QWO CELLULITE TREATMENT BEFORE & AFTERS
The QWO before and after pictures are courtesy of Endo Aesthetics and represent actual patients from the efficacy studies.
Pain levelMild soreness
Type of procedureInjectable
QWO in Action
How QWO Works to Treat Cellulite
An Injectable Treatment for Cellulite!
What is Qwo (the short answer)?
The short answer is that Qwo (rhymes with “whoa!”) is a brand new, first of its kind injectable treatment for cellulite. Presently available cellulite treatments tend to be more invasive and less effective than Qwo. The longer answer, which will explain why Qwo is such a big deal, requires us to discuss exactly what cellulite is and what causes it.
What is Cellulite?
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. The appearance of cellulite is exaggerated by fat globules getting trapped between these fibrous septae. This makes the surface of the skin look even more dimpled, wavy, and uneven. The appearance of cellulite is often described as looking like cottage cheese or an orange peel. Cellulite is most common in women and occurs most frequently on the buttocks and the back of the thighs. It can occur in other areas as well.
What is Qwo (the longer answer)
If dimpling cellulite is caused by thick connective tissue bands (fibrous septae) pulling down on the skin from underneath, wouldn’t it be great if there were a way to cut those fibrous septae? In the past, the most effective way to do this was with a procedure called Cellfina, in which a minimally invasive device was used to physically disrupt these connective tissue bands. While Cellfina is often effective, it can be uncomfortable and requires some recovery. Now, imagine a way to cut those fibrous septae without any device at all and without any pain or downtime. That’s Qwo! Qwo is a special kind of protein (an enzyme) that is actually designed to break down fibrous septae. All we have to do is use a tiny needle (the same one we use for Botox!) to introduce Qwo into the dimples we’d like to treat. From there, it goes to work literally dissolving the fibrous septae, releasing the dimples, treating the cellulite and leaving smooth, unaffected skin behind. All without surgery or downtime. On a technical level, the enzyme in Qwo is called CCH, which stands for Collagenase Clostridium Histolyticum. 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. Qwo is licensed by the US-based pharmaceutical company, Endo Pharmaceuticals.
Benefits of QWO in treating cellulite?
1. Qwo has been rigorously studied and found to be safe and highly effective
2. Qwo is FDA-approved
3. There is no downtime
4. There is minimal discomfort
What treatments are available for cellulite in NYC?
Since cellulite is reported to occur in over 90% of women across cultures and around the world, the question, “how can cellulite be treated? how can we get rid of cellulite?” is one that is very frequently asked. This had led to the development of many, many different cellulite treatments over time. Qwo does seem to be an ideal answer for dimpling cellulite in many cases. However, there is a limit to the amount of Qwo that can be used in a given treatment session. We generally do not like to treat more than 12 dimples per side per treatment. Therefore, if there is an extremely large number of dimples present, Cellfina may be a good option. Alternatively, if the cellulite is wavy rather than true dimpling cellulite, BodyTite may be appropriate. There is more on each of these modalities below. Dr. Smith will help you develop a customized cellulite treatment strategy during your consultation.
How does Qwo work?
Qwo, with its active ingredient 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. As it gradually dissolves those fibrous septae, the tethering effect of the fibrous septae on overlying skin is released. 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. Qwo is FDA-cleared for use on dimpling cellulite of the buttocks, and it has also been used with success on the dimples on the back of the thighs.
Does Qwo work?
Dr. Darren Smith is proud to be one of the first practitioners to offer Qwo for the treatment of cellulite in New York City. But he did not make the decision to introduce Qwo into his practice lightly. Before Dr. Smith began offering Qwo to his patients, he carefully assessed the available data. Qwo received its FDA clearance as a result of the largest cellulite trial ever conducted. This study had over 800 participants and demonstrated extremely effective results.
To put the fact that Qwo is an FDA cleared medication into even greater perspective, consider that every other cellulite treatment ever assessed and given the go-ahead by the FDA has been a device, and not a medication. As an actual drug, Qwo 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.
