31, 2025
Earnings Per Share [Abstract]  
Net Loss Per Share Net Loss Per Share
The following table summarizes the computation of basic and diluted net loss per share for the periods presented:
Year Ended December 31,
202520242023
(in thousands, except share and per share data)
Numerator:
Net loss$(51,064)$(84,596)$(78,502)
Denominator:
Weighted average common shares used for basic and diluted earnings per share29,620,022 28,161,761 25,600,029 
Net loss per share:
Basic and diluted$(1.72)$(3.00)$(3.07)
Basic net loss per share is computed by dividing the net loss by the weighted-average number of shares outstanding for the period. Diluted net loss per share is computed by dividing the net loss by the weighted-average number of shares and dilutive share equivalents outstanding for the period, determined using the treasury-share method and the as-if converted method, for convertible securities, if inclusion of these is dilutive.
If the Company reports a net loss, diluted net loss per share is the same as basic net loss per share for those periods because including the dilutive securities would be anti-dilutive.
The following potentially dilutive securities outstanding at the end of the periods presented have been excluded from the computation of diluted shares:
Year Ended December 31,
202520242023
Options to purchase common shares1,428,878 1,413,948 1,487,387 
Shares issuable on vesting of grants of RSUs331,295 295,705 196,177 
Total potentially dilutive shares outstanding
1,760,173 1,709,653 1,683,564 
v3.25.4
Related Party Transactions
 12 Months Ended
Dec. 31, 2025
Related Party Transactions [Abstract]  
Related Party Transactions Related Party Transactions
During the years ended December 31, 2025, 2024 and 2023, the Company recorded revenue of $1.2 million, $1.1 million and $1.2 million, respectively, for product sales to Herramientas Medicas, S.A., a distribution company owned by a family member of the former (until March 2025) Chief Executive Officer of the Company. Accounts receivable owed to the Company from this distribution company amounted to approximately $0.4 million each as of December 31, 2025 and 2024.
In 2016, the Company also entered into a separate agreement with Dr. Chacón Quirós, the brother of the Company’s former Chief Executive Officer Juan José Chacón Quirós, to maintain his clinic in Costa Rica as a MotivaImagine Excellence Center and to host and train physicians in the use of the Company products in relevant procedures, among other services, in exchange for cash reimbursement of up to $4,500 per day that such services are rendered. In August 2022, the Company entered into a new agreement with Dr. Chacón Quirós, replacing the original agreement, to continue the training services in exchange for cash reimbursement of his hourly rate of $531 when such services are rendered. During the years ended December 31, 2025, 2024 and
2023, the Company paid Dr. Chacón Quirós approximately $0.1 million, $0.2 million and $0.4 million, respectively, for services rendered.
Following his retirement on March 1, 2025, Establishment Labs Holdings Inc. and its subsidiary, Establishment Labs S.A., each entered into separation agreements with its former CEO, Juan José Chacón-Quirós, on August 3 and August 4, 2025, respectively, to formally terminate his employment effective April 30, 2025. The agreements provide for the continued vesting of outstanding equity awards while Mr. Chacón-Quirós serves as a consultant or a member of the Board of Directors, as well as certain customary restrictive covenants. Concurrently, Establishment Labs Holdings Inc. and Mr. Chacón-Quirós entered into a consulting agreement, effective June 1, 2025, for advisory and advocacy services, with a one-year term that automatically renews through May 31, 2028, unless terminated by either party. Under the consulting agreement, Mr. Chacón-Quirós will receive $750,000 per year, paid in equal monthly installments, and an annual equity award with a target value of $750,000, subject to vesting schedules and terms at the Company’s discretion.
On May 14, 2025, the Company granted a stock option award for 36,027 options with a grant date fair value of $0.9 million to Nicholas Lewin, a member of the board of directors, as compensation for consulting services he performs for the Company in addition to his services as a non-employee director.
v3.25.4
Employee Benefits
 12 Months Ended
Dec. 31, 2025
Postemployment Benefits [Abstract]  
Employee Benefits Employee Benefits
Short-term employee benefits, including vacation (paid absences) and year-end bonuses (also known as 13th month salary), are current liabilities included in accrued liabilities on the consolidated balance sheets and are calculated at the non-discounted amount that the Company expects to pay as a result of uncharged employee salaries or retentions.
Regarding employee termination benefits, Costa Rica labor laws establish the payment of benefits in case of death, retirement or termination without cause. This compensation is calculated according to time served in the Company and the corresponding salary in the last six months of employment and is equal to between 19.5 and 22 days’ salary for each year served, up to a maximum of 8 years.
Company policy recognizes termination benefits as expenses of the period during which the termination occurs, when the legal obligation is assumed due to the aforementioned events.
As of December 31, 2025, the Company has 46 employees in Brazil and 8 employees in Argentina who were represented by a labor union.
v3.25.4
Commitments and Contingencies
 12 Months Ended
Dec. 31, 2025
Commitments and Contingencies Disclosure [Abstract]  
Commitments and Contingencies Commitments and Contingencies
Contingencies
Periodically, the Company may have certain contingent liabilities that arise in the ordinary course of business activities. The Company accrues a liability for such matters when it is probable that future expenditures will be made, and such expenditures can be reasonably estimated. As of December 31, 2025, there have been no material contingent liabilities, individually or in aggregate, in the Company’s financial condition, results of operations or cash flows. As of December 31, 2024, contingent liabilities were not material, individually or in aggregate, to the Company’s financial condition, results of operations or cash flows. However, any monetary liability or financial impact to the Company from these contingent liabilities could differ materially from the Company’s expectations.
Indemnification
The Company enters into standard indemnification arrangements in the ordinary course of business. Pursuant to these arrangements, the Company indemnifies, holds harmless, and agrees to reimburse the indemnified parties for losses suffered or incurred by the indemnified party, in connection with any trade secret, copyright, patent or other intellectual property infringement claim by any third party with respect to the Company’s technology. The term of these indemnification agreements is generally perpetual. The maximum potential amount of future payments the Company could be required to make under these agreements is not determinable because it involves claims that may be made against the Company in the future that have not yet been made.
The Company has entered into indemnification agreements with its directors and officers that may require the
Company to indemnify its directors and officers against liabilities that may arise by reason of their status or service as directors or officers, other than liabilities arising from willful misconduct of the individual.
The Company has not incurred costs to defend lawsuits or settle claims related to these indemnification agreements. No liability associated with such indemnifications has been recorded to date.
v3.25.4
Subsequent Events
 12 Months Ended
Dec. 31, 2025
Subsequent Events [Abstract]  
Subsequent Events Subsequent Events
On February 24, 2026, the Company announced a strategic leadership transition of Raj Denhoy, current Chief Financial Officer, to Senior Vice President, Global Strategy, and the appointment of Cassandra “Sandra” Harris, 53, to Senior Vice President and Chief Financial Officer, effective March 9, 2026. Ms. Harris will also replace Mr. Denhoy as the Company’s principal accounting officer.
Ms. Harris brings extensive global finance and operational leadership experience, including prior service as Chief Financial Officer of Genesco Inc., a wholesale distributor and manufacturer, from 2024 to 2026, and Artisan Design Group, LLC, a national provider of interior finishes, from 2023 to 2024, as well as Chief Financial Officer and Chief Operating Officer of Tupperware Brands Corporation, a global consumer products company, from 2019 to 2022 and 2020 to 2022, respectively. Earlier in her career, she held senior finance and operational roles at VF Corporation, an apparel and footwear company, and began her career in audit at Deloitte & Touche LLP, a professional services firm. Ms. Harris is a Certified Public Accountant and holds a Bachelor of Science in Accounting from Clemson University. In connection with her appointment, Ms. Harris entered into an employment agreement that provides for, among other things, an annual base salary of $550,000, a target annual bonus opportunity of up to 50% of base salary, eligibility for annual equity awards, and a one‑time cash award of $700,000 payable in two installments. Ms. Harris has no family relationships with any director or executive officer of the Company, and there are no arrangements or understandings with any person pursuant to which she was selected as an officer of the Company. There are also no related person transactions between Ms. Harris and the Company that would be required to be disclosed pursuant to Item 404(a) of Regulation S-K under the Securities Exchange Act of 1934, as amended.
In his role as Senior Vice President, Global Strategy, Mr. Denhoy will be responsible for key strategic initiatives and long‑term growth priorities. This transition is not the result of any disagreement with the Company on any matter relating to its operations, policies, or practices.
v3.25.4
Insider Trading Arrangements
 3 Months Ended
Dec. 31, 2025
shares
Trading Arrangements, by Individual  
Non-Rule 10b5-1 Arrangement Adopted false
Rule 10b5-1 Arrangement Terminated false
Non-Rule 10b5-1 Arrangement Terminated false
Juan José Chacón Quirós [Member]  
Trading Arrangements, by Individual  
Material Terms of Trading Arrangement
On December 16, 2025, Juan José Chacón Quirós, former Chief Executive Officer and a current member of the Board of Directors, adopted a Rule 10b5-1 trading plan pursuant to which up to 330,000 common shares may be sold in accordance with the trading plan’s specifications. The first half of the shares subject to the plan will sell starting on March 23, 2026 and the remainder will sell starting April 23, 2026, if pre-established stock price thresholds are met. The trading plan will expire once all of the shares have been sold or on March 23, 2027, whichever is earlier. Actual sale transactions will be disclosed publicly through Form 4 filings with the Securities and Exchange Commission, as required.
Name Juan José Chacón Quirós
Title former Chief Executive Officer and a current member of the Board of Directors
Rule 10b5-1 Arrangement Adopted true
Adoption Date December 16, 2025
Expiration Date March 23, 2027
Arrangement Duration 365 days
Aggregate Available 330,000
v3.25.4
Insider Trading Policies and Procedures
 12 Months Ended
Dec. 31, 2025
Insider Trading Policies and Procedures [Line Items]  
Insider Trading Policies and Procedures Adopted true
v3.25.4
Cybersecurity Risk Management and Strategy Disclosure
 12 Months Ended
Dec. 31, 2025
Cybersecurity Risk Management, Strategy, and Governance [Line Items]  
Cybersecurity Risk Management Processes for Assessing, Identifying, and Managing Threats [Text Block]
Our cybersecurity program is designed to identify, assess, manage and mitigate risks from cybersecurity threats, and includes the following elements:
•a risk assessment process to identify and assess cybersecurity risks;
•a risk mitigation strategy to address cybersecurity risks;
•an incident response plan to identify, respond to, mitigate and remediate cybersecurity incidents;
•an awareness and training program to educate employees about cybersecurity risks;
•a procedure to procure information technology services, including cloud computing and data storage, from third-party providers with sufficient cybersecurity provisions, and to monitor their cybersecurity process on an ongoing basis; and
•periodic testing and evaluation by external parties we engage to assess the effectiveness of the cybersecurity intrusion protections and make recommendations to improve the security of our information systems.
As a result, we have implemented a multi-layered cybersecurity program that includes administrative, physical, and technical measures to protect our information systems. Through these processes and the other processes described above, including our incident response plan, our management is informed about cybersecurity threats and incidents affecting us.
Our company has implemented robust processes to assess, identify, and manage material cybersecurity risks effectively. These processes are an integral component of our overall risk management system, ensuring that cybersecurity concerns are comprehensively addressed within our broader risk management framework. Risk assessment, identification, and management processes are seamlessly integrated into our overall risk management system. The processes for assessing, identifying, and managing cybersecurity risks are aligned with our strategic objectives and business goals. We foster cross-functional collaboration and communication to facilitate the integration of cybersecurity risk management into various business functions and processes.
We also review our cybersecurity practices, their effectiveness, and the cybersecurity practices of the third-parties we rely on, on an ongoing basis and make changes as necessary to address new risks. However, we cannot guarantee that our efforts will be successful in preventing all cybersecurity incidents.
We are not aware of any risks from cybersecurity threats, including as a result of previous cybersecurity incidents, that have materially affected or are reasonably likely to materially affect us, including our business strategy, results of operations or financial condition. We can give no assurance that we have detected or protected against all cybersecurity threats or incidents. We are subject to a variety of cybersecurity risks, which could have a material adverse effect on our business, financial condition, and results of operations. See the “Risks Related to Intellectual Property and Data Security” section of Item 1A. Risk Factors for additional discussion on risks affecting our information systems.
Cybersecurity Risk Management Processes Integrated [Flag] true
Cybersecurity Risk Management Processes Integrated [Text Block]
Our cybersecurity program is designed to identify, assess, manage and mitigate risks from cybersecurity threats, and includes the following elements:
•a risk assessment process to identify and assess cybersecurity risks;
•a risk mitigation strategy to address cybersecurity risks;
•an incident response plan to identify, respond to, mitigate and remediate cybersecurity incidents;
•an awareness and training program to educate employees about cybersecurity risks;
•a procedure to procure information technology services, including cloud computing and data storage, from third-party providers with sufficient cybersecurity provisions, and to monitor their cybersecurity process on an ongoing basis; and
•periodic testing and evaluation by external parties we engage to assess the effectiveness of the cybersecurity intrusion protections and make recommendations to improve the security of our information systems.
As a result, we have implemented a multi-layered cybersecurity program that includes administrative, physical, and technical measures to protect our information systems. Through these processes and the other processes described above, including our incident response plan, our management is informed about cybersecurity threats and incidents affecting us.
Our company has implemented robust processes to assess, identify, and manage material cybersecurity risks effectively. These processes are an integral component of our overall risk management system, ensuring that cybersecurity concerns are comprehensively addressed within our broader risk management framework. Risk assessment, identification, and management processes are seamlessly integrated into our overall risk management system. The processes for assessing, identifying, and managing cybersecurity risks are aligned with our strategic objectives and business goals. We foster cross-functional collaboration and communication to facilitate the integration of cybersecurity risk management into various business functions and processes.
