Small islands in the central Mediterranean region are mostly considered sun, sea, and sand destinations, but many also have untapped ecotourism potential. To explore this, ecotour itineraries were designed with local ecotourism operators and community businesses on a group of islands. Ecotourists were then asked to participate in pre-and post-tour surveys to test the tours and provide key information on the package. Their motivations and expectations, their experiences, and levels of satisfaction with the itineraries developed were examined. Focus groups were held with return ecotourists or those who purchased more than one ecotour to further examine these elements, and to explore their reasons for loyalty. This research demonstrates that developing ecotours using a bottom-up approach, which embraces the specific natural attributes of the islands, can lead to high levels of satisfaction. This approach generated loyalty to the island destinations and to ecotourism in the region. Furthermore, co-creation together with ecotourists provided key information to small operators on how to increase satisfaction and identified improvements that need to be made, such as in the field of interpretation, group size, programme planning, and in terms of sustainability of sites and activities outside of the scope of the ecotours that have an impact on the experience.