What to Know About QWO, the Injectable Cellulite Treatment

For most women, cellulite is just a fact of life: it's a condition that affects 90 percent of women, whereas that number is closer to 10 percent for men. Regardless of how you feel about cellulite on your body — if you're totally cool with it or not — the reality is that treating it can be tougher than you think. (No, firming creams don't work.) That's because underneath those bumpy dimples you see are the fibrous tissues that connect our skin to our muscles, which happen way below the surface of the skin, so targeting the area in a meaningful way can be difficult without getting plastic surgery.

Still, the last few years have seen plenty of in-office treatment options — but none have been quite as innovative as QWO, the first FDA-approved injectable for reducing cellulite on the butt area. Here's why it's a big deal: in the past, if you weren't into getting surgery, your noninvasive options were limited to laser treatments and hot or cold therapy with varying results. With QWO, you get a few injections and you're done, with more visible results and minimal side effects.

To break down what you need to know before getting QWO, we spoke to Leif Rogers, MD, FACS, a board-certified plastic and reconstructive surgeon in Los Angeles.

To understand how this injectable works, let's go back to why cellulite happens in the first place. It happens when there is a buildup of fat beneath the skin, which pushes on the connective tissues. The fibrous bands of collagen create little pockets where the fat is pushing through, which is why you see the dimpled effect on your skin. Unfortunately, there isn't a specific reason why you get cellulite — it can be genetics, hormones, or lifestyle, among many other reasons. Weight gain can have an effect, as well as skin thickness, and because estrogen production goes down (and therefore skin elasticity) as we age, women often start to see more cellulite as they hit menopause.

While it's not fully understood how QWO works, according to Dr. Rogers, the injection — which uses an enzyme called collagenases — breaks down the peptide bonds in collagen, causing the fibrous bands that cause that ripple to smooth out. "When injected around a tight fibro-septal band, it will cause that band to release, releasing the dimple that it was responsible for," he says.

Currently, QWO is only FDA-approved for use on the buttocks, but Dr. Rogers says posterior thighs can be treated in the right patient.

Like most injectables, the cost of QWO depends on the number of units or vials used in your particular treatment regime. Depending on where you get the procedure done, how much they charge per vial, and the amount you need, the series of three appointments can run you anywhere from $2,000 to $4,000. Clinics in larger metropolitan cities tend to be more expensive, but not always.

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QWO is given in a series of three treatments, 21 days apart. The appointment itself lasts only about 10 minutes, and it feels like getting any other shot — if you're a partaker in Botox, it should feel about the same as those quick needle pinches. Dr. Rogers says you should start see a visible effect a few weeks after your first treatment, but it depends on the severity of your cellulite.

The only significant side effect of QWO is mild bruising, which is totally normal. You might also feel some tenderness or mild burning at the injection sites.

Clinical trials for QWO showed (in layman's terms) that moderate and severe cellulite was significantly improved, but it wasn't fully gone. It's also important to note that QWO isn't the right treatment for everyone. "Patients with distinct dimples on the buttocks are the best candidates," Dr. Rogers says. "Patients with cellulite that resembles 'cottage cheese' are not ideal candidates because that condition is more highly associated with skin laxity than specific fibrous septal bands."

That said, QWO does show the most dramatic results compared to pretty much all other treatments on the market, and it has been studied in more patients than any other FDA-approved injectable cellulite treatment. Plus, unlike many other nonsurgical treatments, the results of QWO are permanent (although "new cellulite dimples may appear with weight change or aging," Dr. Rogers notes).

For the most part, other devices and topical creams treat skin quality, but not the underlying structure of the fat and fibrous tissue — meaning that tightening cream might work for a few hours, but it's not going to fix the issue. A treatment like CoolSculpting treats the fat itself, but not the tissues that cause the dimpling — meaning that if some of that fat comes back, you're still going to see the cellulite. QWO is the only treatment that attacks the "fibro-septal component of cellulite," as Dr. Rogers puts it.