November 19, 2019

Juan Jos  Chac n Quir s
Chief Executive Officer
Establishment Labs Holdings Inc.
Building B15 and 25
Coyol Free Zone
Alajuela
Costa Rica

       Re: Establishment Labs Holdings Inc.
           Registration Statement on Form S-3
           Filed November 12, 2019
           File No. 333-234649

Dear Mr. Quir s:

       This is to advise you that we have not reviewed and will not review your
registration
statement.

        Please refer to Rules 460 and 461 regarding requests for acceleration.
We remind you
that the company and its management are responsible for the accuracy and
adequacy of their
disclosures, notwithstanding any review, comments, action or absence of action
by the staff.

       Please contact Ada D. Sarmento at 202-551-3798 with any questions.



                                                            Sincerely,

                                                            Division of
Corporation Finance
                                                            Office of Life
Sciences
cc:    Elton Satusky, Esq.