Standing Appointment is our review series that investigates the best new and notable cosmetic procedures in the aesthetics space and determines whether or not they are worth trying for yourself.
You can love your butt and you cannot lie, but if you’re like the roughly 90% of women on Earth, then that butt has probably accumulated a little or a lot of cellulite. Whatever your size, height, workout routine or geographical origin, cellulite waits for no one, and it has more to do with your genetics than anything else (thanks, mom and dad!). More importantly — it is nothing to be ashamed about, especially since the majority of people walking around on this planet have it. However, you are also not at fault if you’re interested in any or all options that can lessen the appearance of those stubborn dimples. I certainly am.
Cellulite can range from subtle dents to a dimply cottage cheese texture, depending on your hormone levels and cell structure, and usually affects the thighs, butt, and stomach. Over time, the collagen bands (known as fibrous septae) that connect the skin to underlying tissue can strengthen and drag the skin downwards while pushing fat up toward the skin — thus creating the depressions, known as dimples. It is the tension of these fibers that causes the protrusions of fat, *not* the fat itself, which is why cellulite cannot be eliminated through diet and exercise alone (and why the number you see on the scale is not an indicator of whether or not you’ll experience cellulite in the first place). Basically, this all means that getting rid of cellulite, even temporarily, is frustratingly tricky.
There's an overwhelming amount of lotions, creams, ointments, serums, and vacuum-sucking devices on the market today that claim they can make cellulite vanish quickly. But, because cellulite occurs on a deeper level within the skin, these treatments usually fall flat. That's where QWO, a buzzy new cellulite treatment, comes into the spotlight — and has remained there since being FDA-approved in July 2020. Obviously, I was intrigued, and decided to try it out for myself.
What Is QWO?
QWO, otherwise known as Collagenase clostridium histolyticum-aaes, is the first FDA-approved injectable treatment that has been found to reduce the appearance of cellulite dimpling. Endo Aesthetics developed the treatment, which involves a series of injections administered every 21 days, for a total of three visits to your dermatologist or plastic surgeon.
You may be thinking: Did they just say injectable? Yes — that’s right. Unlike more invasive cellulite procedures, QWO requires a few simple in-office injections that hurt less than a tattoo, and a little more than a regular finger prick.
To really put the injectable (which already has a lengthy waiting list) to the test, I visited board certified dermatologist Dr. Bruce Katz at the Manhattan-based JUVA Skin and Laser Center a few weeks ago.
How Does QWO Work?
When I walked into the office, I was met with smiles and excitement from the staff. I changed into a dressing gown and stood in an illustrated box within the borders of the tile floor. Dr. Katz and his nurse moved me into various poses, all with my derriere on display, as they took photos of my forever-there cellulite. Then, I carefully laid on the exam room table as they sterilized needles and cleaned off the circled areas. Dr. Katz injected a small amount of QWO (via a needle and a small vial) into each dimple, which felt like a small — but quick — pinch. Before I knew it, the treatment was over.
“The injections work to dissolve the buildup of collagen in the fibrous bands,” Dr. Katz says, “which are bands under the skin that thicken and cause tension and the ‘dimpled’ look of cellulite.” He went on to explain that QWO works by merging two collagen-targeting enzymes that occur naturally in the body. When inserted under the skin, these enzymes break down the accumulation of collagen in the fibrous bands that lead to cellulite formation — something that has never been accomplished before with either an in-office or over-the-counter treatment.
Per the FDA, QWO has been determined as a safe and powerful treatment for cellulite dimpling via the biggest clinical trials in the history of cellulite examination in the U.S. The most common side effects are mild bruising at the injection site, swelling, tenderness, and itching. However, I was able to treat all my symptoms with Tylenol.
As an injectable, it carries far fewer hazards and shorter recovery time than the other two cellulite procedures currently on the market, Cellulaze and Cellfina. Cellulaze is a laser treatment that maneuvers the laser under your skin to melt the fat present with heat, delivered by multiple tiny incisions about the size of a ballpoint pen. Cellfina targets the fibrous bands with a micro-blade technique, but requires lengthy downtime. Comparatively, the ease and lack of discomfort of QWO is an obvious plus, but with all three treatments, the appearance of cellulite (courtesy of the bands regrowing or fat resettling into that area) will ultimately return. How quickly that happens is the most important question (aside from things like cost, recovery time, etc).
How Many Treatments Does It Take To See Results?
Dr. Katz explains that, “QWO requires three sessions and patients see results quickly — in as little as three to six weeks.” When I went home after the first round of injections, I noticed my bottom bruising pretty rapidly. Bruising and tenderness is a pretty standard side effect of dermal fillers, so this wasn’t necessarily a surprise. Small lumps appeared on my skin and over the course of the next week, dark bruises began to emerge that were a bit tender to the touch but didn’t require compression, laying down, or changing my day-to-day schedule.
The following day, I couldn't sit down correctly on hard surfaces. Although this sounds brutal, the pain subsided quickly compared to other treatments, like Botox and filler, with which the skin can feel sensitive for a few days after the injections. Within the first week, I noticed the bruising getting darker, but by the end of the third week they faded with the lumps.
After only two weeks, I stood naked in the mirror, squealing for my boyfriend to come look at how even my butt skin appeared for the fifth time that day. I stared proudly at my new, smoother behind throughout the day. As the third week post-injection approached, I noticed the dimples lessening more and more. I didn't think it was possible, because although I had learned to accept my cellulite, I still didn't particularly enjoy its persistent appearance. For having only received the first of three rounds of treatments, it was safe to say that the initial results are impressive.
How Long Does The QWO Treatment Last?
For many cellulite treatments, even surgical options, the results fade after just a few months as the septae fibers grow back (and they will always grow back) — which can be extremely discouraging when you consider the price tag on in-office invasive procedures. I asked Dr. Katz this very question. “I was part of the clinical trials for QWO, and so far patients have seen results lasting two and a half years [after completing all three rounds of injections],” he says. “While we are in the process of testing it for five years, it seems as though results are long-lasting, though we can’t say for sure without the scientific data after the new trials.”
How Much Does QWO Cost?
Like most in-office skin care treatments, these injectable sessions can add up quickly. Each QWO session ranges from $695 to $1000, depending on the number of areas the patient would like to treat, as well as where you live (providers in populous cities tend to be on the pricier side). On the plus side, since QWO treatments are spread out across three sessions, you won’t owe such a large sum up front — at least compared to some other cosmetic procedures for which payment is due that same day.
Like anything involving needles and your skin, it’s wise to save up your money and visit a board-certified provider with plenty of experience.
Who’s The Ideal Candidate For This Treatment?
The ideal candidate for QWO is an adult woman with moderate to severe cellulite which includes dimpling on the buttocks. So far, it works for all skin types and tones — even on me, a dark-skinned woman! Your candidacy will be thoroughly evaluated during your private consultation, and although the injectable is only FDA-approved for the buttocks, most providers will be comfortable utilizing it on the thigh area as well (similar to how Botox is used in areas other than the FDA-approved “11s” between the eyebrows).
How I’m Feeling Now
I’m due for my second round of QWO injections soon, but I've already shown everyone my butt on Facetime because of how amazing the transformation has been. Even on the first round, the little dimples I've had since age 13 have lessened, and some have even vanished. I’m looking forward to my cellulite next treatment, and will continue to love myself regardless — and long after it reappears.