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ANNUAL REPORT PURSUANT TO SECTION 13 OR 15 ( d ) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31 , 2020 or TRANSITION REPORT PURSUANT TO SECTION 13 OR 15 ( d ) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from to UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington , D.C. 20549 FORM 10 - K British Virgin Islands State or Other Jurisdiction of Incorporation or Organization Building B15 and 25 Coyol Free Zone Alajuela Costa Rica Address of Principal Executive Offices Commission File Number : 001-38593 Establishment Labs Holdings Inc. ( Exact name of Registrant as specified in its charter ) Title of Each Class Common Shares , No Par Value Large accelerated filer Non - accelerated filer ■ X +506 2434 2400 Registrant's Telephone Number , Including Area Code Not applicable Former Name , Former Address and Former Fiscal Year , if Changed Since Last Report Securities registered pursuant to Section 12 ( b ) of the Act : Not applicable I.R.S. Employer Identification No. Not applicable Zip Code None . Yes No > Indicate by check mark if the registrant is a well - known seasoned issuer , as defined in Rule 405 of the Securities Act . Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or 15 ( d ) of the Act . Yes No X Indicate by check mark whether the registrant ( 1 ) has filed all reports required to be filed by Section 13 or 15 ( d ) of the Securities Exchange Act of 1934 during the preceding 12 months ( or for such shorter period that the registrant was required to file such reports ) and ( 2 ) has been subject to such filing requirements for the past 90 days . Yes No Securities registered pursuant to Section 12 ( g ) of the Act : Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S - T ( § 232.405 of this chapter ) during the preceding 12 months ( or for such shorter period that the registrant was required to submit such files ) . Yes No Name of Each Exchange on Which Registered The NASDAQ Capital Market Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S - K ( 229.405 of this chapter ) is not contained herein , and will not be contained , to the best of registrant's knowledge , in definitive proxy or information statements incorporated by reference in Part III of this Form 10 - K or any amendment to this Form 10 - K . Indicate by check mark whether the registrant is a large accelerated filer , an accelerated filer , a non - accelerated filer , a smaller reporting company , or an emerging growth company . See the definitions of " large accelerated filer , " " accelerated filer " , " smaller reporting company " , and " emerging growth company " in Rule 12b - 2 of the Exchange Act . ( Check one ) Securities registered pursuant to Section 12 ( b ) of the Act : Title of each class Common Shares , No Par Value Accelerated filer Smaller reporting company Emerging growth company || Trading symbol ESTA If an emerging growth company , indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13 ( a ) of the Exchange Act . Name of each exchange on which registered The NASDAQ Capital Market