Cybersecurity Risk Management Third Party Engaged [Flag] true
Cybersecurity Risk Third Party Oversight and Identification Processes [Flag] true
Cybersecurity Risk Materially Affected or Reasonably Likely to Materially Affect Registrant [Flag] false
Cybersecurity Risk Board of Directors Oversight [Text Block]
The Audit Committee oversees the cybersecurity program and receives reports from management regarding the Company’s cybersecurity policies and procedures on an annual basis. The Audit Committee also receives reports from management on any cybersecurity incidents that may occur.
As part of our cybersecurity program, our IT management reports to the Company’s Chief Operating Officer and Chief Executive Officer and is responsible for assessing and managing cybersecurity risks and developing and implementing our cybersecurity program. Our current Head of Global IT has more than 15 years of experience in technology and process improvements, which includes the execution of digital business strategies within highly regulated industries. Our IT management has obtained relevant experience in various sectors such as technology firms, financial institutions, and consulting firms and has actively engaged in continuous learning and professional development initiatives to stay updated on evolving cybersecurity threats and trends. This includes participating in industry conferences, workshops, training programs, and becoming members of professional cybersecurity organizations.
Cybersecurity Risk Board Committee or Subcommittee Responsible for Oversight [Text Block] The Audit Committee oversees the cybersecurity program and receives reports from management regarding the Company’s cybersecurity policies and procedures on an annual basis.
Cybersecurity Risk Process for Informing Board Committee or Subcommittee Responsible for Oversight [Text Block] The Audit Committee also receives reports from management on any cybersecurity incidents that may occur.As part of our cybersecurity program, our IT management reports to the Company’s Chief Operating Officer and Chief Executive Officer and is responsible for assessing and managing cybersecurity risks and developing and implementing our cybersecurity program.
Cybersecurity Risk Role of Management [Text Block]
As part of our cybersecurity program, our IT management reports to the Company’s Chief Operating Officer and Chief Executive Officer and is responsible for assessing and managing cybersecurity risks and developing and implementing our cybersecurity program. Our current Head of Global IT has more than 15 years of experience in technology and process improvements, which includes the execution of digital business strategies within highly regulated industries. Our IT management has obtained relevant experience in various sectors such as technology firms, financial institutions, and consulting firms and has actively engaged in continuous learning and professional development initiatives to stay updated on evolving cybersecurity threats and trends. This includes participating in industry conferences, workshops, training programs, and becoming members of professional cybersecurity organizations.
Cybersecurity Risk Management Positions or Committees Responsible [Flag] true
Cybersecurity Risk Management Positions or Committees Responsible [Text Block]
As part of our cybersecurity program, our IT management reports to the Company’s Chief Operating Officer and Chief Executive Officer and is responsible for assessing and managing cybersecurity risks and developing and implementing our cybersecurity program. Our current Head of Global IT has more than 15 years of experience in technology and process improvements, which includes the execution of digital business strategies within highly regulated industries. Our IT management has obtained relevant experience in various sectors such as technology firms, financial institutions, and consulting firms and has actively engaged in continuous learning and professional development initiatives to stay updated on evolving cybersecurity threats and trends. This includes participating in industry conferences, workshops, training programs, and becoming members of professional cybersecurity organizations.
Cybersecurity Risk Management Expertise of Management Responsible [Text Block] Our current Head of Global IT has more than 15 years of experience in technology and process improvements, which includes the execution of digital business strategies within highly regulated industries.
Cybersecurity Risk Process for Informing Management or Committees Responsible [Text Block]
The Audit Committee oversees the cybersecurity program and receives reports from management regarding the Company’s cybersecurity policies and procedures on an annual basis. The Audit Committee also receives reports from management on any cybersecurity incidents that may occur.
As part of our cybersecurity program, our IT management reports to the Company’s Chief Operating Officer and Chief Executive Officer and is responsible for assessing and managing cybersecurity risks and developing and implementing our cybersecurity program. Our current Head of Global IT has more than 15 years of experience in technology and process improvements, which includes the execution of digital business strategies within highly regulated industries. Our IT management has obtained relevant experience in various sectors such as technology firms, financial institutions, and consulting firms and has actively engaged in continuous learning and professional development initiatives to stay updated on evolving cybersecurity threats and trends. This includes participating in industry conferences, workshops, training programs, and becoming members of professional cybersecurity organizations.
Cybersecurity Risk Management Positions or Committees Responsible Report to Board [Flag] true
v3.25.4
Summary of Significant Accounting Policies (Policies)
 12 Months Ended
Dec. 31, 2025
Accounting Policies [Abstract]  
Basis of Presentation Basis of PresentationThe accompanying consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America, or GAAP, and the applicable rules and regulations of the Securities and Exchange Commission, or SEC.
Consolidation Consolidation
The consolidated financial statements include the Company’s accounts and those of its wholly owned subsidiaries as of December 31, 2025 as follows:
SubsidiaryIncorporation/Acquisition Date
Establishment Labs, S.A. (Costa Rica)January 18, 2004
Motiva USA, LLC (USA)February 20, 2014
JAMM Technologies, Inc. (USA)October 27, 2015
Establishment Labs Produtos par Saude Ltda (Brazil)January 4, 2016
European Distribution Center Motiva BV (Belgium)March 4, 2016
Motiva Implants France SAS (France)September 12, 2016
JEN-Vault AG (Switzerland)November 22, 2016
Motiva Nordica AB (Sweden)November 2, 2017
Motiva Implants UK Limited (the United Kingdom)July 31, 2018
Motiva Italy S.R.L (Italy)July 31, 2018
Motiva Implants Spain, S.L. (Spain)January 3, 2019
Motiva Austria GmbH (Austria)January 14, 2019
Motiva Germany GmbH (Germany)August 1, 2019
Motiva Argentina S.R.L. (Argentina)February 7, 2020
Motiva Benelux BV (Belgium)
October 1, 2024
Motiva NL BV (Netherlands)October 1, 2024
All intercompany accounts and transactions have been eliminated in consolidation.
Segments
Segments
The chief operating decision maker, or CODM, for the Company is the Chief Executive Officer. The Chief Executive Officer reviews financial information presented on a consolidated basis, accompanied by information about revenue by geographic region, for purposes of allocating resources and evaluating financial performance. The Company has one business activity, and there are no segment managers who are held accountable for operations, operating results or plans for levels or components below the consolidated unit level. Accordingly, the Company has determined that it has one single reportable and operating segment structure. The Company and its Chief Executive Officer evaluate performance based primarily on revenue in the geographic regions in which the Company operates. See the consolidated statements of operations for the consolidated financial information and “Revenue Recognition” for revenue by geographic region used in evaluating financial performance. The level of disaggregation and amounts of significant segment expenses that are regularly provided to the CODM are the same as those presented in the consolidated statements of operations. Likewise, the measure of segment assets is reported on the consolidated balance sheets as total assets.
Geographic Concentrations
Geographic Concentrations
The Company derives substantially all of its revenues from sales to customers in the United States, Europe, the Middle East, Latin America, and Asia. The Company received approval to sell its Motiva Implants in the United States in September 2024 and Motiva Flora Tissue Expanded in October 2023. The revenue derived in the United States prior to the FDA approvals consisted of microtransponder sales.
Use of Estimates
Use of Estimates
The preparation of financial statements in accordance with GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Significant accounting estimates and management judgments reflected in the consolidated financial statements include items such as accounts receivable valuation and allowances, inventory valuation and allowances, valuation of acquired intangible assets, valuation of long-lived assets, valuation of stock grants and valuation of deferred income tax assets, including tax valuation allowances. Estimates are based on historical experience, where applicable, and other assumptions believed to be reasonable by management. Actual results may differ from those estimates under different assumptions or conditions.
Concentration of Credit Risk and Other Risks and Uncertainties
Concentration of Credit Risk and Other Risks and Uncertainties
Financial instruments that potentially subject the Company to a concentration of credit risk consist principally of cash and accounts receivable. The majority of the Company’s cash is held at two financial institutions in the United States. Balances in the Company’s cash accounts exceed the Federal Deposit Insurance Corporation, or FDIC, limit of $250,000. The Company has not experienced any losses to its deposits of cash.
Substantially all of the Company’s revenue has been derived from sales of its products in international markets, principally Europe, the Middle East, Latin America, and Asia. In the international markets in which the Company operates, the Company uses a combination of distributors and direct sales to customers. The Company performs ongoing credit evaluations of its distributors and customers, does not require collateral, and maintains allowances for potential credit losses on customer accounts when deemed necessary.
Substantially all of the Company’s revenues were derived from the sale of Motiva Implants. During the years ended December 31, 2025, 2024 and 2023, no customer accounted for more than 10% of the Company’s revenue. One customer accounted for 14.1% of the Company’s trade accounts receivable balance as of December 31, 2025. One customer accounted for 17.0% of the Company’s trade accounts receivable balance as of December 31, 2024.
The Company relies on Avantor, Inc. (formerly NuSil Technology, LLC), or Avantor, as the sole supplier of medical-grade silicone used in Motiva Implants. During the years ended December 31, 2025, 2024 and 2023, the Company had purchases of $31.6 million, or 55.8% of total purchases, $29.2 million, or 44.7% of total purchases, and $53.7 million, or 68.4% of total purchases, respectively, from Avantor. As of December 31, 2025 and 2024, the Company had an outstanding balance owed to this vendor of $8.9 million and $15.0 million, respectively.
The Company’s financial condition and future results of operations involve a number of risks and uncertainties. Factors that could affect the Company’s future operating results and cause actual results to vary materially from expectations include, but are not limited to, unfavorable economic conditions, uncertainty of continued or new regulatory approval for the Company’s current and potential future products, uncertainty of market acceptance of the Company’s products, competition from substitute products and larger companies, securing and protecting proprietary technology, access to capital, strategic relationships and dependence on key individuals and sole source suppliers.
Products developed by the Company require clearance from the FDA or other international regulatory agencies prior to commercial sales. There can be no assurance that the products will receive the necessary clearances. If the Company is denied clearance, clearance is delayed, or if the Company is unable to maintain its existing clearances, these developments could have a material adverse impact on the Company.
Cash and Cash Equivalents
Cash and Cash Equivalents
The Company’s cash consists of cash maintained in checking and interest-bearing accounts. The majority of the Company’s cash is held at two financial institutions in the United States, with balances in excess of FDIC
insurance limits. The Company accounts for financial instruments with original maturities of three months or less at the date of purchase as cash equivalents.
Accounts Receivable and Allowance for Credit Losses
Accounts Receivable and Allowance for Credit Losses
Accounts receivable balance is stated at invoice value less estimated allowances for returns and credit losses. The Company continually monitors customer payments and maintains an allowance for estimated losses resulting from customers’ inability to make required payments. In evaluating the Company’s ability to collect outstanding receivable balances, the Company considers various factors including the age of the balance, the creditworthiness of the customer, which is assessed based on ongoing credit evaluations and payment history, and the customer’s current financial condition. In cases where there are circumstances that may impair a specific customer’s ability to meet its financial obligations, an allowance is recorded against amounts due, which reduces the net recognized receivable to the amount reasonably believed to be collectible.
Inventory and Cost of Revenue
Inventory and Cost of Revenue
Inventory is stated at the lower of cost to purchase or manufacture the inventory or the net realizable value of such inventory. Cost is determined using the standard cost method which approximates actual costs using the first-in, first-out basis. The Company regularly reviews inventory quantities, actual losses, projected future demand, and remaining shelf life to record a provision for obsolete and/or damaged inventory.
The Company recognizes the cost of inventory transferred to the customer in cost of revenue when revenue is recognized.
Leases
Leases
The Company determines if an arrangement is, or contains, a lease at the inception date of the contract. The Company has elected an expedient to account for each separate lease component and its associated non-lease components as a single lease component for the majority of its asset classes.
The lease term may include periods covered by options to extend or terminate the lease when it is reasonably certain that the Company will exercise a renewal option, or reasonably certain it will not exercise an early termination option. The Company recognizes lease liabilities and right-of-use, or ROU, assets upon commencement for all material leases with a term greater than 12 months. The Company has elected an expedient not to recognize leases with a lease term of 12 months or less on the balance sheet. These short-term leases are expensed on a straight-line basis over the lease term.
Shipping and Handling Costs and Revenue Recognition
Shipping and Handling Costs
Shipping and handling costs are expensed as incurred and are included in selling, general and administrative, or SG&A, expenses.
Revenue Recognition
The Company recognizes revenue related to sales of products to distributors or directly to customers in markets where it has regulatory approval, net of discounts and allowances. The Company recognizes revenue in accordance with Accounting Standards Codification, or ASC, Revenue from Contracts with Customers (Topic 606). ASC 606 requires the Company to recognize revenue to depict the transfer of goods or services to a customer at an amount that reflects the consideration it expects to receive in exchange for those goods or services.
The Company recognizes revenue related to the sales of products to distributors at the time of shipment of the product, which represents the point in time when the distributor has taken ownership and assumed the risk of loss, and the required revenue recognition criteria are satisfied. The Company’s distributors are obligated to pay within specified terms regardless of when, or if, they sell the products. The Company’s contracts with distributors typically do not contain right of return or price protection and have no post-delivery obligations.
