SMEs in the life sciences industries face a fundamental challenge. On the one hand, high product development costs push companies into early internationalization to increase turnover and recover investments. On the other hand, they face tough hinders towards internationalization, such as financial and managerial resource limitations as well as the demand to follow local regulations. To date, little is known about how SMEs manage this challenge in practice. This paper presents an in-depth case study of the internationalization process of a Swedish SME from the medical technology industry, to develop a better understanding of how this challenge is handled in practice. Our findings outline some industry-specific characteristics affecting the internationalization process, such as the regulatory burden, complex buying patterns and lengthy lead times. These determinants lead to financial vulnerability, which has an impact on how (further) internationalization can be pursued. Being able to conduct business in English as well as the structure of the foreign country’s healthcare organization are important factors when entering new geographical markets. International congresses and fairs are important events for developing new network links and building brand recognition. Existing international contacts also play a crucial role in the choice of the international distribution channels. Local network ties are important for developing the initial business idea development as well as to secure financing.