Qwo Cellulite Treatment: What You Need to Know

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.

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.

• Average Cost:
• $2,700

• Range:
• $1,599 - $4,000

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.

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.

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.

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.

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.”