The Company recognizes revenue when title to the product and risk of loss transfer to customers, provided there are no remaining performance obligations required of the Company or any written matters requiring customer acceptance. The Company allows for the return of products from direct customers in certain regions in limited instances within 15 to 60 days after the original sale and records estimated sales returns as a reduction of sales in the same period revenue is recognized. Appropriate reserves are established for anticipated sales returns based on historical experience, recent gross sales and any notification of pending returns. Actual sales returns in any future period are inherently uncertain and thus may differ from the estimates. If actual sales returns differ significantly from the estimates, an adjustment to revenue in the current or subsequent period is recorded. As of December 31, 2025 and 2024, an allowance of $1.9 million and $0.4 million was recorded for product returns, respectively. Taxes collected from customers for remittance to governmental authorities are excluded from net sales.
A portion of the Company’s revenue is generated from the sale of consigned inventory maintained at physician, hospital, or clinic locations. For these products, revenue is recognized at the time the Company is notified by the consignee that the product has been implanted, not when the consigned products are delivered to the consignee’s warehouse.
The Company has a limited warranty for the shelf life of breast implants, which is five years from the time of manufacture. Estimated warranty obligations are recorded at the time of sale. The Company also offers a warranty to patients in the event of rupture and a replacement program for capsular contracture events, provided certain registration requirements are met. Revenue for extended warranties is recognized ratably over the term of the agreement. To date, these warranty and program costs have been de minimis. The Company will continue to evaluate the warranty reserve policies for adequacy considering claims history.
Deferred revenue primarily consists of payments received in advance of meeting revenue recognition criteria. The Company has received payments from distributors to provide distribution exclusivity within a geographic area and recognizes revenue on a ratable basis over the term of such contractual distribution relationship. Additionally, the Company has received payments from customers in direct markets prior to surgical implantation and recognizes deferred revenue at the time the Company is notified by the customer that the product has been implanted. For all arrangements, any revenue that has been deferred and is expected to be recognized beyond one year is classified as long-term deferred revenue and included in “Other liabilities, long-term” on the consolidated balance sheets (see Note 3).
Research and Development
Research and Development
Costs related to research and development, or R&D, activities are expensed as incurred. R&D costs primarily include personnel costs, materials, clinical expenses, regulatory expenses, product development, consulting services, and outside research activities, all of which are directly related to research and development activities.
The Company estimates IDE clinical trial expenses based on the services performed, pursuant to contracts with research institutions and clinical research organizations that conduct and manage clinical trials on its behalf. In accruing service fees, the Company estimates the time period over which services will be performed and the level of patient enrollment and activity expended in each period. If the actual timing of the performance of services or the level of effort varies from the estimate, the Company will adjust the accrual accordingly.
Selling, General and Administrative Expenses
Selling, General and Administrative Expenses
SG&A expenses include sales and marketing costs, payroll and related benefit costs, insurance expenses, shipping and handling costs, legal and professional fees and administrative overhead.
Property and Equipment
Property and Equipment
Property and equipment are stated at cost less accumulated depreciation and amortization.
The Company depreciates owned buildings on a straight-line basis over 50 years of useful life. Depreciation of property and equipment is computed using the straight-line method over the assets’ estimated useful lives of five to ten years. Leasehold improvements are amortized on a straight-line basis over the shorter of the estimated useful life of the asset or the remaining lease term after factoring expected renewal periods. Upon retirement or disposal of assets, the costs and related accumulated depreciation are eliminated from the accounts and any gain or loss is recognized in operations. Maintenance and repairs are expensed as incurred. Substantially all of the
Company’s manufacturing operations and related property and equipment are located in Costa Rica.
Goodwill and Intangible Assets
Goodwill and Intangible Assets
The Company records the excess of the acquisition purchase price over the net fair value of the tangible and identifiable intangible assets acquired and liabilities assumed as goodwill. In accordance with ASC 350, Intangibles - Goodwill and Other, the Company tests goodwill for impairment annually during the fourth quarter of each year and whenever events or changes in circumstances indicate that the carrying value of the asset may not be recoverable. In connection with the annual impairment test for goodwill, the Company elected the option to perform a qualitative assessment to determine whether it is more likely than not that the fair value of the reporting unit is less than its carrying amount. If the Company determines that it was more likely than not that the fair value of the reporting unit is less than its carrying amount, then the impairment test is performed.
Consistent with the Company’s assessment that it has only one reporting segment, the Company has determined that it has only one reporting unit and tests goodwill for impairment at the entity level using the two-step process required by ASC 350. In the first step, the Company compares the carrying amount of the reporting unit to the fair value of the enterprise. If the fair value of the enterprise exceeds the carrying value, goodwill is not considered impaired and no further testing is required. If the carrying value of the enterprise exceeds the fair value, goodwill is potentially impaired, and the second step of the impairment test must be performed. In the second step, the Company compares the implied fair value of the goodwill, as defined by ASC 350, to its carrying amount to determine the impairment loss, if any.
The Company capitalizes certain costs related to intangible assets, such as patents, trademarks and software development costs. The Company follows the provisions of ASC 350-40, Internal Use Software for determining whether computer software is internal-use software and on accounting for the costs of computer software originally developed or obtained for internal use. The Company expenses all costs incurred during the preliminary project stage of software development and capitalizes the costs incurred during the application development stage. Costs incurred relating to upgrades and enhancements to the software are capitalized if it is determined that these upgrades or enhancements add additional functionality to the software. Costs incurred to improve and support products after they become available are charged to expense as incurred.
The Company records purchased intangible assets at their respective estimated fair values at the date of acquisition. Purchased finite-lived intangible assets are being amortized using the straight-line method over their remaining estimated useful lives, which range from one to ten years. The Company evaluates the remaining useful lives of intangible assets on a periodic basis to determine whether events or circumstances warrant a revision to the remaining estimated amortization period. The Company tests indefinite-lived intangible assets for impairment on at least an annual basis and whenever circumstances suggest the assets may be impaired. If indicators of impairment are present, the Company evaluates the carrying value of the intangible assets in relation to estimates of future undiscounted cash flows. The Company also evaluates the remaining useful life of an indefinite-lived intangible asset to determine whether events and circumstances continue to support an indefinite useful life.
Long-Lived Assets
Long-Lived Assets
The Company reviews long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset might not be recoverable. When such an event occurs, management determines whether there has been impairment by comparing the anticipated undiscounted future net cash flows to the related asset group’s carrying value. If an asset is considered impaired, the asset is written down to fair value, which is determined based either on discounted cash flows or appraised value, depending on the nature of the asset.
Debt Issuance Costs and Debt Discounts
Debt Issuance Costs and Debt Discounts
Costs incurred in connection with the issuance of new debt are capitalized. Capitalizable debt issuance costs paid to third parties and debt discounts, net of amortization, are recorded as a reduction to the long-term debt balance
on the consolidated balance sheets. Amortization expense on capitalized debt issuance costs and debt discounts related to loans are calculated using the effective interest method over the term of the loan commitment and is recorded as interest expense in the consolidated statements of operations.
Income Taxes
Income Taxes
The Company accounts for income taxes using the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences of differences between the financial reporting and tax bases of assets and liabilities, and for operating loss and tax credit carryforwards. Deferred tax balances are measured using enacted tax laws and rates expected to apply when the related temporary differences reverse. The Company establishes a valuation allowance when it is more likely than not that some portion or all of a deferred tax asset will not be realized.
The Company operates in multiple tax jurisdictions and is subject to examination by various tax authorities. The Company recognizes uncertain tax positions using a two‑step approach: (1) a tax position is recognized only if it is more likely than not to be sustained based on its technical merits, and (2) the amount recognized is the largest amount of benefit that is more than 50% likely to be realized upon settlement. Interest and penalties related to uncertain tax positions are recorded in income tax expense. There were no material uncertain tax positions in the years ended December 31, 2025, 2024 and 2023.
Effective January 1, 2025, the Company adopted ASU 2023‑09, Improvements to Income Tax Disclosures, on a prospective basis. As a result, our income tax disclosures now include enhanced disaggregation of income taxes paid and a standardized effective tax rate reconciliation, as required by the amended guidance. The adoption did not affect our accounting for income taxes under ASC 740.
Foreign Currency
Foreign Currency
The financial statements of the Company’s foreign subsidiaries whose functional currencies are the local currencies are translated into U.S. dollars for consolidation as follows: assets and liabilities at the exchange rate as of the balance sheet date, shareholders’ equity at the historical rates of exchange, and income and expense amounts at the average exchange rate for the period. Translation adjustments resulting from the translation of the subsidiaries’ accounts are included in “Accumulated other comprehensive income” as equity in the consolidated balance sheet. Transactions denominated in currencies other than the applicable functional currency are converted to the functional currency at the exchange rate on the transaction date. At period end, monetary assets and liabilities are remeasured to the functional currency using exchange rates in effect at the balance sheet date. Non-monetary assets and liabilities are remeasured at historical exchange rates. Gains and losses resulting from foreign currency transactions are included within “Other income (expense), net” in the consolidated statement of operations.
Comprehensive Loss
Comprehensive Loss
The Company’s comprehensive loss consists of net loss and foreign currency translation adjustments arising from the consolidation of the Company’s foreign subsidiaries.
Share-Based Compensation
Share-Based Compensation
The Company measures and recognizes compensation expense for all share-based awards in accordance with the provisions of ASC 718, Stock Compensation. Share-based awards granted include stock options, restricted stock units, or RSUs, and restricted stock awards, or RSAs. Share-based compensation expense for stock
options, RSUs and RSAs granted to employees is measured at the grant date based on the fair value of the awards and is recognized as an expense ratably on a straight-line basis over the requisite service period. The fair value of options to purchase shares is estimated on the grant date using the Black-Scholes option valuation model.
The calculation of share-based compensation expense requires the Company to make assumptions and judgments about the variables used in the Black-Scholes model, including the expected term, expected volatility of the underlying common shares, risk-free interest rate and dividends.
Net Income (Loss) Per Share
Net Income (Loss) Per Share
Basic net income (loss) per share is calculated by dividing the net income (loss) attributable to shareholders by the weighted-average number of shares outstanding during the period, without consideration for potentially dilutive securities. Diluted net income (loss) per share is computed by dividing the net income (loss) by the weighted-average number of shares and potentially dilutive securities outstanding for the period. For purposes of the diluted net loss per share calculation, any shares issuable upon exercise of warrants, stock options and non-vested RSUs or RSAs outstanding under the Company’s equity plan are potentially dilutive securities. Diluted net loss per share is the same as basic net loss per share for periods where the Company reported a net loss because including the dilutive securities would be anti-dilutive.
Recent Accounting Standards
Recent Accounting Standards
Periodically, new accounting pronouncements are issued by the Financial Accounting Standards Board, or FASB, and adopted by the Company as of the specified effective date. Unless otherwise discussed, the impact of recently issued standards that are not yet effective will not have a material impact on the Company’s consolidated financial statements upon adoption.
Recently Adopted Accounting Standards
In December 2023, the FASB issued ASU No. 2023-09, Income Taxes (Topics 740): Improvements to Income Tax Disclosures, which enhances the disclosure requirements for income taxes, specifically related to the rate reconciliation and income taxes paid and certain other amendments to improve the effectiveness of income tax disclosures. The guidance is effective for annual periods beginning after December 15, 2024, with early adoption permitted, and may be applied either prospectively or retrospectively. The Company adopted ASU 2023-09 as of December 31, 2025 on a prospective basis. Upon adoption, the Company expanded disclosures under Note 12, “Income Taxes”.
Recently Issued Accounting Standards
In November 2024, the FASB issued ASU 2024-03, Disaggregation of Income Statement Expenses, which enhances disclosure requirements over the disaggregation of relevant expense categories within the income statement. The new guidance requires tabular presentation of prescribed expense categories such as the purchases of inventory, employee compensation, depreciation, intangible asset amortization, and other specific expense, gains and losses required by existing GAAP, that reconciles to the face of the income statement. It is effective for annual periods beginning after December 15, 2026 and interim periods beginning after December 15, 2027, with early adoption permitted, and may be applied either prospectively or retrospectively. The Company is currently evaluating the potential effect that the updated standard will have on the financial statement disclosures.