While all of this is extremely encouraging, Dr. Smith has now been using Qwo for long enough in his own practice to speak from personal experience. Qwo does appear to be living up to the hype and seems to be an extremely effective treatment for dimpling cellulite without surgery, pain or downtime.
The other exciting thing that we learned from the Qwo approval study is that Qwo appears to last for the long haul. Early study data shows that the improvements achieved with Qwo last for at least a year. As time goes on and the study subjects are followed, we hope to see these results lasting for even more time to come.
What is the downtime and recovery like after the treatment of Qwo in NYC?
The Qwo injections themselves are relatively painless. We use the same kind of needle that we use for Botox injections, which is extremely small. There is mild to moderate soreness in the days after treatment. In general, patients can return to work and their regular lifestyle immediately after treatment. Treatment with Qwo may cause significant bruising that can last for a couple of weeks. We have found that the bruising after Qwo becomes less significant after each round of treatment.
When will you see results after treatment with Qwo?
Our experience has shown that you may start to see results as soon as a few weeks after your first Qwo treatment. That result continues to improve over time, especially after your second and third treatments.
Who is a good candidate for Qwo?
Women with true, well-defined, dimpling cellulite can expect to see the best results with Qwo. Dr. Smith is an expert in evaluating cellulite and recommending the best course of treatment. There is more on other Cellulite treatments below.
Does Qwo have any side effects??
The most common side effects of Qwo are bruising and mild soreness. Dr. Smith will guide you through an in-depth informed consent process as part of your consultation for treatment with Qwo.
Am I a candidate for QWO?
Adult women with cellulite should contact Dr. Smith’s team to see if they are a candidate for the procedure..
Is QWO permanent?
The results of QWO have been followed out to one year in studies and found to be long-lasting. As time goes on, we can follow patients out further to see how long their results last. It does appear that the results of QWO will last for the long term.
How much does Qwo cost in NYC?
The cost of cellulite treatment with Qwo is determined by the number of cellulite dimples being treated. A very precise dose of Qwo is required to treat each dimple. Dr. Smith will work with you during your cellulite treatment consultation to determine the location and number of cellulite dimples that you would like to treat with Qwo. From there, Dr. Smith will know how much Qwo is required to achieve your cellulite treatment goals. This, in turn, will determine the cost of your treatment. Qwo is available in two vial sizes, 0.92 ml and 1.84 ml. Most patients can be treated with 0.92 ml vial size. The cost for treatment with a 0.92 ml vial of Qwo is $3000. This includes three 0.92 ml vials of Qwo, enough to complete all three treatment sessions (one 0.92 ml vial of Qwo is used for each of the three treatment sessions). A small number of patients will have enough cellulite to require the 1.84 ml vial of Qwo. The cost for treatment with a 1.84 ml vial of Qwo is $3500. This includes three 1.84 ml vials of Qwo, enough to complete all three treatment sessions (one 1.84 ml vial of Qwo is used for each of the three treatment sessions).
Cellfina for dimpling cellulite
Qwo is at present Dr. Smith’s favorite treatment for most cases of true dimpling cellulite. However, in cases that exceed the maximum number of treatable dimples per side (twelve), Cellfina may be a good option. Cellfina is a minimally invasive procedure, which when performed for the right patient by an expert practitioner, can achieve excellent results. Cellfina can be performed under straight local anesthesia with a minimal downtime.
Cellfina is essentially a very well controlled form of a much older technique called subcision. In this technique, 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. Cellfina can also have its results augmented with fat transfer. Fat transfer, or fat grafting, involves the harvest of fat from one area of the body to then deposit it in the treatment area. This smooths out the region and also improves 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 with a combination of fat grafting and BodyTite. BodyTite is a form of radiofrequency skin tightening in which the skin is heated to induce contraction and the formation of new collagen and elastin. The theory behind using BodyTite to treat wavy cellulite adheres to the same principle by which physically pulling up on your thigh skin removes slack in the soft tissue and smooths out any waviness that may be present. The BodyTite device is able to do something analogous and essentially tightens the skin in the area and reduces the prominence of the waves.
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.
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.
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.
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.
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 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.
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.
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.