Body
How Can I Get Rid of Cellulite? Let's Talk About Qwo!
Current update: On December 6, 2022, Endo announced that it would cease Qwo production and sales, citing concerns about variable bruising and prolonged skin discoloration. This was a manufacturer decision, not an FDA ban. The recording's launch plans, wait list and pricing predictions are historical. Read Endo's announcement .
In this episode.
Episode summary
Current update: On December 6, 2022, Endo announced that it would cease Qwo production and sales, citing concerns about variable bruising and prolonged skin discoloration. This was a manufacturer decision, not an FDA ban. The recording's launch plans, wait list and pricing predictions are historical. Read Endo's announcement.
What causes cellulite, and why do treatments differ? Darren M. Smith, MD, a board-certified plastic surgeon in New York City, explains how fibrous bands tether skin and contribute to dimpling. This episode explores Qwo at the time of its introduction and distinguishes discrete dimples from broader wavy skin texture.
Originally published July 23, 2020. This is an archival discussion of a then-new treatment, with current context added above.
Key takeaways from the recording
🧬 Cellulite anatomy
Cellulite involves the relationship between skin, fibrous bands and underlying fat; simply removing fat does not address every contributing feature.
💉 Historical Qwo treatment
Qwo was an injectable collagenase treatment intended to affect the fibrous bands involved in dimpling. Its approved indication was moderate to severe buttock cellulite in adult women.
📚 Evidence in 2020
Dr. Smith reviews the early evidence and uncertainty available in 2020, rather than reporting long-term experience with the product.
🧩 Treatment approaches
He compares approaches that release individual bands with treatments aimed at skin laxity and broader contour irregularities.
⚖️ Weight and skin changes
Weight changes do not predictably improve cellulite; loss of volume can also make skin laxity more apparent.
Questions this episode answers
Is this episode an invitation to book Qwo?
No. The wait-list invitation in the original audio predates Endo's decision to stop production and sales. A current consultation can address available options and whether treatment fits your particular concern.
Will losing weight get rid of cellulite?
The episode explains that the response varies. Less fatty volume may reduce prominence in some people, while accompanying skin laxity can make irregularities more visible in others.
ℹ️ Current related information
For today's practice information, see Avéli cellulite treatment and BodyTite skin tightening, or schedule a consultation. These links provide current context; Avéli is not part of the original recording.
Educational information, not individualized medical advice. No cellulite treatment guarantees complete removal or identical results. Show notes updated September 30, 2026.
Original show notes
Board Certified NYC plastic surgeon Darren Smith introduces Qwo, a potential breakthrough in the quest to defeat cellulite and discusses frequently asked questions about cellulite and existing treatments.
Read the conversation.
[00:08] I'm board certified New York City plastic surgeon, Dr. Darren Smith, and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures, news about trends in aesthetic medicine, and candid sessions with industry insiders. We hope you enjoy today's episode. What is QO? That's Q-W-O. The short answer is that it is a brand new first of its kind injectable treatment for cellulite? The longer answer, which will explain why this is such a big deal, requires us to discuss exactly what cellulite is and what causes it. So on the most basic level, cellulite is that rough, uneven, dimpled or wavy appearance of affected areas of the skin.
[00:59] Cellulite is often described as having a mattress-like appearance because mattresses tend to have dimples where the outer surface is anchored to the deeper surfaces of the mattress. In the case of cellulite, those dimples are caused by structures called fibrous septae. that are anchoring the skin to deeper tissues in the body like fascia and muscle. And the appearance of cellulite is exaggerated by fat globules getting trapped between these fibrocepti and making the surface of the skin look even more dimpled, wavy, and uneven. And since cellulite is reported to occur in over 90% of women across cultures around the world, the question, how can cellulite be treated? How can we get rid of cellulite is one that is very frequently asked. And when there's a new answer, it tends to get a lot of attention. There are...
[02:07] a few treatment modalities available right now that in the right patient and when done by the right practitioner can achieve an improvement in the appearance of cellulite. And we'll talk about some of those existing modalities at the end of the episode. But to this day in 2020, cellulite remains one of the most difficult problems to solve in aesthetic plastic surgery. And the subject of this episode is a brand new way to address this extremely difficult problem, and this, of course, is QUO. So what is QUO? QUO is the first FDA-cleared injectable for cellulite. It's licensed by the U.S.-based pharmaceutical company Endopharmaceuticals. Its active ingredient is called CCH, which stands for Collagenase Clostridium Histolyticum. And this is an enzyme that dissolves the kinds of collagen that's mainly at type 1 and type 3 collagen that comprise those fibrous septae that cause the dimpling appearance of cellulite. So how does QUO work? QUO, with its active ingredients of CCH or collagenase, Clostridium, Histolyticum, is injected into the dimples in an area of cellulite.