v3.25.4
Summary of Significant Accounting Policies (Tables)
 12 Months Ended
Dec. 31, 2025
Accounting Policies [Abstract]  
Schedule of Consolidated Entities
The consolidated financial statements include the Company’s accounts and those of its wholly owned subsidiaries as of December 31, 2025 as follows:
SubsidiaryIncorporation/Acquisition Date
Establishment Labs, S.A. (Costa Rica)January 18, 2004
Motiva USA, LLC (USA)February 20, 2014
JAMM Technologies, Inc. (USA)October 27, 2015
Establishment Labs Produtos par Saude Ltda (Brazil)January 4, 2016
European Distribution Center Motiva BV (Belgium)March 4, 2016
Motiva Implants France SAS (France)September 12, 2016
JEN-Vault AG (Switzerland)November 22, 2016
Motiva Nordica AB (Sweden)November 2, 2017
Motiva Implants UK Limited (the United Kingdom)July 31, 2018
Motiva Italy S.R.L (Italy)July 31, 2018
Motiva Implants Spain, S.L. (Spain)January 3, 2019
Motiva Austria GmbH (Austria)January 14, 2019
Motiva Germany GmbH (Germany)August 1, 2019
Motiva Argentina S.R.L. (Argentina)February 7, 2020
Motiva Benelux BV (Belgium)
October 1, 2024
Motiva NL BV (Netherlands)October 1, 2024
Schedule of Allowance for Doubtful Accounts
A roll-forward of the allowance for credit losses is as follows:
Year Ended December 31,
2025
2024
2023
(in thousands)
Beginning balance$3,088 $1,841 $741 
Provision for credit losses3,352 1,722 1,223 
Recoveries (write-offs)
395 (475)(123)
Ending balance$6,835 $3,088 $1,841 
Schedule of Inventory Reserves
A roll-forward of the inventory reserve is as follows:
Year Ended December 31,
2025
2024
2023
(in thousands)
Beginning balance$4,177 $3,930 $2,649 
Provision for inventory obsolescence2,646 1,805 1,392 
Write-offs(2,915)(1,558)(111)
Ending balance$3,908 $4,177 $3,930 
Schedule of Disaggregation Revenue
Revenue was generated in these primary geographic markets:
Year Ended December 31,
202520242023
(in thousands)
EMEA (Europe / Middle East / Africa)$91,052 $78,209 $80,150 
Latin America39,926 34,998 48,891 
Asia-Pacific34,541 48,408 33,953 
North America45,557 4,410 2,157 
Total revenue$211,076 $166,025 $165,151 
v3.25.4
Balance Sheet Accounts (Tables)
 12 Months Ended
Dec. 31, 2025
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
Schedule of Inventory, Net
Inventory, Net
December 31,
20252024
(in thousands)
Raw materials$35,161 $41,310 
Work in process2,842 2,454 
Finished goods47,608 35,002 
Total inventory, net
$85,611 $78,766 
Schedule of Prepaid Expenses and Other Current Assets
Prepaid Expenses and Other Current Assets
December 31,
20252024
(in thousands)
Prepaid insurance$3,072 $2,768 
Prepaid services653 571 
Prepaid taxes1,392 458 
Prepaid assets1,629 505 
Prepaid raw materials and accessories384 1,005 
Prepaid U.S. clinical trial costs120 184 
Prepaid warranty and distribution rights379 409 
Prepaid software1,146 408 
Other
2,485 2,614 
Total prepaid expenses
$11,260 $8,922 
Schedule of Property and Equipment, Net
Property and Equipment, Net
December 31,
20252024
(in thousands)
Machinery and equipment$23,083 $22,764 
Building improvements17,361 16,902 
Furniture and fixtures17,645 14,772 
Building37,227 37,227 
Leasehold improvements2,537 2,516 
Land3,694 3,694 
Vehicles281 269 
Total101,828 98,144 
Less: Accumulated depreciation and amortization(26,213)(20,116)
Total property and equipment, net
$75,615 $78,028 
Schedule of Accrued Liabilities
Accrued liabilities consisted of the following:
December 31,
20252024
(in thousands)
Performance bonus$6,703 $6,235 
Payroll and related expenses5,129 4,832 
Operating lease liabilities - current1,712 1,514 
Commissions1,889 1,312 
Professional and legal services1,891 876 
Warranty reserve288 141 
Taxes377 153 
Other867 1,473 
Total accrued liabilities
$18,856 $16,536 
Schedule of Other Liabilities, Short-Term
Other liabilities, short-term consisted of the following:
December 31,
20252024
(in thousands)
Deferred revenue$1,208 $1,749 
Borrowings of short term notes payable for purchases of silicone raw material
10,000 — 
Borrowings of short term notes payable for insurance premium financing
2,413 — 
Consideration payable for business acquisitions
315 2,774 
Contingent consideration payable for business acquisitions
4,474 737 
Other
1,767 1,722 
Total other liabilities, short-term
$20,177 $6,982 
Schedule of Other Liabilities, Long-Term
Other liabilities, long-term consisted of the following:
December 31,
20252024
(in thousands)
Deferred revenue$1,136 $1,124 
Consideration payable for business acquisitions
— 278 
Contingent consideration payable for business acquisitions
— 174 
Other— 102 
Total other liabilities, long-term
$1,136 $1,678 
v3.25.4
Goodwill and Other Intangible Assets (Tables)
 12 Months Ended
Dec. 31, 2025
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of Goodwill
Changes in the carrying amount of goodwill during the year ended December 31, 2025 were as follows:
Balance as of January 1, 2025
AdditionsAccumulated Impairment Losses
Balance as of December 31, 2025
(in thousands)
Goodwill$1,209 $— $— $1,209 
Schedule of Finite-Lived Intangible Assets
The carrying amounts of these intangible assets other than goodwill as of December 31, 2025 were as follows:
Gross Carrying AmountAccumulated AmortizationNet Carrying AmountEstimated Useful Lives
(in thousands)(in years)
Patents and license rights$2,033 $(1,593)$440 
7-12
Customer relationships3,658 (2,142)1,516 
4-10
510(k) authorization567 (481)86 15
Developed technology62 (62)— 10
Capitalized software development costs14,678 (7,480)7,198 
2-5
Other183 (92)91 
2-5
Capitalized software development costs not yet amortized170 — 170 
Patents and license rights not yet amortized441 — 441 
Total intangibles other than goodwill$21,792 $(11,850)$9,942 

The carrying amounts of intangible assets other than goodwill as of December 31, 2024 were as follows:
Gross Carrying AmountAccumulated AmortizationNet Carrying AmountEstimated Useful Lives
(in thousands)(in years)
Patents and license rights$2,033 $(1,509)$524 
7-12
Customer relationships3,466 (1,997)1,469 
4-10
510(k) authorization567 (345)222 15
Developed technology62 (62)— 10
Capitalized software development costs13,559 (4,839)8,720 
2-5
Other183 (91)92 
2-5
Capitalized patents and license rights not yet amortized215 — 215 
Patents and license rights not yet amortized441 — 441 
Total intangibles other than goodwill$20,526 $(8,843)$11,683 
Schedule of Indefinite-Lived Intangible Assets
The carrying amounts of these intangible assets other than goodwill as of December 31, 2025 were as follows:
Gross Carrying AmountAccumulated AmortizationNet Carrying AmountEstimated Useful Lives
(in thousands)(in years)
Patents and license rights$2,033 $(1,593)$440 
7-12
Customer relationships3,658 (2,142)1,516 
4-10
510(k) authorization567 (481)86 15
Developed technology62 (62)— 10
Capitalized software development costs14,678 (7,480)7,198 
2-5
Other183 (92)91 
2-5
Capitalized software development costs not yet amortized170 — 170 
Patents and license rights not yet amortized441 — 441 
Total intangibles other than goodwill$21,792 $(11,850)$9,942 

The carrying amounts of intangible assets other than goodwill as of December 31, 2024 were as follows:
Gross Carrying AmountAccumulated AmortizationNet Carrying AmountEstimated Useful Lives
(in thousands)(in years)
Patents and license rights$2,033 $(1,509)$524 
7-12
Customer relationships3,466 (1,997)1,469 
4-10
510(k) authorization567 (345)222 15
Developed technology62 (62)— 10
Capitalized software development costs13,559 (4,839)8,720 
2-5
Other183 (91)92 
2-5
Capitalized patents and license rights not yet amortized215 — 215 
Patents and license rights not yet amortized441 — 441 
Total intangibles other than goodwill$20,526 $(8,843)$11,683 
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense
As of December 31, 2025, the amortization expense related to identifiable intangible assets, with definite useful lives, in future periods is expected to be as follows:
Year Ending December 31,(in thousands)
2026
$2,877 
20272,314 
20281,951 
2029950 
2030258 
Thereafter981 
Total expected future amortization expense$9,331 
v3.25.4
Fair Value Measurements (Tables)
 12 Months Ended
Dec. 31, 2025
Fair Value Disclosures [Abstract]  
Schedule of Fair Value, Liabilities Measured on Recurring Basis
The following table sets forth the Company’s financial instruments that were measured at fair value on a recurring basis by level within the fair value hierarchy at December 31, 2025 and 2024:
 
Fair Value Measurements at December 31, 2025
 TotalLevel 1Level 2Level 3
(in thousands)
Liabilities
Acquisition-related contingent consideration$4,474 — — $4,474 
 
Fair Value Measurements at December 31, 2024
 TotalLevel 1Level 2Level 3
(in thousands)
Liabilities
Acquisition-related contingent consideration$973 — — $973 
Schedule of Level 3 Financial Instruments
The following table sets forth a summary of the changes in the fair value of the Company’s Level 3 financial instruments as follows:
Acquisition-related Contingent Consideration
(in thousands)
Balance at December 31, 2024
$973 
Settlement(787)
Additional liability
4,277 
Change in fair value
11 
Balance at December 31, 2025
$4,474 
v3.25.4
Debt (Tables)
 12 Months Ended
Dec. 31, 2025
Debt Disclosure [Abstract]  
Schedule of Long-term Debt
The Company recorded Oaktree debt on the consolidated balance sheets as follows:
December 31,
20252024
(in thousands)
Principal$246,367 $221,367 
Net unamortized prepayment premium (debt discount and issuance costs)
1,155 (1,790)
Net carrying value of Oaktree debt$247,522 $219,577 
v3.25.4
Leases (Tables)
 12 Months Ended
Dec. 31, 2025
Leases [Abstract]  
Schedule of Lease, Cost and Cash Flows
Total lease cost includes the following components for the years ended December 31, 2025, 2024 and 2023:
202520242023
(in thousands)
Operating lease expense cost$2,113 $1,481 $1,079 
Sublease income(311)(311)(233)
Total lease cost, net of sublease income$1,802 $1,170 $846 
Year Ended December 31,
2025
2024
2023
(in thousands)
Cash paid for amounts included in the measurement of lease liabilities
Operating cash outflows from operating leases$2,117 $1,384 $1,052 
Operating cash inflows from subleases(332)(320)(214)
Operating cash outflows from operating leases, net of sublease income$1,785 $1,064 $838 
ROU assets obtained in exchange for new lease liabilities
Operating leases$335 $3,115 $478 
Schedule of Lessee, Assets and Liabilities
December 31,
2025
2024
(in thousands)
Supplemental balance sheet information
Operating lease right-of-use assets$4,339 $5,561 
Operating lease liabilities - short-term1,712 1,514 
Operating lease liabilities - long-term2,820 4,203 
Total operating lease liabilities$4,532 $5,717 
Weighted-average remaining lease term (years)
Operating leases
2.73.4
Weighted-average discount rate (%)
Operating leases11.2 %11.1 %
Schedule of Lessee, Operating Lease, Liability, Maturity
Maturities of lease liabilities as of December 31, 2025 were as follows:
Years Ending December 31,Operating Leases
(in thousands)
2026
$2,097 
20271,807 
2028948 
2029459 
203086 
Thereafter37 
Total future minimum lease payments5,434 
Less: Amount of lease payments representing interest(902)
Present value of future minimum lease payments$4,532 
Schedule of Undiscounted Future Cash Receipts
The undiscounted future cash receipts from the Company’s sublease as of December 31, 2025 were as follows:
Years Ending December 31,
Sublease
(in thousands)
2026
$343 
2027355 
2028368 
2029316 
Thereafter— 
Total undiscounted future sublease cash receipts
$1,382 
v3.25.4
Shareholders’ Equity (Tables)
 12 Months Ended
Dec. 31, 2025
Equity [Abstract]  
Schedule of Reserved Ordinary Shares for Future Issuances
The Company had reserved common shares for future issuances at December 31:
20252024
Warrants to purchase common shares659,403 626,589 
Options to purchase common shares1,428,878 1,413,948 
Remaining shares available under the 2018 Equity Incentive Plan2,230,340 2,068,033 
Shares issuable on vesting of grants of RSUs331,295 295,705 
Remaining shares available under the 2018 ESPP1,409,000 1,222,000 
Total common shares reserved for future issuances
6,058,916 5,626,275 
v3.25.4
Warrants (Tables)
 12 Months Ended
Dec. 31, 2025
Equity [Abstract]  
Schedule of Stockholders' Equity Note, Warrants or Rights
As of December 31, 2025, warrants to purchase up to 659,403 common shares were outstanding and exercisable, as set forth in the table below. As of December 31, 2024, 626,589 warrants were outstanding and exercisable.
Warrant HolderIssue DateSharesExercise PriceExpiration Date
RTW Master Fund, Ltd.1/9/2024164,367$0.001 *
RTW Innovation Master Fund, Ltd.1/9/2024134,068$0.001 *
RTW Master Fund, Ltd.11/7/2024164,077$0.001 *
RTW Innovation Master Fund, Ltd.11/7/2024134,543$0.001 *
RTW Biotech Opportunities Operating Ltd.
