Everything to Know About Qwo, the First FDA-Approved Injectable for Cellulite

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Ninety percent of women have cellulite. It’s 100 percent normal — and completely natural. It is nothing more than an interaction between two body parts (fat meeting connective tissue, like collagen, under the skin). But as part of that 90 percent, I realize how cellulite brings with it mixed emotions, from ambivalence to embarrassment. 

In the past, there’s been a feeling of helplessness. For those who want to get rid of their cellulite, a lot of the options have been unappealing, delivering unimpressive results via invasive procedures that break connective tissue using scalpels or heat from lasers. And topical creams merely minimize the appearance of dimples, not to mention the results are fleeting. So it’s a big deal that the FDA has approved the first injectable for cellulite, called Qwo. “It’s an exciting, less invasive treatment option for women with good skin firmness, meaning not loose skin, who are also bothered by dimpling from cellulite,” says Shari Marchbein, M.D., a clinical assistant professor of dermatology at NYU School of Medicine. 

How Qwo Works

But these injections are not always a quick fix. While some patients notice improvement after one or two appointments, it usually takes three treatments over the course of three months to see full results. Most patients receive 12 shots (one vial) in a session (taking 10 minutes or less) and each injection is said to feel similar to a Botox pinch. The material that’s being injected is collagenases, an enzyme known to break peptide bonds in collagen. Inject it into cellulite and it is believed to go to work dissolving the collagen bands (via a chemical process called Enzymatic Subcision and Remodeling) that fat was protruding through.

If there are no bands of collagen for the fat to press through then there is nothing to cause dimpling. “It is a permanent fix for the treated area,” says David Shafer, M.D., a plastic surgeon in New York City, noting that it is different from invasive procedures where there is a possibility the bands can reconnect, causing a recurrence of cellulite. (Dr. Shafer has previously served as a medical consultant for Qwo, but is not currently on contract with the company.) In clinical trials on Qwo, there was a two-level improvement of cellulite on the Photonumeric Cellulite Severity Scale (yes, this is something that exists) — basically, moderate and severe cellulite was drastically improved, but not one hundred percent erased. (Qwo is FDA approved for use in the butt, but some dermatologists and plastic surgeons are also using it off-label on the thighs with similar results.)

There is one likely side effect, but it’s temporary. “Every single patient will get bruises,” says Dr. Shafer. “Blood vessels around the area get a little leaky, causing internal bruising. It’s nothing dangerous, but it can look dramatic for around two weeks.” 

Even so, the long-term results seem to outweigh the temporary bruising. Besides smoothing things over, for many, Qwo is injecting a boost of confidence. 

A version of this story originally appeared in the November 2021 issue of Allure. Learn how to subscribe here.

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