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QWO in NYC
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QWO in NYC

QWO in NYC

What is Qwo? 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. 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 fibrous septae and making the surface of the skin look even more dimpled, wavy, and uneven. 

What treatments are available for cellulite?

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 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 Qwo.

What is Qwo?

So what is Qwo? Qwo is the first FDA-cleared injectable for cellulite. It's licensed by the US-based pharmaceutical company, Endo Pharmaceuticals. Its active ingredient is called CCH, which stands for Collagenase Clostridium Histolyticum. And this is an enzyme that dissolves the kinds of collagen (mainly type one and type three collagen) that comprise those fibrous septae that cause the dimpling appearance of cellulite.

How does Qwo work?

Qwo with its active ingredients of CCH or Collagenase Clostridium Histolyticum is injected into the dimples in an area of cellulite. It then dissolves those fibrous septae that are drawing the skin down to the deeper tissue. And as it gradually dissolves those fibrous septae, the tethering effect is released. And this allows the skin to float up away from the deeper tissues and have a much smoother appearance. Qwo is given as a series of three treatments, three weeks apart from each other, and Qwo 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.

Does Qwo work?

So why should we believe that Qwo 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 Qwo 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 Qwo is that Qwo 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, Qwo had to actually meet the bar of FDA clearance for a medication. So while we can't make any guarantees about their performance of Qwo 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 Qwo from this approval study with over 800 participants. For example, how long does Qwo last? Early study data shows that the improvements achieved with Qwo 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 Qwo?

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 Qwo?

Early experience suggests that you'll start to see results as soon as three weeks after your Qwo treatment. And that result just goes on to continue to improve over time. Who's a good candidate for Qwo? In terms of aesthetic criteria, it seems that women with true well-defined dimpling cellulite can expect to see the best results with the treatment of Qwo.

Is Qwo safe?

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.

How much does Qwo cost?

One of the big questions with Qwo like with any new treatment is how much is cellulite removal going to cost with Qwo? And while we don't have the exact answer yet, we expect the pricing for Qwo to be in line with other existing cosmetic injectables and cellulite treatments. So, it's probably reasonable to guess that the pricing will vary on the severity of the dimpling and the size of the treatment area and therefore the amount of Qwo 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 I book my Qwo treatment?

Qwo will not be clinically available until spring of 2021, but we encourage you to join our waitlist for Qwo by submitting a contact form at darrensmithmd.com. And when you do this, we'll be sure to alert you as soon as Qwo does become clinically available and as soon as we do get more exact pricing information about this treatment.

Qwo before and after pictures

What do before and after pictures look like for treatments with Qwo? These so far are extremely limited given the early stages of Qwo’s 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 in terms of Qwo results.

What can I do about my cellulite right now?

So now that we've discussed this exciting new treatment for cellulite, Qwo, I want to just review existing cellulite treatments so that you can get a sense of the landscape and exactly how Qwo 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 Qwo is great for and then there is wavy cellulite. And the difference is exactly what it sounds like. Dimpling cellulite are these discrete pocks or depressions in the skin caused by these fibrous septae and wavy cellulite are these kind of rolling irregularities in the surface of the skin.

Cellfina for dimpling cellulite

So in terms of true dimpling cellulite and the kind of best existing treatment right now is Cellfina, 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.

Cellfina 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. So Cellfina 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.

BodyTite for wavy cellulite

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 radiofrequency skin tightening that we've also described in a recent episode.

And the theory here is the same way that if you pull up on your thigh and you have some waves of cellulite by taking up that slack, you smooth things out. Well, the BodyTite 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 kind of 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 Qwo as a brand new way to treat cellulite. And we 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.

Does losing weight improve cellulite? Does gaining weight improve cellulite?

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 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 septae 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?

What we find 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.

Why is cellulite more common in women than in men?

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 fibrous septae that we mentioned are oriented differently in women from the way they are in men and specifically men have more of these fibrous septae 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's 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 the 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 septae 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.

Is the fat involved in cellulite the same as other fat in the body?

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 fibrous septae 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. 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 septae and cellulite leading to yet another reason why weight loss and weight gain may not affect the appearance of cellulite in a reliable way.

Conclusion

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 Qwo, 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.

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  • Darren M. Smith MD
  • Darren M. Smith MD
  • Darren M. Smith MD

All photos are of models except before and after images.

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