11/7/202429,534$0.001 *
RTW Master Fund, Ltd.9/5/202516,407$0.001 *
RTW Innovation Master Fund, Ltd.9/5/202513,454$0.001 *
RTW Biotech Opportunities Operating Ltd.9/5/20252,953$0.001 *
* The warrants are exercisable immediately and until exercised in full.
v3.25.4
Share-Based Compensation (Tables)
 12 Months Ended
Dec. 31, 2025
Share-Based Payment Arrangement [Abstract]  
Schedule of Share-based Compensation Expense
During the periods presented, the Company recorded the following share-based compensation expense for stock options, RSUs and RSAs:
Year Ended December 31,
202520242023
(in thousands)
Sales, general and administrative $9,844$12,073$12,101
Research and development1,5712,3312,261
Total stock compensation expense
$11,415$14,404$14,362
Schedule of Stock Options and Stock Option Granted to Employees
Stock Options
 Number of Options OutstandingWeighted-Average Exercise PriceWeighted-Average Remaining Contractual Term (in years)Aggregate Intrinsic Value (in thousands)
Balance at December 31, 2024
1,413,948 $47.96 6.30$14,010 
Granted (weighted-average fair value of $21.26 per share)
327,392 35.84 
Exercised(256,696)29.57 
Forfeited/canceled(56,397)52.24 
Balance at December 31, 2025
1,428,247 $48.16 6.16$35,902 
Schedule of Employee Stock Options Valuation Assumptions
The fair value of stock options granted to employees was estimated using the following assumptions:
Year Ended December 31,
202520242023
Volatility
55% - 56%
63% - 122%
62% - 71%
Risk-free interest rate
3.8% - 4.3%
3.7% - 4.8%
3.4% - 4.4%
Term (in years)6.25
6.25
6.25
Dividend yield———
The fair value of stock options granted to consultants was estimated using the following assumptions during the following periods presented:
Year Ended December 31,
202520242023
Volatility
54% - 55%
57% - 102%
60% - 65%
Risk-free interest rate
4.1% - 4.5%
4.2% - 4.5%
4.0% - 4.1%
Term (in years)101010
Dividend yield———
Schedule of Restricted Stock
The following table represents RSU activity for fiscal 2025:
 Restricted Stock 
Weighted-Average Grant Date Fair Value
Outstanding unvested at December 31, 2024
295,705 $48.53 
Granted185,170 36.10 
Vested(84,194)55.86 
Forfeited/canceled(65,744)47.83 
Outstanding unvested at December 31, 2025
330,937 $39.85 
v3.25.4
Business Combinations (Tables)
 12 Months Ended
Dec. 31, 2025
Business Combination, Asset Acquisition, Transaction between Entities under Common Control, and Joint Venture Formation [Abstract]  
Schedule of Purchase Price Allocation and Consideration Still Payable
The following table summarizes the consideration paid and payable at the acquisition date of October 1, 2024:
(in thousands)
Consideration:
Cash paid$221 
Equity issued (26,018 common shares)
1,177 
Contingent consideration payable
973 
Consideration payable3,262 
Fair value of trade receivable considered settled2,184 
Total consideration
$7,817 
The following table summarizes the consideration still payable at December 31, 2025 and 2024:
Year Ended December 31,
20252024
(in thousands)
Contingent consideration payable
$4,474 $973 
Consideration payable315 3,262 
Total liabilities
$4,789 $4,235 
Schedule of Fair Values of the Assets Acquired and Liabilities
The following table summarizes the estimated fair values of the assets acquired and liabilities assumed at the acquisition date of October 1, 2024:
(in thousands)
Recognized amounts of identifiable assets acquired and liabilities assumed:
Financial assets$904 
Inventory4,946 
Property, plant, and equipment125 
Intangible assets1,527 
Financial liabilities(482)
Total identifiable net assets$7,020 
Recognized goodwill:
Goodwill
$797 
v3.25.4
Income Taxes (Tables)
 12 Months Ended
Dec. 31, 2025
Income Tax Disclosure [Abstract]  
Schedule of Income before Income Tax, Domestic and Foreign
For the year ended December 31, loss before income tax consisted of the following:
2025
(in thousands)
Costa Rica operations$(24,542)
U.S. operations
2,792 
Other foreign operations
(36,272)
Total loss before income taxes$(58,022)
20242023
(in thousands)
Costa Rica operations$(60,665)$(13,556)
Non-Costa Rica operations(23,963)(65,027)
Total loss before income taxes$(84,628)$(78,583)
Schedule of Income Tax (Benefit) Provision
For the year ended December 31, the income tax benefit consisted of the following:
2025
(in thousands)
Current:
Costa Rica$112 
United States
270 
Other foreign
2,095 
Total current2,477 
Deferred:
Costa Rica— 
United States
(8,790)
Other foreign
(645)
Total deferred(9,435)
Total benefit for income taxes
$(6,958)
20242023
(in thousands)
Current:
Costa Rica$183 $297 
Non-Costa Rica1,963 3,328 
Total current2,146 3,625 
Deferred:
Costa Rica— — 
Non-Costa Rica(2,178)(3,706)
Total deferred(2,178)(3,706)
Total (benefit) provision for income taxes$(32)$(81)
Schedule of Effective Income Tax Rate Reconciliation
The items accounting for the difference between income taxes computed at the Costa Rica statutory income tax
rate and the income tax benefit consisted of the following for the year ended December 31:
Year Ended December 31,
2025
(in thousands)
Tax benefit at Costa Rica statutory rate$(17,406)30.0 %
State and local income taxes, net of federal (national) tax effects
— — 
Foreign tax effects
United States
Valuation allowance release
(9,384)16.2 
Other
27 — 
BVI
Foreign tax rate differential
12,283 (21.2)
Other foreign jurisdictions
Other49 (0.1)
Effect of change in tax law or rates (Costa Rica)
— — 
Tax credits— — 
Changes in valuation allowance
— — 
Nontaxable or nondeductible items
Costa Rica tax holiday benefit
7,473 (12.9)
Total benefit for income taxes$(6,958)12.0 %
20242023
(in thousands)
Tax benefit at Costa Rica statutory rate$(25,388)30.0 %$(23,575)30.0 %
Foreign tax rate differential7,166 (8.5)18,070 (22.9)
Tax rate changes(446)0.5 (7)— 
Return to provision adjustment(561)0.7 (539)0.7 
Tax credits— — — — 
Change in valuation allowance(14,157)16.7 438 (0.6)
Tax holiday adjustment (benefit)18,373 (21.7)4,386 (5.6)
U.S. stock compensation227 (0.3)984 (1.3)
Prior year true-up
14,744 (17.4)— — 
Other10 — 162 (0.2)
Total provision (benefit) for income taxes$(32)— %$(81)0.1 %
Schedule of Income Tax Paid
For the year ended December 31, income taxes paid consisted of the following:
2025
(in thousands)
Costa Rica93 
Foreign – by jurisdiction ≥5%:
U.S. federal78 
U.S. state and local— 
Spain83 
Sweden
29 
Germany57 
France55 
Italy21 
Belgium— 
Foreign – all other jurisdictions4 
Total cash paid for income taxes
$420 
Schedule of Deferred Tax Assets and Liabilities
As of December 31, the components of the Company’s deferred tax assets and liabilities are as follows:
2025
2024
(in thousands)
Accruals and reserves$345 $563 
Fixed assets
(1,284)(1,036)
Intangibles116 105 
Stock compensation 4,613 3,763 
Net operating loss9,247 10,742 
R&D credits325 325 
Allowance for credit losses
1,653 593 
Other97 56 
Valuation allowance— (9,223)
Total net deferred tax assets (included in “Other non-current assets”)$15,112 $5,888 
v3.25.4
Net Loss Per Share (Tables)
 12 Months Ended
Dec. 31, 2025
Earnings Per Share [Abstract]  
Schedule of Basic and Diluted Earnings Per Share
The following table summarizes the computation of basic and diluted net loss per share for the periods presented:
Year Ended December 31,
202520242023
(in thousands, except share and per share data)
Numerator:
Net loss$(51,064)$(84,596)$(78,502)
Denominator:
Weighted average common shares used for basic and diluted earnings per share29,620,022 28,161,761 25,600,029 
Net loss per share:
Basic and diluted$(1.72)$(3.00)$(3.07)
Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share
The following potentially dilutive securities outstanding at the end of the periods presented have been excluded from the computation of diluted shares:
Year Ended December 31,
202520242023
Options to purchase common shares1,428,878 1,413,948 1,487,387 
Shares issuable on vesting of grants of RSUs331,295 295,705 196,177 
Total potentially dilutive shares outstanding
1,760,173 1,709,653 1,683,564 
v3.25.4
Summary of Significant Accounting Policies - Narrative (Details)
 3 Months Ended 12 Months Ended
Jun. 30, 2025
USD ($)
Dec. 31, 2025
USD ($)
unit
financial_institution
segment
Dec. 31, 2024
USD ($)
Dec. 31, 2023
USD ($)
Summary Of Significant Accounting Policies [Line Items]        
Number of operating segments | segment   1    
Number of reportable segments | segment   1    
Number of financial institutions holding cash | financial_institution   2    
Cash equivalents   $ 0 $ 3,000,000.0  
Shipping and handling expenses   165,069,000 139,806,000 $ 145,575,000
Valuation allowances and reserves, amount   $ 1,900,000 400,000  
Product shelf life (in years)   5 years    
Number of reporting units | unit   1    
Goodwill and intangible asset impairment   $ 0 0 0
Asset impairment charges   0 0 0
Foreign currency transaction gain (loss)   6,400,000 (8,800,000) 1,800,000
Non-cash loss on contract termination $ 500,000 $ 543,000 6,004,000 0
Contract termination costs, payable     1,500,000  
Minimum        
Summary Of Significant Accounting Policies [Line Items]        
Product return period (in days)   15 days    
Estimated useful lives (in years)   5 years    
Estimated useful lives   1 year    
Maximum        
Summary Of Significant Accounting Policies [Line Items]        
Product return period (in days)   60 days    
Estimated useful lives (in years)   10 years    
Estimated useful lives   10 years    
Building        
Summary Of Significant Accounting Policies [Line Items]        
Estimated useful lives (in years)   50 years    
Shipping and Handling        
Summary Of Significant Accounting Policies [Line Items]        
Shipping and handling expenses   $ 13,000,000.0 $ 7,200,000 $ 11,800,000
Geographic Concentration Risk | Revenue | Brazil        
Summary Of Significant Accounting Policies [Line Items]        
Concentration risk (as a percent)       13.30%
Geographic Concentration Risk | Revenue | U.S. operations        
Summary Of Significant Accounting Policies [Line Items]        
Concentration risk (as a percent)   21.60%    
Geographic Concentration Risk | Long-lived Assets | Costa Rica        
Summary Of Significant Accounting Policies [Line Items]        
Concentration risk (as a percent)   73.00% 78.00%  
Customer Concentration Risk | Accounts Receivable | Customer One        
Summary Of Significant Accounting Policies [Line Items]        
Concentration risk (as a percent)   14.10% 17.00%  
Product Concentration Risk | Avantor        
Summary Of Significant Accounting Policies [Line Items]        
Purchases from suppliers   $ 31,600,000 $ 29,200,000 $ 53,700,000
Outstanding balance owed   $ 8,900,000 $ 15,000,000.0  
Product Concentration Risk | Purchases | Avantor        
Summary Of Significant Accounting Policies [Line Items]        
Concentration risk (as a percent)   55.80% 44.70% 68.40%
v3.25.4
Summary of Significant Accounting Policies - Schedule of Allowance for Doubtful Accounts (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Accounts Receivable, Allowance for Credit Loss [Roll Forward]      
Beginning balance $ 3,088 $ 1,841 $ 741
Provision for credit losses 3,352 1,722 1,223
Recoveries (write-offs) 395 (475) (123)
Ending balance $ 6,835 $ 3,088 $ 1,841
v3.25.4
Summary of Significant Accounting Policies - Schedule of Inventory Reserves (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Inventory, Valuation Reserves [Roll Forward]      
Beginning balance $ 4,177 $ 3,930 $ 2,649
Provision for inventory obsolescence 2,646 1,805 1,392
Write-offs (2,915) (1,558) (111)
Ending balance $ 3,908 $ 4,177 $ 3,930
v3.25.4
Summary of Significant Accounting Policies - Schedule of Disaggregation of Revenue (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Disaggregation of Revenue [Line Items]      
Total revenue $ 211,076 $ 166,025 $ 165,151
EMEA (Europe / Middle East / Africa)      
Disaggregation of Revenue [Line Items]      
Total revenue 91,052 78,209 80,150
Latin America      
Disaggregation of Revenue [Line Items]      
Total revenue 39,926 34,998 48,891
Asia-Pacific      
Disaggregation of Revenue [Line Items]      
Total revenue 34,541 48,408 33,953
North America      
Disaggregation of Revenue [Line Items]      
Total revenue $ 45,557 $ 4,410 $ 2,157
v3.25.4
Balance Sheet Accounts - Schedule of Inventory, Net (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]    
Raw materials $ 35,161 $ 41,310
Work in process 2,842 2,454
Finished goods 47,608 35,002
Total inventory, net $ 85,611 $ 78,766
v3.25.4
Balance Sheet Accounts - Narrative (Details) - USD ($)
$ in Thousands
 1 Months Ended 12 Months Ended
Sep. 26, 2025
Jun. 20, 2025
Aug. 31, 2021
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
May 23, 2025
Property, Plant and Equipment [Line Items]              
Inventory on consignment       $ 14,100 $ 9,000    
Depreciation and amortization expense       6,200 4,700 $ 2,800  
Proceeds from short-term debt $ 5,000 $ 5,000   10,000 0 $ 0  
Proceeds from notes payable       $ 3,400      
Product Financing Arrangement              
Property, Plant and Equipment [Line Items]              
Maximum aggregate amount of short-term debt             $ 10,000
Interest rate (as a percent)   12.00%          
Debt term (in months)   4 months          
Short-term debt $ 5,000 $ 5,000          
Notes Payable, Other Payables              
Property, Plant and Equipment [Line Items]              
Debt term (in months)       10 months      
Short-term debt       $ 2,413 $ 0    
Notes Payable, Other Payables | Minimum              
Property, Plant and Equipment [Line Items]              
Interest rate (as a percent)       7.70%      
Notes Payable, Other Payables | Maximum              
Property, Plant and Equipment [Line Items]              
Interest rate (as a percent)       8.30%      
Land | Zona Franca Coyol, S.A.              
