For years, we’ve been hearing whispers of a mythical-sounding shot for cellulite—those frustrating dimples blazoning the backsides of women of all ages, sizes, and ethnicities. And now, after almost a decade in clinical trials, Qwo (formerly known as CCH, or collagenase clostridium histolyticum-aaes, from Endo Aesthetics) has officially won FDA approval for the treatment of moderate to severe cellulite in the buttocks of adult women.
How Qwo works
The first FDA-sanctioned injectable treatment for cellulite, Qwo (pronounced kwhoa) contains two types of collagen-degrading enzymes that eat away at the fibrous bands (or fibrous septae) connecting skin to muscle, gradually dissolving the tethers and allowing skin to float up and smooth out. (Septae are regarded as the root cause of cellulite, since they tug the skin down, causing surrounding fat to visibly bulge under the surface.) The full minimally invasive treatment consists of three rounds of injections, spaced 21 days apart.
“This is the single biggest study that’s ever been done on cellulite,” says board-certified Miami dermatologist Dr. Joely Kaufman. (She served as a clinical investigator on the double-blind, placebo-controlled trials, which included 845 participants, 30% of whom were Fitzpatrick skin types IV–VI, ranging from light brown to very dark brown). For the drug to earn approval, study subjects and evaluators had to independently report a two-point improvement in cellulite severity.
These clinical grading scales can be painfully esoteric, but as Dr. Kaufman clearly explains: “A two-point improvement is like going from a lot of cellulite—a very bad-looking backside—to a very, very smooth one.”
“It’s a huge endpoint,” she adds—“unattainable by anything I’ve ever seen before [in this realm].” These impressive clinical improvements followed subjects’ third and final treatment—up to 12 injections were given during each round, across the right and left butt cheeks—though Dr. Kaufman says folks with mild dimpling may see improvements sooner or in fewer sessions.
In the studies, the best results tended to be quite durable, she points out, with effects lasting for a year or more. Proper patient selection is key for optimal outcomes, however. Ideal candidates for the new treatment have distinct “tight” cellulite divots, directly caused by fibrous bands of connective tissue. “A lot of women see skin laxity in the area of the buttocks or thighs and read that as cellulite—but that’s not really what cellulite is, and this drug is not designed to treat laxity or sagging,” notes Dr. Deanne Mraz Robinson, a board-certified dermatologist in Westport, Connecticut, who was also involved with the trials.
Qwo recovery
The shot experience is akin to that of other injectables, like Botox or fillers, and requires no anesthesia. “It’s quick, relatively painless—and 30 minutes after, patients can walk out of the office and continue with their day,” Dr. Kaufman says.
Qwo side effects
The main side effect is bruising around the injection sites, which can be extreme and tender and typically lasts two weeks or longer. (The more dimples injected, the more widespread the discoloration.) “In my experience, the bruising decreases with each subsequent treatment,” says Dr. Mraz Robinson. While study participants were not advised to limit their activity post-shot, she suggests “listening to your body if you’re sore and taking it easy for a day or two, since vigorous exercise will bring more blood to the treatment area and increase localized bruising.” It’s also important to avoid exposing treated areas to the sun during the healing phase.
“This injectable is backed by excellent clinical work,” says Dr. Mraz Robinson. “Up until now, there have been only surgical and invasive options to get at those bands under the skin—and they come with downtime, aftercare, and side effects.”
Two notable FDA-cleared cellulite treatment options, Cellfina and Cellulaze, also target the septae, to reduce the appearance of cellulite, but by different means: the former severs the bands mechanically, with a small blade; the latter, thermally, with laser energy. RealSelf reviews of both devices are laced with disappointment—a fact that comes as no surprise to the doctors we interviewed.
“Patients are jaded,” notes Dr. Mraz Robinson. “They’ve been sold a lot of things [for treatment of cellulite] that just don’t work, so there are a lot of skeptics out there. But we have to remember, Qwo is a drug, and drug trials are much more rigorous than device trials. We now have a wealth of data on this injectable, with more long-term studies forthcoming. It really is a game-changer.”
Qwo cost
While Endo has not yet set a price for Qwo, the injectable is expected to arrive in doctors’ offices in spring 2021. Stay tuned to RealSelf for updated pricing info from providers and consumers as the treatment gets rolled out to patients early next year.
