Establishment Labs has climbed 10% in a week and 22% in a month — and its founder has been selling into every uptick.
The most striking story this week is the insider tape. Juan José Chacón Quirós, the company's founder, director, and top-five shareholder, sold roughly $5.3 million worth of stock across multiple transactions between April 23 and May 4. The sales spanned nine separate trades, all executed as the stock pushed higher from the mid-$60s toward $71. His declared holding has dropped by roughly 70,000 shares over the period, and his 90-day net sale total has reached nearly $15 million. Chacón Quirós still holds approximately 3.9% of the company, but the pattern of consistent selling into price strength is hard to ignore.
The options market reinforces that caution. The put/call ratio has surged to 1.98 — almost at its 52-week high of 1.99, and more than two standard deviations above the 20-day average of 1.13. That is an unusually defensive posture for any stock, and the jump in PCR happened abruptly at the start of May, after spending most of April in the 0.88–1.06 range. Options traders moved sharply toward downside protection in tandem with the stock's latest leg higher.
The short side tells a more complicated story. Short interest has held broadly steady this month at roughly 15.7% of the float — a meaningful level, but one that has barely moved over the past week (+0.4%). The more notable shift was earlier: shorts climbed from around 4.2 million shares in early April to 5.2 million during mid-April, then dropped sharply around April 23 before stabilising near current levels. That mid-April build and partial unwind suggests short sellers reacted to newsflow rather than establishing a persistent directional view. Cost to borrow is low at under 1%, and borrow availability is ample, meaning there is no mechanical squeeze pressure in the lending pool to explain the price strength. The ORTEX short score, at 72.7, ranks in the 4th percentile for its sector — a high reading that reflects the elevated float short and moderate availability, not a runaway squeeze setup.
Analysts are broadly constructive, though the most recent activity was mixed. BTIG reiterated its Buy with an $88 target as recently as April 29, putting implied upside at around 24% from current levels. Earlier in the year, Mizuho raised its target to $100 and Canaccord and Stephens both pushed targets to $90 following what was likely the Q4 print. The outlier is Citigroup, which in March cut its target from $81 to $74 while holding a Neutral rating — the only firm visibly pulling back. The consensus leans bullish, but with the stock having rallied 22% in a month, bulls are increasingly relying on earnings execution to justify current levels. The EV/EBITDA multiple, at 85x, has compressed about 10 turns over the past 30 days as EBITDA estimates improved — but at that level, the stock prices in a significant growth trajectory for a company still running a net loss and $201 million in net debt.
The next catalyst is close. Establishment Labs is scheduled to report Q1 2026 results on May 22. Factor scores offer a cautionary note heading in: EPS momentum ranks in just the 4th percentile over 30 days and the 8th over 90 days, and EPS surprise history ranks in the 24th percentile — not a setup that suggests the company has habitually beaten estimates. Peers have had a mixed week: ISRG fell 3.3% while STE dropped 3.1%, making ESTA's 10% gain notably divergent from the broader medical device group.
The key watch into May 22 is whether the revenue trajectory justifies a stock running at 85x EBITDA — and whether the founder, who has sold consistently at prices below today's close, keeps selling.
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