Property, Plant and Equipment [Line Items]              
Option to purchase land and buildings     $ 2,800        
v3.25.4
Balance Sheet Accounts - Schedule of Prepaid Expenses and Other Current Assets (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]    
Prepaid insurance $ 3,072 $ 2,768
Prepaid services 653 571
Prepaid taxes 1,392 458
Prepaid assets 1,629 505
Prepaid raw materials and accessories 384 1,005
Prepaid U.S. clinical trial costs 120 184
Prepaid warranty and distribution rights 379 409
Prepaid software 1,146 408
Other 2,485 2,614
Total prepaid expenses $ 11,260 $ 8,922
v3.25.4
Balance Sheet Accounts - Schedule of Property and Equipment, Net (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Property, Plant and Equipment [Line Items]    
Property, plant and equipment, gross $ 101,828 $ 98,144
Less: Accumulated depreciation and amortization (26,213) (20,116)
Total property and equipment, net 75,615 78,028
Machinery and equipment    
Property, Plant and Equipment [Line Items]    
Property, plant and equipment, gross 23,083 22,764
Building improvements    
Property, Plant and Equipment [Line Items]    
Property, plant and equipment, gross 17,361 16,902
Furniture and fixtures    
Property, Plant and Equipment [Line Items]    
Property, plant and equipment, gross 17,645 14,772
Building    
Property, Plant and Equipment [Line Items]    
Property, plant and equipment, gross 37,227 37,227
Leasehold improvements    
Property, Plant and Equipment [Line Items]    
Property, plant and equipment, gross 2,537 2,516
Land    
Property, Plant and Equipment [Line Items]    
Property, plant and equipment, gross 3,694 3,694
Vehicles    
Property, Plant and Equipment [Line Items]    
Property, plant and equipment, gross $ 281 $ 269
v3.25.4
Balance Sheet Accounts - Schedule of Accrued Liabilities (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]    
Performance bonus $ 6,703 $ 6,235
Payroll and related expenses 5,129 4,832
Operating lease liabilities - current $ 1,712 $ 1,514
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration] Total accrued liabilities Total accrued liabilities
Commissions $ 1,889 $ 1,312
Professional and legal services 1,891 876
Warranty reserve 288 141
Taxes 377 153
Other 867 1,473
Total accrued liabilities $ 18,856 $ 16,536
v3.25.4
Balance Sheet Accounts - Schedule of Other Liabilities, Short-Term (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Short-Term Debt [Line Items]    
Deferred revenue $ 1,208 $ 1,749
Consideration payable for business acquisitions 315 2,774
Contingent consideration payable for business acquisitions 4,474 737
Other 1,767 1,722
Total other liabilities, short-term 20,177 6,982
Notes Payable To Funding Providers    
Short-Term Debt [Line Items]    
Borrowings of short term notes payable for purchases of silicone raw material/insurance premium financing 10,000 0
Notes Payable, Other Payables    
Short-Term Debt [Line Items]    
Borrowings of short term notes payable for purchases of silicone raw material/insurance premium financing $ 2,413 $ 0
v3.25.4
Balance Sheet Accounts - Schedule of Other Liabilities, Long-Term (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]    
Deferred revenue $ 1,136 $ 1,124
Consideration payable for business acquisitions 0 278
Contingent consideration payable for business acquisitions 0 174
Other 0 102
Total other liabilities, long-term $ 1,136 $ 1,678
v3.25.4
Goodwill and Other Intangible Assets - Schedule of Goodwill (Details)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
USD ($)
Goodwill [Roll Forward]  
Beginning Balance $ 1,209
Additions 0
Accumulated Impairment Losses 0
Ending Balance $ 1,209
v3.25.4
Goodwill and Other Intangible Assets - Schedule of Finite-Lived Intangible Assets and Indefinite-Lived Intangible Assets (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Finite-Lived Intangible Assets, Net [Abstract]    
Accumulated Amortization $ (11,850) $ (8,843)
Net Carrying Amount 9,331  
Intangible Assets, Net (Excluding Goodwill) [Abstract]    
Gross Carrying Amount 21,792 20,526
Net Carrying Amount 9,942 11,683
Capitalized software development costs    
Indefinite-lived Intangible Assets (Excluding Goodwill) [Abstract]    
Patents and license rights not yet amortized 170 215
Patents and license rights not yet amortized    
Indefinite-lived Intangible Assets (Excluding Goodwill) [Abstract]    
Patents and license rights not yet amortized $ 441 441
Minimum    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated Useful Lives 1 year  
Maximum    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated Useful Lives 10 years  
Patents and license rights    
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Carrying Amount $ 2,033 2,033
Accumulated Amortization (1,593) (1,509)
Net Carrying Amount $ 440 $ 524
Patents and license rights | Minimum    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated Useful Lives 7 years 7 years
Patents and license rights | Maximum    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated Useful Lives 12 years 12 years
Customer relationships    
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Carrying Amount $ 3,658 $ 3,466
Accumulated Amortization (2,142) (1,997)
Net Carrying Amount $ 1,516 $ 1,469
Customer relationships | Minimum    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated Useful Lives 4 years 4 years
Customer relationships | Maximum    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated Useful Lives 10 years 10 years
510(k) authorization    
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Carrying Amount $ 567 $ 567
Accumulated Amortization (481) (345)
Net Carrying Amount $ 86 $ 222
Estimated Useful Lives 15 years 15 years
Developed technology    
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Carrying Amount $ 62 $ 62
Accumulated Amortization (62) (62)
Net Carrying Amount $ 0 $ 0
Estimated Useful Lives 10 years 10 years
Capitalized software development costs    
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Carrying Amount $ 14,678 $ 13,559
Accumulated Amortization (7,480) (4,839)
Net Carrying Amount $ 7,198 $ 8,720
Capitalized software development costs | Minimum    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated Useful Lives 2 years 2 years
Capitalized software development costs | Maximum    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated Useful Lives 5 years 5 years
Other    
Finite-Lived Intangible Assets, Net [Abstract]    
Gross Carrying Amount $ 183 $ 183
Accumulated Amortization (92) (91)
Net Carrying Amount $ 91 $ 92
Other | Minimum    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated Useful Lives 2 years 2 years
Other | Maximum    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated Useful Lives 5 years 5 years
v3.25.4
Goodwill and Other Intangible Assets - Narrative (Details) - USD ($)
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]      
Amortization of intangible assets $ 3,300,000 $ 2,100,000 $ 1,200,000
Goodwill and intangible asset impairment $ 0 $ 0 $ 0
v3.25.4
Goodwill and Other Intangible Assets - Schedule of Finite-Lived Intangible Assets, Future Amortization Expense (Details)
$ in Thousands
Dec. 31, 2025
USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]  
2026 $ 2,877
2027 2,314
2028 1,951
2029 950
2030 258
Thereafter 981
Net Carrying Amount $ 9,331
v3.25.4
Fair Value Measurements - Schedule of Fair Value, Liabilities Measured on Recurring Basis (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Acquisition-related contingent consideration $ 4,474 $ 973
Level 1    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Acquisition-related contingent consideration 0 0
Level 2    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Acquisition-related contingent consideration 0 0
Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Acquisition-related contingent consideration $ 4,474 $ 973
v3.25.4
Fair Value Measurements - Narrative (Details)
$ in Thousands
Dec. 31, 2025
USD ($)
Dec. 31, 2024
USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Acquisition-related contingent consideration $ 4,474 $ 973
Measurement Input, Revenue Multiple | Minimum    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Contingent consideration, measurement input 0.5  
Measurement Input, Revenue Multiple | Maximum    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Contingent consideration, measurement input 0.9  
Measurement Input, Discount Rate    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Contingent consideration, measurement input   0.125
Measurement Input, Actual Revenue    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Contingent consideration, measurement input 6,000 6,000
Measurement Input, Forecasted Revenue, Base    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Contingent consideration, measurement input 9,500 6,400
Measurement Input, Interest Rate Volatility    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Contingent consideration, measurement input   0.10
v3.25.4
Fair Value Measurements - Schedule of Level 3 Financial Instruments (Details)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]  
Beginning balance $ 973
Settlement (787)
Additional liability 4,277
Change in fair value 11
Ending balance $ 4,474
v3.25.4
Debt - Narrative (Details)
 12 Months Ended
Feb. 21, 2024
tranche
Apr. 26, 2022
USD ($)
tranche
Dec. 31, 2025
USD ($)
Dec. 31, 2024
USD ($)
Dec. 31, 2023
USD ($)
Sep. 29, 2025
USD ($)
Sep. 28, 2025
USD ($)
Feb. 20, 2024
USD ($)
Debt Instrument [Line Items]                
Number of remaining available tranches | tranche 2              
Number of tranches | tranche   4            
Minimum                
Debt Instrument [Line Items]                
Debt instrument covenant minimum liquidity, amount             $ 25,000,000  
Maximum                
Debt Instrument [Line Items]                
Debt instrument covenant minimum liquidity, amount             $ 30,000,000  
Oaktree Credit Agreement | Line of Credit                
Debt Instrument [Line Items]                
Maximum borrowing capacity   $ 225,000,000            
Early repayment amount   $ 5,000,000            
Debt term (in years)   5 years            
Effective interest rate (as a percent)     10.90%          
Interest rate paid in kind, basis points   6.00%            
Original discount rate (as a percent)   2.00%            
Exit fee (as a percent)   3.00%            
Minimum liquidity requirement   $ 20,000,000            
Gross sales requirement, period   12 months            
Minimum gross sales   $ 200,000,000            
Minimum gross sales (as a percent)   50.00%            
Weighted average interest rate (as a percent)     9.20%          
Interest expense     $ 24,500,000 $ 21,100,000 $ 16,900,000      
Principal     246,367,000 $ 221,367,000        
Interest accrued     21,400,000          
Oaktree Credit Agreement | Line of Credit | Debt Instrument, Redemption, Period One                
Debt Instrument [Line Items]                
Yield protection premium fee (as a percent)   4.00%            
Oaktree Credit Agreement | Line of Credit | Debt Instrument, Redemption, Period Two                
Debt Instrument [Line Items]                
Yield protection premium fee (as a percent)   4.00%            
Oaktree Credit Agreement | Line of Credit | Debt Instrument, Redemption, Period Three                
Debt Instrument [Line Items]                
Yield protection premium fee (as a percent)   2.00%            
Oaktree Credit Agreement | Line of Credit | Debt Instrument, Redemption, Period Four                
Debt Instrument [Line Items]                
Yield protection premium fee (as a percent)   0.00%            
Credit Agreement, Tranche A Term Loan | Line of Credit                
Debt Instrument [Line Items]                
Maximum borrowing capacity   $ 150,000,000 150,000,000          
Effective interest rate (as a percent)   9.00%            
Minimum initial cash interest rate   0.030            
Credit Agreement, Tranche A Term Loan | Line of Credit | Triggering Event One                
Debt Instrument [Line Items]                
Effective interest rate (as a percent)   8.25%            
Madryn Credit Agreement | Line of Credit                
Debt Instrument [Line Items]                
Early repayment amount   $ 6,500,000            
Credit Agreement, Tranche B Term Loan | Line of Credit                
Debt Instrument [Line Items]                
Maximum borrowing capacity   $ 25,000,000 25,000,000          
Effective interest rate (as a percent)   9.00%            
Minimum liquidity requirement   $ 25,000,000            
Minimum initial cash interest rate   0.030            
Credit Agreement, Tranche B Term Loan | Line of Credit | Triggering Event One                
Debt Instrument [Line Items]                
Effective interest rate (as a percent)   8.25%            
Credit Agreement, Tranche C Term Loan | Line of Credit                
Debt Instrument [Line Items]                
Maximum borrowing capacity   $ 25,000,000 25,000,000          
Effective interest rate (as a percent) 10.00%              
Yield protection premium fee (as a percent)   4.00%            
Period after advance (in years) 1 year              
Minimum initial cash interest rate   0.040            
Credit Agreement, Tranche D Term Loan | Line of Credit                
Debt Instrument [Line Items]                
Maximum borrowing capacity     $ 25,000,000     $ 25,000,000    
Effective interest rate (as a percent) 10.00%              
Trailing twelve month gross sales, milestones               $ 225,000,000
Yield protection premium fee (as a percent)   4.00%            
Period after advance (in years) 1 year              
v3.25.4
Debt - Schedule of Oaktree Debt (Details) - Oaktree Credit Agreement - Line of Credit - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Line of Credit Facility [Line Items]    
Principal $ 246,367 $ 221,367
Net unamortized prepayment premium (debt discount and issuance costs) 1,155 (1,790)
Net carrying value of Oaktree debt $ 247,522 $ 219,577
v3.25.4
Leases - Narrative (Details)
Dec. 31, 2025
Maximum  
Lessee, Lease, Description [Line Items]  
Operating lease, term of contract (in years) 6 years
v3.25.4
Leases - Schedule of Lease, Cost (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Leases [Abstract]      
Operating lease expense cost $ 2,113 $ 1,481 $ 1,079
Sublease income (311) (311) (233)
Total lease cost, net of sublease income $ 1,802 $ 1,170 $ 846
v3.25.4
Leases - Schedule of Lessee, Assets and Liabilities (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Operating leases    
Operating lease right-of-use assets $ 4,339 $ 5,561
Operating lease liabilities - short-term 1,712 1,514
Operating lease liabilities - long-term 2,820 4,203
Total operating lease liabilities $ 4,532 $ 5,717
Weighted-average remaining lease term (years)    
Operating leases 2 years 8 months 12 days 3 years 4 months 24 days
Weighted-average discount rate (%)    
Operating leases 11.20% 11.10%
v3.25.4
Leases - Supplemental Cash Flows (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Cash paid for amounts included in the measurement of lease liabilities      
Operating cash outflows from operating leases $ 2,117 $ 1,384 $ 1,052
Operating cash inflows from subleases (332) (320) (214)