[03:32] It then dissolves those fibrosepti that are drawing the skin down to the deeper tissue and as it gradually dissolves those fibrosepti, the tethering effect is released and this allows the skin to float up away from the deeper tissues and have a much smoother appearance. Quo is given as a series of three treatments, three weeks apart from each other. and Quo is FDA cleared for use on dimpling cellulite of the buttocks, but it has also been used with success on the dimples on the back of the thighs. So why should we believe that Quo will work? And the answer is we certainly can't be sure exactly how it will perform until we've had a chance to work with it extensively in clinical practice, but Quo received its FDA clearance as a result of the largest cellulite trial ever conducted, and this had over 800 participants. And I've told you that cellulite remains one of the most difficult problems to treat in aesthetic plastic surgery today, despite the existence of several devices and treatment modalities, all of which can do an okay job, but none of them really hit it out of the park. So one reason to be particularly optimistic about QUO is that QUO is an actual medication. So it was subjected to the medication approval process by the FDA, which is much more rigorous and robust than the device approval process required by the FDA. So while existing cellulite treatments had to only meet the bar for FDA clearance for devices, had to actually meet the bar of FDA clearance for a medication. So while we can't make any guarantees about the performance of Quo at this point, I do think there is real cause for cautious optimism that this could be a very big thing in terms of treating cellulite. We've already learned a great deal about Quo from this approval study with over 800 participants.
[05:54] For example, how long does QUO last? Early study data shows that the improvements achieved with QUO last for at least a year. And as time goes on and these subjects are followed and new patients are enrolled and followed, we hope to see these results lasting for even more time to come. What is the downtime and recovery like after a treatment of QUO? Reportedly, there is mild to moderate soreness and in general, patients can return to an active lifestyle the day after treatment. They may have swelling that lasts for a few days and bruising that can last for a couple of weeks. But again, this should not prohibit anyone from getting back to their regular activities the day after treatment. When will you see results after treatment with Quo?
[06:48] early experience suggests that you'll start to see results as soon as three weeks after your QO treatment. And that result just goes on to continue to improve over time. Who's a good candidate for QO? In terms of aesthetic criteria, it seems that women with true, well-defined, dimpling cellulite can expect to see the best results with a treatment of QO. Is QO safe? Well, the extensive FDA clearance study that we referenced earlier so far demonstrates a similar side effect profile to that which we see with other injectables, namely things like some bruising and swelling and soreness at the injection sites. One of the big questions with Quo, like with any new treatment, is how much is cellulite removal going to cost with Quo? And While we don't have the exact answer yet, we expect the pricing for Quo to be in line with other existing cosmetic injectables and cellulite treatments. So you know, it's probably reasonable to guess.
[07:57] that the pricing will vary on the severity of the dimpling and the size of the treatment area, and therefore the amount of quo that's required to achieve the desired result. But all things considered, somewhere in the range of $2,000 to $5,000 seems to be a reasonable prediction. But again, that's not based on any real data. That is purely speculation on my part, based on what we're seeing in the cosmetic injectable and cellulite treatment market right now. How can you get treatment with Quo? Well, Quo will not be clinically available until spring of 2021, but we'd encourage you to join our wait list for Quo by submitting a contact form at darrensmithmd.com. And when you do this, we'll be sure to alert you as soon as Quo does become clinically available and as soon as we do get more exact pricing information about this treatment.
[08:53] What do before and after pictures look like for treatments with Quo? These so far are extremely limited given the early stages of Quo availability But again, if you join our mailing list as soon as these do become more widely available We'll be sure to send them out so that people can get a better sense of what they can expect So now that we've discussed this exciting new treatment for cellulite I wanted to just review existing cellulite treatments so that you can get a sense of the landscape and exactly how Quo is adding to what's available. So to do this, I'd like to divide cellulite into two primary forms. There's dimpling cellulite, which we've been really concentrating on up until now. And that's what Quo is great for. And then there is wavy cellulite.
