Q: What were the pros and cons of Qwo?

Pros Qwo was the first injectable treatment for cellulite. Previously, “only surgical and more invasive options could address the structural cause of cellulite under the skin,” says Dr. Mraz Robinson. The injections, done with a 30-gauge needle (similar to what’s used for Botox or filler), were quick and relatively painless, requiring no anesthesia or aftercare. Qwo could be used in all skin types and tones. The double-blind, placebo-controlled clinical trials included 845 participants, 30% of whom had Fitzpatrick skin types IV–VI , ranging from light brown to very dark brown. When Qwo worked successfully, improvements were long-lasting. There was no downtime with Qwo—no need to limit activities or wear compression garments following injections. Cons Extreme, persistent bruising, lasting two weeks or more, was routinely seen following Qwo injections. Some patients “developed hemosiderin staining of their tissues from the prolonged bruising,” notes Dr. Gordon . A number of RealSelf members mention this lasting skin discoloration—which can be impossible to correct—in their Qwo reviews . Other common side effects included pain, areas of hardness, itching, and a worsening of skin laxity in and around the treatment area. Qwo worked only on true, tight cellulite dimples, not textural irregularities like lax, sagging, or wavy skin on the buttocks or thighs. Multiple treatments were needed for optimal outcomes.

Question 1

What was Qwo cellulite treatment?

Accepted Answer

Qwo was a novel injectable FDA approved to treat moderate to severe cellulite in the buttocks, “the most common area for cellulite,” says Dr. Joely Kaufman, a dermatologist in Coral Gables, Florida, who was a clinical investigator on the trials for Qwo (formerly known as collagenase clostridium histolyticum-aaes, or CCH).

Qwo was commonly used off-label to treat cellulite on thighs, too.

The cellulite treatment used natural enzymes to address the root cause of cellulite: the septae, or fibrous bands that tether skin to muscle and tug skin down, forming divots.

“There are three things that cause cellulite’s signature dimples,” explains Dr. Deanne Mraz Robinson, a board-certified dermatologist in Westport, Connecticut, and clinical investigator for Qwo. “Over time, the skin thins, fat cells enlarge and push against the skin, and the fibrous bands under the skin surface thicken and cause tension.” Releasing these bands smooths out the dimples.

The unique characteristics of cellulite make the condition notoriously difficult to correct. Topicals promising to treat cellulite typically disappoint. Though certain cellulite creams can temporarily smooth the skin a bit by either plumping or dehydrating the tissues, any effects are very short-lived.

Liposuction, while effective at reducing fat, does not address the septae—and can actually worsen the look of cellulite.

Qwo aimed to target the connective tissue matrix responsible for creating dimples.

Related: The 4 Best Cellulite Treatments, According to Doctors and Patients

Question 2

Why was Qwo taken off the market?

Accepted Answer

In December 2022, Endo Aesthetics, the manufacturer of Qwo, announced that it was ceasing production and sale of the injectable “in light of market concerns about the extent and variability of bruising following initial treatment as well as the potential for prolonged skin discoloration.”

According to a company press release, Endo had funded a study to investigate various strategies that might mitigate the bruising, but “none achieved a consistent level of reduced bruising following initial treatment to adequately alleviate the market's concerns.”

Dr. Ashley Gordon, a plastic surgeon in Austin, Texas, previously told RealSelf that bruising was inevitable with Qwo, because it was part of the drug’s mechanism of action. “When Qwo starts dissolving the fibrous septae, the veins in the area get leaky, and this causes internal bruising.” It was most significant after the first treatment and couldn’t really be avoided.

To be clear, Qwo wasn’t pulled from the market because it was ineffective: it did work to alleviate cellulite dimples. The bruising and lingering discoloration was simply intolerable to providers and patients, as reflected in its low RealSelf Worth It Rating.

While Qwo is no longer being produced, it “remains an FDA-approved product with clinically proven results and an established safety profile,” notes the company.

Question 3

What were the pros and cons of Qwo?

Accepted Answer

Pros

Qwo was the first injectable treatment for cellulite. Previously, “only surgical and more invasive options could address the structural cause of cellulite under the skin,” says Dr. Mraz Robinson.
The injections, done with a 30-gauge needle (similar to what’s used for Botox or filler), were quick and relatively painless, requiring no anesthesia or aftercare.
Qwo could be used in all skin types and tones. The double-blind, placebo-controlled clinical trials included 845 participants, 30% of whom had Fitzpatrick skin types IV–VI, ranging from light brown to very dark brown.
When Qwo worked successfully, improvements were long-lasting.
There was no downtime with Qwo—no need to limit activities or wear compression garments following injections.

Cons

Extreme, persistent bruising, lasting two weeks or more, was routinely seen following Qwo injections.
Some patients “developed hemosiderin staining of their tissues from the prolonged bruising,” notes Dr. Gordon. A number of RealSelf members mention this lasting skin discoloration—which can be impossible to correct—in their Qwo reviews.
Other common side effects included pain, areas of hardness, itching, and a worsening of skin laxity in and around the treatment area.
Qwo worked only on true, tight cellulite dimples, not textural irregularities like lax, sagging, or wavy skin on the buttocks or thighs.
Multiple treatments were needed for optimal outcomes.

Question 4

How much did Qwo cost?

Accepted Answer

The price of Qwo depended on the provider’s level of experience, their practice location, and the extent of your treatment.

This was an elective cosmetic treatment, so insurance plans didn’t cover it.

Question 5

How did Qwo cellulite injections work?