Operating cash outflows from operating leases, net of sublease income 1,785 1,064 838
ROU assets obtained in exchange for new lease liabilities      
Operating leases $ 335 $ 3,115 $ 478
v3.25.4
Leases - Schedule of Lessee, Operating Lease, Liability, Maturity (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Leases [Abstract]    
2026 $ 2,097  
2027 1,807  
2028 948  
2029 459  
2030 86  
Thereafter 37  
Total future minimum lease payments 5,434  
Less: Amount of lease payments representing interest (902)  
Present value of future minimum lease payments $ 4,532 $ 5,717
v3.25.4
Leases - Schedule of Undiscounted Future Cash Receipts (Details)
$ in Thousands
Dec. 31, 2025
USD ($)
Leases [Abstract]  
2026 $ 343
2027 355
2028 368
2029 316
Thereafter 0
Total undiscounted future sublease cash receipts $ 1,382
v3.25.4
Shareholders’ Equity - Narrative (Details) - USD ($)
$ / shares in Units, $ in Millions
Aug. 31, 2025
Nov. 07, 2024
Jan. 09, 2024
Dec. 31, 2025
Sep. 30, 2025
Dec. 31, 2024
Nov. 30, 2024
Jan. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Subsidiary, Sale of Stock [Line Items]                    
Common stock, shares issued (in shares)       29,713,024   29,195,439        
Common stock, shares outstanding (in shares)       29,304,954   28,787,369        
Number of shares called by warrants (in shares)           599,991        
Common Shares                    
Subsidiary, Sale of Stock [Line Items]                    
Common stock, shares outstanding (in shares)       29,713,024   29,195,439     26,495,250 24,815,908
Private Placement                    
Subsidiary, Sale of Stock [Line Items]                    
Shares issued (in shares)   765,696                
Purchase price per share (in dollars per share) $ 45.71 $ 45.71                
Number of shares called by warrants (in shares)         32,814   360,968 898,435    
Exercise price of warrants (in dollars per share) $ 0.001   $ 0.001   $ 0.001   $ 0.001 $ 0.001    
Consideration received on transaction $ 49.7   $ 49.7              
Private Placement | Common Shares                    
Subsidiary, Sale of Stock [Line Items]                    
Shares issued (in shares)     1,101,565              
Purchase price per share (in dollars per share)     $ 25.00              
Private Placement | Pre-Funded Warrant                    
Subsidiary, Sale of Stock [Line Items]                    
Purchase price per share (in dollars per share)     $ 24.999              
Number of shares called by warrants (in shares)     898,435              
Private Placement | Pre-Funded Warrant                    
Subsidiary, Sale of Stock [Line Items]                    
Purchase price per share (in dollars per share)   $ 45.709                
Number of shares called by warrants (in shares)   328,154                
Private Placement Additional Issuance                    
Subsidiary, Sale of Stock [Line Items]                    
Shares issued (in shares) 76,569                  
Number of shares called by warrants (in shares) 32,814                  
v3.25.4
Shareholders’ Equity - Schedule of Reserved Ordinary Shares for Future Issuances (Details) - shares
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2018
Class of Stock [Line Items]      
Common shares reserved for future issuance (in shares) 6,058,916 5,626,275  
Pre-Funded Warrant      
Class of Stock [Line Items]      
Common shares reserved for future issuance (in shares) 659,403 626,589  
Remaining shares available under the 2018 Equity Incentive Plan      
Class of Stock [Line Items]      
Common shares reserved for future issuance (in shares) 2,230,340 2,068,033 1,500,000
Options to purchase common shares      
Class of Stock [Line Items]      
Common shares reserved for future issuance (in shares) 1,428,878 1,413,948  
Shares issuable on vesting of grants of RSUs      
Class of Stock [Line Items]      
Common shares reserved for future issuance (in shares) 331,295 295,705  
Remaining shares available under the 2018 ESPP      
Class of Stock [Line Items]      
Common shares reserved for future issuance (in shares) 1,409,000 1,222,000  
v3.25.4
Warrants - Narrative (Details) - $ / shares
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Sep. 30, 2025
Aug. 31, 2025
Nov. 30, 2024
Jan. 31, 2024
Jan. 09, 2024
Class of Stock [Line Items]              
Number of shares called by warrants (in shares)   599,991          
Warrant net exercises (in shares) 0 600,000          
Warrants outstanding (in shares) 659,403 626,589          
Private Placement              
Class of Stock [Line Items]              
Number of shares called by warrants (in shares)     32,814   360,968 898,435  
Exercise price of warrants (in dollars per share)     $ 0.001 $ 0.001 $ 0.001 $ 0.001 $ 0.001
v3.25.4
Warrants - Schedule of Stockholders' Equity Note, Warrants or Rights (Details) - $ / shares
Dec. 31, 2025
Dec. 31, 2024
Class of Stock [Line Items]    
Shares (in shares) 659,403 626,589
Warrants Issued January 9, 2024 | RTW Master Fund, Ltd.    
Class of Stock [Line Items]    
Shares (in shares) 164,367  
Exercise price of warrants (in dollars per share) $ 0.001  
Warrants Issued January 9, 2024 | RTW Innovation Master Fund, Ltd.    
Class of Stock [Line Items]    
Shares (in shares) 134,068  
Exercise price of warrants (in dollars per share) $ 0.001  
Warrants Issued November 7, 2024 | RTW Master Fund, Ltd.    
Class of Stock [Line Items]    
Shares (in shares) 164,077  
Exercise price of warrants (in dollars per share) $ 0.001  
Warrants Issued November 7, 2024 | RTW Innovation Master Fund, Ltd.    
Class of Stock [Line Items]    
Shares (in shares) 134,543  
Exercise price of warrants (in dollars per share) $ 0.001  
Warrants Issued November 7, 2024 | RTW Biotech Opportunities Operating Ltd.    
Class of Stock [Line Items]    
Shares (in shares) 29,534  
Exercise price of warrants (in dollars per share) $ 0.001  
Warrants Issued September 5, 2025 | RTW Master Fund, Ltd.    
Class of Stock [Line Items]    
Shares (in shares) 16,407  
Exercise price of warrants (in dollars per share) $ 0.001  
Warrants Issued September 5, 2025 | RTW Innovation Master Fund, Ltd.    
Class of Stock [Line Items]    
Shares (in shares) 13,454  
Exercise price of warrants (in dollars per share) $ 0.001  
Warrants Issued September 5, 2025 | RTW Biotech Opportunities Operating Ltd.    
Class of Stock [Line Items]    
Shares (in shares) 2,953  
Exercise price of warrants (in dollars per share) $ 0.001  
v3.25.4
Share-Based Compensation - Narrative (Details)
$ / shares in Units, $ in Thousands
 12 Months Ended
Jan. 01, 2019
shares
Dec. 31, 2025
USD ($)
$ / shares
shares
Dec. 31, 2024
USD ($)
shares
Dec. 31, 2023
USD ($)
Jan. 01, 2025
shares
Jan. 01, 2024
shares
Jan. 01, 2023
shares
Jan. 01, 2022
shares
Jan. 01, 2021
shares
Jan. 01, 2020
shares
Dec. 31, 2018
shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]                      
Shares reserved for future issuance (in shares) | shares   6,058,916 5,626,275                
Number of options vested and exercisable (in shares) | shares   902,758                  
Weighted average exercise price vested and exercisable (in dollars per share) | $ / shares   $ 51.00                  
Aggregate intrinsic value of options vested and exercisable   $ 20,300                  
Stock option exercises (in shares) | shares   256,696                  
Intrinsic value of options exercised in period   $ 9,300 $ 4,100 $ 5,100              
Unrecognized compensation expense period for recognition (in years)   2 years 7 months 6 days                  
Unrecognized share-based compensation cost of unvested RSAs   $ 11,415 $ 14,404 14,362              
Employee                      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]                      
Unrecognized compensation expense of stock options granted   8,500                  
Nonemployee                      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]                      
Unrecognized compensation expense of stock options granted   $ 1,800                  
Options to purchase common shares                      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]                      
Shares reserved for future issuance (in shares) | shares   1,428,878 1,413,948                
Vesting period   4 years                  
Options to purchase common shares | Employee                      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]                      
Unrecognized share-based compensation cost of unvested RSAs   $ 5,400 $ 7,400 8,700              
Options to purchase common shares | Nonemployee                      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]                      
Unrecognized share-based compensation cost of unvested RSAs   $ 800 $ 700 900              
Restricted Stock                      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]                      
Shares reserved for future issuance (in shares) | shares   331,295 295,705                
Restricted stock conversion ratio   1                  
RSAs vested in period   $ 5,300 $ 6,400 $ 4,800              
Unrecognized share-based compensation cost   $ 9,600                  
Employee unrecognized compensation expense, period for recognition   2 years 4 months 24 days                  
Minimum | Restricted Stock                      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]                      
Vesting period   1 year                  
Maximum | Restricted Stock                      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]                      
Vesting period   4 years                  
Equity Incentive Plan, 2018                      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]                      
Shares reserved for future issuance (in shares) | shares   2,230,340 2,068,033               1,500,000
Number of authorized common shares automatically increased (in shares) | shares 750,000       750,000 750,000 750,000 750,000 750,000 750,000  
Common stock, capital shares reserved for future issuance, increase (decrease) (as a percent) 4.00%                    
Number of common shares reserved under share based compensation plan (in shares) | shares   6,750,000                  
v3.25.4
Share-Based Compensation - Schedule of Share-based Compensation Expense (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Total stock compensation expense $ 11,415 $ 14,404 $ 14,362
Sales, general and administrative      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Total stock compensation expense 9,844 12,073 12,101
Research and development      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Total stock compensation expense $ 1,571 $ 2,331 $ 2,261
v3.25.4
Share-Based Compensation - Schedule of Stock Options (Details) - USD ($)
$ / shares in Units, $ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Share-Based Payment Arrangement [Abstract]    
Weighted average fair value (in dollars per share) $ 21.26  
Number of Options Outstanding    
Beginning balance, options outstanding (in shares) 1,413,948  
Granted (in shares) 327,392  
Exercised (in shares) (256,696)  
Forfeited/canceled (in shares) (56,397)  
Ending balance, options outstanding (in shares) 1,428,247 1,413,948
Weighted-Average Exercise Price    
Beginning balance (in dollars per share) $ 47.96  
Granted (in dollars per share) 35.84  
Exercised (in dollars per share) 29.57  
Forfeited/canceled (in dollars per share) 52.24  
Ending balance (in dollars per share) $ 48.16 $ 47.96
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract]    
Weighted-Average Remaining Contractual Term (in years) 6 years 1 month 28 days 6 years 3 months 18 days
Aggregate intrinsic value $ 35,902 $ 14,010
v3.25.4
Share-Based Compensation - Schedule of Stock Option Granted to Employees (Details) - Options to purchase common shares - Employee
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Volatility, minimum 55.00% 63.00% 62.00%
Volatility, maximum 56.00% 122.00% 71.00%
Risk free interest rate, minimum 3.80% 3.70% 3.40%
Risk-free interest rate, maximum 4.30% 4.80% 4.40%
Term (in years) 6 years 3 months 6 years 3 months 6 years 3 months
Dividend yield 0.00% 0.00% 0.00%
v3.25.4
Share-Based Compensation - Schedule of Employee Stock Options Valuation Assumptions (Details) - Nonemployee - Options to purchase common shares
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Volatility, minimum 54.00% 57.00% 60.00%
Volatility, maximum 55.00% 102.00% 65.00%
Risk free interest rate, minimum 4.10% 4.20% 4.00%
Risk-free interest rate, maximum 4.50% 4.50% 4.10%
Term (in years) 10 years 10 years 10 years
Dividend yield 0.00% 0.00% 0.00%
v3.25.4
Share-Based Compensation - Schedule of Restricted Stock (Details) - Restricted Stock
 12 Months Ended
Dec. 31, 2025
$ / shares
shares
Restricted Stock  
Outstanding balance (in shares) | shares 295,705
Granted (in shares) | shares 185,170
Vested (in shares) | shares (84,194)
Forfeited/canceled (in shares) | shares (65,744)
Outstanding balance (in shares) | shares 330,937
Weighted-Average Grant Date Fair Value  
Balance outstanding (in dollars per share) | $ / shares $ 48.53
Granted (in dollars per share) | $ / shares 36.10
Vested (in dollars per share) | $ / shares 55.86
Forfeited/canceled (in dollars per share) | $ / shares 47.83
Balance outstanding (in dollars per share) | $ / shares $ 39.85
v3.25.4
Business Combinations - Narrative (Details)
 1 Months Ended 3 Months Ended 12 Months Ended
Jun. 30, 2025
USD ($)
Jan. 13, 2025
USD ($)
Oct. 01, 2024
USD ($)
Apr. 30, 2025
USD ($)
Jan. 31, 2025
USD ($)
Oct. 31, 2024
USD ($)
Mar. 31, 2026
USD ($)
Dec. 31, 2025
USD ($)
Dec. 31, 2024
USD ($)
Business Combination [Line Items]                  
Acquisition-related contingent consideration               $ 4,474,000 $ 973,000
Stock compensation in lieu of cash fees               $ 4,300,000  
Weighted average price of common shares, acquisition date               30 days  
Goodwill               $ 1,209,000 1,209,000
Goodwill expected to be deductible for income tax purposes               0  
Contingent equity consideration (see Note 5)               $ 4,474,000 $ 737,000
Measurement Input, Revenue Multiple | Minimum                  
Business Combination [Line Items]                  
Contingent consideration, measurement input               0.5  
Measurement Input, Revenue Multiple | Maximum                  
Business Combination [Line Items]                  
Contingent consideration, measurement input               0.9  
Measurement Input, Discount Rate                  
Business Combination [Line Items]                  
Contingent consideration, measurement input                 0.125
Measurement Input, Forecasted Revenue, Base                  
Business Combination [Line Items]                  
Contingent consideration, measurement input               9,500,000 6,400,000
Measurement Input, Interest Rate Volatility                  
Business Combination [Line Items]                  
Contingent consideration, measurement input                 0.10
Measurement Input, Actual Revenue                  
Business Combination [Line Items]                  
Contingent consideration, measurement input               6,000,000.0 6,000,000.0
Motiva Benelux BV And Motiva NL B.V.                  