[09:45] and the difference is exactly what it sounds like. Dimpling cellulite are these discrete pox or depressions in the skin caused by these fibrous septi and wavy cellulite are these kind of rolling irregularities in the surface of the skin. So in terms of true dimpling cellulite the kind of best existing treatment right now is Sulfina, which is a minimally invasive procedure, which when performed for the right patient by an expert practitioner, you can really get some nice results. And this is something that could be done under straight local anesthesia with a minimal downtime. And Sulfina is essentially a very well controlled form of a much older technique called Subcision. And that's where a sharp needle is used to make tiny punctures in the skin and then disrupt the fibrous septae that are pulling down on the skin causing dimples.
[10:43] So, Sulfina can actually have its results augmented with fat transfer. And we've talked about fat transfer, fat grafting in an earlier episode, but essentially this is where we harvest fat from one area of the body and then deposit it in the treatment area to smooth things out and also to improve the soft tissue and skin quality by virtue of the adipose derived stem cells that are present in fat grafts. In terms of treatments for wavy cellulite, we've had a great deal of success treating wavy cellulite with a combination of fat grafting, like we just described, as well as body tight, which is radio frequency skin tightening that we've also described in a recent episode. And the theory here is the same way that if you...
[11:32] pull up on your thigh and you have some waves of cellulite by taking up that slack, you smooth things out. Well, the body type device is able to do something analogous and essentially tighten the skin in the area and reduce the prominence of the waves. There are also some laser modalities available to treat different kinds of cellulite. And this is a technology that I've seen really variable reports regarding how effective it is from colleagues and in the literature. So now we've talked about what causes cellulite and we've talked about quo as a brand new way to treat cellulite. And we've also talked about... methods of cellulite treatment that we have available to us today. And I'd like to wrap up by addressing some common questions about cellulite itself. And one thing that we are very frequently asked is, does gaining or losing weight affect the appearance of cellulite? And unfortunately, the answer to this question really varies pretty wildly and...
[12:35] is very different from person to person. So while weight loss can in some folks minimize the appearance of cellulite because there is less fat to protrude between those fibrous septi and cause that rough skin appearance, weight loss can actually sometimes make cellulite appear more prominent because if you lose a significant amount of fatty volume from an area, that will result in an excess of skin laxity. The same way that if you deflate a balloon, the shell of the balloon will ripple. A similar effect applies to the appearance of cellulite. what are the most common sites for cellulite to appear? And what we found in clinical practice and from a review of the literature is that cellulite presents most frequently in the buttocks, the thighs, the lower abdomen, and the arms. However, it can be present in other areas as well. So why is cellulite more common in women than it is in men. Recall that over 90% of mature women have some degree of cellulite, and this is something that's very uncommon to be a clinical issue in men. And there are a couple different things that are thought to contribute to this gender difference. First, the fibroceptic that we mentioned are oriented differently in women from the way they are in men, and specifically men have more of these fibrosepti and they are stronger than those that are present in women. So it follows that if you have more of these tether points, if they're very close together and they're fairly strong, there is simply less room for these fat cells to get trapped and cause the irregular skin appearance that is characteristic of cellulite. And another very interesting difference in the skin and superficial fat anatomy of women as compared to that in men is that women actually have increased fat lobule height as compared to that in men. So that, again, the fat that is getting trapped between the septi in women is taller than it is in men. So the kind of surface differences caused by that trapped fat are going to look more prominent. So finally, and to get away from gender differences in cellulite appearance, another kind of interesting biological question about the fat cells in cellulite is, are the fat cells that are getting trapped between these fibrocepti the same as other fat cells in the body? And data is coming out showing that they're actually different in a couple of ways.
[15:40] First, they tend to be larger than other fat cells in the body. And second, they tend to be more metabolically stable. So efforts at weight loss and weight gain are less likely to affect the size of these fat cells that are getting trapped between the fibrous septi in cellulite, leading to yet another reason why weight loss and weight gain may not affect the appearance of cellulite in a reliable way. So cellulite is a very difficult problem that's been around for quite some time We still don't have a perfect solution for it. But with the advent of quo We really are very excited to see what this new product can offer So we'll be watching very closely and we hope you watch along with us Thanks for listening, and don't forget to subscribe, share the show, and head over to darrensmithmd.com for more real-world plastic surgery talk.
Sources and context.
Original Captivate episode. Original release date: 2020-07-23. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.
Behind the conversation.
Darren M. Smith, MD, FACS