Accepted Answer

Qwo used two types of collagen-degrading enzymes to perform a sort of chemical subcision, severing the septae bands that cause cellulite dimples. This injectable treatment “enzymatically target[ed] the collagen in the fibrous septae and release[d] those bands, which allow[ed] the skin to smooth out and improve[d] the appearance of cellulite,” explains Dr. Mraz Robinson.

These enzymes worked similarly to other cellulite treatment options that sever septae: Cellfina uses a needle to sever the bands, Cellulaze uses a laser, and Avéli uses a probe outfitted with a tiny hook and blade.

In the Qwo clinical trial funded by the manufacturer, the drug was also shown to increase collagen production, thickening skin over time, and to aid in the redistribution of fat cells.

Question 6

How soon could you see results?

Accepted Answer

While some patients saw results a few weeks after their first treatment, in most cases, three treatments, spaced three weeks apart, were needed.

Intense bruising in the treatment area typically obscured early improvements.

Question 7

Were Qwo results permanent?

Accepted Answer

The effects of Qwo were not permanent. Data presented at the 2020 American Society for Dermatologic Surgery meeting showed Qwo results lasting up to four years, following a series of treatments to subjects’ buttocks and thighs.

Question 8

Was Qwo safe? What were the side effects?

Accepted Answer

Qwo’s FDA approval was “backed by excellent clinical work,” says Dr. Mraz Robinson, so it was considered safe and effective.

Prior to being studied for cellulite, CCH was long used in the treatment and management of connective tissue disorders, like Peyronie's disease and Dupuytren's contracture, Dr. Kaufman tells us.

As we’ve mentioned, Qwo’s most significant side effect was bruising and subsequent skin discoloration. The more dimples one had injected, the more bruising one could expect to see. “If we were treating cellulite all over the butt, the bruise would cover the entire buttocks,” says Dr. Kaufman.

Some RealSelf members also complained about painful lumps and contour irregularities after Qwo injections. Regarding the latter, Dr. Gordon reminds us that “Qwo is a liquid, so upon injection, it could diffuse and dissolve collagen in areas not intended. And by further degrading collagen, Qwo could make skin laxity worse,” she says.

Another serious side effect noted on the Qwo website was allergic reactions, including anaphylaxis. Thankfully, allergic reactions to CCH were said to be extremely rare. According to a 2016 review of CCH (unrelated to Qwo), “One anaphylactic reaction was reported in a post-marketing clinical study of CCH for Dupuytren’s contracture.”

Question 9

Are there alternatives to Qwo?

Accepted Answer

Compare Qwo to other top cellulite treatment options.

Avéli

A newcomer to the cellulite realm, Avéli is a minimally invasive treatment. A stainless probe outfitted with a light, a hook, and a blade glides under the skin to cut and release the septae, the connective-tissue bands underlying divots.

“Each depression has a complex septae structure,” says Chicago plastic surgeon Dr. Laurie Casas. “Avéli helps me identify all the septae within a depression, then allows me to cut each one and verify that I’ve released all of them.” With Qwo, she says, the process was more blind: “I [was] basically trying and hoping to chemically destroy the septae.”

Dr. Gordon also finds Avéli to be a more precise treatment that produces less bruising. “Avéli can cause some bruising due to the injection of local anesthetic and the manipulation of the tissues, but it’s not as severe and does not last as long [as that seen with Qwo].”

Emtone

From the makers of Emsculpt, noninvasive Emtone is an FDA-cleared treatment that uses a combination of thermal and mechanical energy to improve the appearance of cellulite over a series of no-downtime treatments. The heat generated by radiofrequency energy ramps up collagen production to gradually thicken the skin, while acoustic waves increase circulation and force excess fluid from tissues to give skin a smoother look. Since it’s not dimple-specific, EmTone can help with general skin laxity too. It can treat cellulite anywhere on the body.

Sculptra Aesthetic

Made of collagen-stimulating poly-L-lactic acid (PLLA), Sculptra is an injectable that’s used to restore volume in the face and body. It can be injected into cellulite dimples to essentially fill in the shallows over time, as new collagen gradually thickens the skin to level things out.

Most patients need two or three treatments and tend to see best results three to six months following the final session.

Since Sculptra restores volume by building your own collagen, results can last for about two years. It’s important to note, however, that Sculptra does not directly address the septae that are responsible for dimples. For this reason, doctors often pair it with other modalities to more comprehensively treat cellulite.

BodyFx

Combining radiofrequency heat and vacuum suction, BodyFx melts fat and provides a mild skin tightening effect. In clinical trials, the average patient saw a 68% reduction in the appearance of cellulite.

That said, in a RealSelf Q&A, Las Vegas dermatologist Dr. F. Victor Rueckl says that the “BodyFx treats fat and deep fat very well, and it treats this fat permanently. But it is not a skin smoothing device.”

Again, doctors may find it most effective to combine this device with another treatment, depending on the unique characteristics of your cellulite. Since cellulite dimples have multiple causes, a singular treatment will rarely deliver remarkable results.

QWO

Jolene Edgar

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	Qwo nonsurgical	Aveli surgical	Emtone nonsurgical	Sculptra nonsurgical	BodyFX nonsurgical
Worth It Rating	39%	86%	59%	82%	100%
Average Cost	$2731	$5541	$2836	$1905	$1361
Downtime	No downtime	Little to no downtime	No downtime	Minimal downtime	No downtime
Anesthesia	No anesthesia	Local anesthesia	No anesthesia	Topical anesthesia	No anesthesia

Jolene Edgar

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