Business Combination [Line Items]                  
Business acquisition (as a percent)     100.00%            
Total consideration     $ 7,817,000            
Cash paid   $ 300,000 221,000 $ 800,000 $ 300,000        
Value of equity issued as consideration $ 900,000 $ 2,400,000 1,177,000   $ 2,600,000 $ 1,200,000      
Receivables     2,200,000            
Acquisition-related contingent consideration     1,000,000.0            
Consideration payable     3,262,000            
Acquisition related costs                 $ 300,000
Intangible assets acquired     $ 1,527,000            
Useful life (in years)     10 years            
Financial liabilities     $ 482,000            
Accounts payable     200,000            
Accrued liabilities     200,000            
Loan payable     100,000            
Goodwill     $ 797,000            
Changes in the recognized amounts of goodwill resulting from acquisition               $ 0  
Revenues                 1,800,000
Earnings                 500,000
Contingent equity consideration (see Note 5)               $ 4,474,000 $ 973,000
Motiva Benelux BV And Motiva NL B.V. | Measurement Input, Discount Rate                  
Business Combination [Line Items]                  
Contingent consideration, measurement input     0.125            
Intangible assets, measurement input (as a percent)     0.175            
Motiva Benelux BV And Motiva NL B.V. | Measurement Input, Revenue Attrition Rate                  
Business Combination [Line Items]                  
Intangible assets, measurement input (as a percent)     0.250            
Motiva Benelux BV And Motiva NL B.V. | Forecast                  
Business Combination [Line Items]                  
Total consideration             $ 500,000    
v3.25.4
Business Combinations - Schedule of Purchase Price Allocation (Details) - Motiva Benelux BV And Motiva NL B.V. - USD ($)
$ in Thousands
 1 Months Ended
Jun. 30, 2025
Jan. 13, 2025
Oct. 01, 2024
Apr. 30, 2025
Jan. 31, 2025
Oct. 31, 2024
Business Combination [Line Items]            
Cash paid   $ 300 $ 221 $ 800 $ 300  
Equity issued (26,018 common shares) $ 900 $ 2,400 1,177   $ 2,600 $ 1,200
Contingent consideration payable     973      
Consideration payable     3,262      
Fair value of trade receivable considered settled     2,184      
Total consideration     $ 7,817      
Equity interest issued or issuable (in shares)     26,018      
v3.25.4
Business Combinations - Schedule of Consideration Still Payable (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Business Combination [Line Items]    
Contingent consideration payable $ 4,474 $ 737
Motiva Benelux BV And Motiva NL B.V.    
Business Combination [Line Items]    
Contingent consideration payable 4,474 973
Consideration payable 315 3,262
Total liabilities $ 4,789 $ 4,235
v3.25.4
Business Combinations - Schedule of Fair Values of the Assets Acquired and Liabilities (Details) - USD ($)
$ in Thousands
Dec. 31, 2025
Dec. 31, 2024
Oct. 01, 2024
Business Combination [Line Items]      
Goodwill $ 1,209 $ 1,209  
Motiva Benelux BV And Motiva NL B.V.      
Business Combination [Line Items]      
Financial assets     $ 904
Inventory     4,946
Property, plant, and equipment     125
Intangible assets     1,527
Financial liabilities     (482)
Total identifiable net assets     7,020
Goodwill     $ 797
v3.25.4
Income Taxes - Schedule of Income before Income Tax (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Income (Loss) Before Income Tax [Line Items]      
Costa Rica operations $ (24,542) $ (60,665) $ (13,556)
Non-Costa Rica operations   (23,963) (65,027)
Loss before income taxes (58,022) $ (84,628) $ (78,583)
U.S. operations      
Income (Loss) Before Income Tax [Line Items]      
Non-Costa Rica operations 2,792    
Other foreign operations      
Income (Loss) Before Income Tax [Line Items]      
Non-Costa Rica operations $ (36,272)    
v3.25.4
Income Taxes - Schedule of Income Tax (Benefit) Provision (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Current:      
Costa Rica $ 112 $ 183 $ 297
Other foreign   1,963 3,328
Total current 2,477 2,146 3,625
Deferred:      
Costa Rica 0 0 0
Other foreign   (2,178) (3,706)
Total deferred (9,435) (2,178) (3,706)
Total benefit for income taxes (6,958) $ (32) $ (81)
U.S. operations      
Current:      
Other foreign 270    
Deferred:      
Other foreign (8,790)    
Other foreign operations      
Current:      
Other foreign 2,095    
Deferred:      
Other foreign $ (645)    
v3.25.4
Income Taxes - Schedule of Effective Income Tax Rate Reconciliation (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Amount      
Tax benefit at Costa Rica statutory rate $ (17,406) $ (25,388) $ (23,575)
State and local income taxes, net of federal (national) tax effects 0    
Changes in valuation allowance   (14,157) 438
Other 27 10 162
Foreign tax rate differential   7,166 18,070
Effect of change in tax law or rates (Costa Rica) 0 (446) (7)
Return to provision adjustment   (561) (539)
Tax credits 0 0 0
Costa Rica tax holiday benefit 7,473 18,373 4,386
U.S. stock compensation   227 984
Prior year true-up   14,744 0
Total benefit for income taxes $ (6,958) $ (32) $ (81)
Percent      
Tax benefit at Costa Rica statutory rate 30.00% 30.00% 30.00%
State and local income taxes, net of federal (national) tax effects 0.00%    
Changes in valuation allowance   16.70% (0.60%)
Other 0.00% 0.00% (0.20%)
Foreign tax rate differential   (8.50%) (22.90%)
Effect of change in tax law or rates (Costa Rica) 0.00% 0.50% 0.00%
Return to provision adjustment   0.70% 0.70%
Tax credits 0.00% 0.00% 0.00%
Costa Rica tax holiday benefit (12.90%) (21.70%) (5.60%)
U.S. stock compensation   (0.30%) (1.30%)
Prior year true-up   (17.40%) 0.00%
Total benefit for income taxes 12.00% 0.00% 0.10%
U.S. operations      
Amount      
Changes in valuation allowance $ (9,384)    
Percent      
Changes in valuation allowance 16.20%    
VIRGIN ISLANDS, BRITISH      
Amount      
Foreign tax rate differential $ 12,283    
Percent      
Foreign tax rate differential (21.20%)    
Other foreign operations      
Amount      
Foreign tax rate differential $ 49    
Percent      
Foreign tax rate differential (0.10%)    
Costa Rica      
Amount      
Changes in valuation allowance $ 0    
Percent      
Changes in valuation allowance 0.00%    
v3.25.4
Income Taxes - Narrative (Details) - USD ($)
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Operating Loss Carryforwards [Line Items]      
Changes in valuation allowance   $ 14,157,000 $ (438,000)
Deferred tax benefit $ 9,435,000 2,178,000 3,706,000
Valuation allowance 0 (9,223,000)  
Tax credit carryforwards, research 500,000    
Costa Rica tax holiday benefit 7,473,000 $ 18,373,000 $ 4,386,000
U.S. operations      
Operating Loss Carryforwards [Line Items]      
Changes in valuation allowance 9,384,000    
Operating loss carryforwards 21,400,000    
Intercompany true-up adjustment applied against the valuation allowance 80,000,000    
State and Local Jurisdiction      
Operating Loss Carryforwards [Line Items]      
Operating loss carryforwards 11,100,000    
Argentina      
Operating Loss Carryforwards [Line Items]      
Operating loss carryforwards 1,500,000    
Brazil      
Operating Loss Carryforwards [Line Items]      
Operating loss carryforwards $ 10,600,000    
Subsidiaries      
Operating Loss Carryforwards [Line Items]      
Tax holiday benefit 0.00% 0.00% 0.00%
Tax holiday, length of term (in years) 12 years    
v3.25.4
Income Taxes - Schedule of Income Tax Paid (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Foreign – by jurisdiction ≥5%:      
Total cash paid for income taxes $ 420 $ 1,735 $ 2,165
Costa Rica      
Income Tax Paid, by Individual Jurisdiction [Line Items]      
Federal 93    
U.S. federal      
Foreign – by jurisdiction ≥5%:      
Total Foreign 78    
U.S. state and local      
Foreign – by jurisdiction ≥5%:      
Total Foreign 0    
Spain      
Foreign – by jurisdiction ≥5%:      
Total Foreign 83    
Sweden      
Foreign – by jurisdiction ≥5%:      
Total Foreign 29    
Germany      
Foreign – by jurisdiction ≥5%:      
Total Foreign 57    
France      
Foreign – by jurisdiction ≥5%:      
Total Foreign 55    
Italy      
Foreign – by jurisdiction ≥5%:      
Total Foreign 21    
Belgium      
Foreign – by jurisdiction ≥5%:      
Total Foreign 0    
Other foreign operations      
Foreign – by jurisdiction ≥5%:      
Total Foreign $ 4    
v3.25.4
Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Details) - USD ($)
Dec. 31, 2025
Dec. 31, 2024
Income Tax Disclosure [Abstract]    
Accruals and reserves $ 345,000 $ 563,000
Fixed assets (1,284,000) (1,036,000)
Intangibles 116,000 105,000
Stock compensation 4,613,000 3,763,000
Net operating loss 9,247,000 10,742,000
R&D credits 325,000 325,000
Allowance for credit losses 1,653,000 593,000
Other 97,000 56,000
Valuation allowance 0 (9,223,000)
Total net deferred tax assets (included in “Other non-current assets”) $ 15,112,000 $ 5,888,000
v3.25.4
Net Loss Per Share - Schedule of Basic and Diluted Net Loss Per Share (Details) - USD ($)
$ / shares in Units, $ in Thousands
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Numerator:      
Net loss $ (51,064) $ (84,596) $ (78,502)
Denominator:      
Weighted average outstanding shares used for basic net loss per share (in shares) 29,620,022 28,161,761 25,600,029
Weighted average outstanding shares used for diluted net loss per share (in shares) 29,620,022 28,161,761 25,600,029
Net loss per share:      
Basic (in dollars per share) $ (1.72) $ (3.00) $ (3.07)
Diluted (in dollars per share) $ (1.72) $ (3.00) $ (3.07)
v3.25.4
Net Loss Per Share - Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share (Details) - shares
 12 Months Ended
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Total Potentially dilutive shares outstanding (in shares) 1,760,173 1,709,653 1,683,564
Options to purchase common shares      
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Total Potentially dilutive shares outstanding (in shares) 1,428,878 1,413,948 1,487,387
Shares issuable on vesting of grants of RSUs      
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Total Potentially dilutive shares outstanding (in shares) 331,295 295,705 196,177
v3.25.4
Related Party Transactions (Details) - USD ($)
 12 Months Ended
Aug. 03, 2025
May 14, 2025
Dec. 31, 2025
Dec. 31, 2024
Dec. 31, 2023
Aug. 31, 2022
Dec. 31, 2016
Related Party Transaction [Line Items]              
Accounts payable     $ 43,109,000 $ 44,760,000      
Sales, general and administrative     $ 165,069,000 139,806,000 $ 145,575,000    
Granted (in shares)     327,392        
Annual Consulting Agreement              
Related Party Transaction [Line Items]              
Consulting agreement, term 1 year            
Consulting agreement, amount of transaction $ 750,000            
Annual Consulting Agreement, Equity Award, Target              
Related Party Transaction [Line Items]              
Consulting agreement, amount of transaction $ 750,000            
Immediate Family Member of Management or Principal Owner | Herramientas Medicas, S.A.              
Related Party Transaction [Line Items]              
Revenues     $ 1,200,000 1,100,000 1,200,000    
Accounts payable     400,000 400,000      
Immediate Family Member of Management or Principal Owner | Dr. Chacon Quiros              
Related Party Transaction [Line Items]              
Cash reimbursement per day for services             $ 4,500
Cash reimbursement per hour of services           $ 531  
Sales, general and administrative     $ 100,000 $ 200,000 $ 400,000    
Related Party | Nicholas Lewin, BoD              
Related Party Transaction [Line Items]              
Granted (in shares)   36,027          
Grant date fair value, options   $ 900,000          
v3.25.4
Employee Benefits (Details)
 12 Months Ended
Dec. 31, 2025
employee
Brazil  
Deferred Compensation Arrangement with Individual, Postretirement Benefits [Line Items]  
Number of employees represented by a labor union 46
Argentina  
Deferred Compensation Arrangement with Individual, Postretirement Benefits [Line Items]  
Number of employees represented by a labor union 8
v3.25.4
Subsequent Events (Details) - Subsequent Event - Senior Vice President And Chief Financial Officer
$ in Thousands
Feb. 24, 2026
USD ($)
installment
Subsequent Event [Line Items]  
Annual base salary $ 550
Target annual bonus (in percent) 50.00%
Cash awards $ 700
Number of payable installments for cash awards | installment 2