July 16, 2020Trends in Technology

QWO: The First FDA Approved Injectable for Cellulite

Cellulite is one of those topics that dermatologists find frustrating.  We are very solution driven, and up until now, there haven’t been many effective long term solutions for cellulite.  All the creams and gadgets out there claiming to help with cellulite are more hype than reality, and the in-office procedures that actually work have been, for the most part, somewhat invasive to the point that most patients are turned off by the process.

So, you can imagine, I was pretty pumped to learn about a new FDA approved injectable treatment for cellulite… yes, an injection, similar to Botox and Dysport, injections I do all day long… that can be done in the office and dramatically improve the appearance of cellulite.

Caveat: Whenever things are new, they tend to be hyped up and marketing tends to focus on all the good without doing justice to the bad.  We also tend to learn about the downside of procedures long after they launch… sometimes it takes a full year or more to really assess the real life efficacy and safety of a new treatment.

That being said, this is pretty exciting! Let’s break it down together.

First, some groundwork. What is cellulite? 

There’s a major misconception out there that cellulite is caused by diet or lack of exercise.  That’s totally not the case- stop blaming yourself for your cellulite!

Cellulite is caused by the outpouching of fat lobules under the skin.  So we have a layer of fat under the skin, and there are bands of collagen called septae that attach the skin to the underlying layer of fascia.  So imagine a sort of sandwich—the skin on top, the fascia on the bottom.  These fibrous septae run up and down and tether the two together.  Where the septae tug on the skin, that’s where you see a dimple. In between the dimples are bulges of fat pooching up (protrusions of fat). So you’re left with an uneven surface.  There are some shadows and some bulges.  That’s cellulite. These fibrous septae are oriented differently in women as compared to men, so almost ALL women get cellulite whereas lass than 10% of men get it. About 9 out of 10 women have cellulite, and it affects women of all races and ethnicities and all shapes and sizes. Yes, you can be thin, muscular, in great shape and still have cellulite!

Why do we care?

Cellulite can have a major impact on self-esteem and confidence. And no surprise here: we blame ourselves!  Studies show that the majority of women are convinced it’s THEIR FAULT they have cellulite!

What can we do about it and what is Qwo? 

Yes, there are topical treatments and devices that can temporarily improve the treatment of cellulite.  Any time you boost circulation to the area, or any topical ingredients that stimulate blood flow or help to thicken the dermal layer of the skin can make the area look better.  The thing is that most creams and lotions on the market, and most at home devices, only give you a temporary improvement.  If they do create lasting changes, those results are very subtle.

So what’s Qwo?  It’s the first FDA approved injectable for cellulite. It just got FDA approval for moderate to severe cellulite in the buttocks of adult women. Will we end up using it off label for the thighs or the arms?  Maybe!  It’s still super early so that remains to be seen.

Qwo uses an enzyme called collagenase that targets types 1 and 3 collagen, so it basically eats away at or dissolves those fibrous collagen bands tethering the skin down.  I think it’s so interesting how we are trying to fight these types of collagen degrading enzymes in the skin, face and neck, but when it comes to cellulite, we want them to chew away at the collagen.  You can see the collagen band dissolving in the images below:

The trials to evaluate Qwo are the largest cellulite studies every conducted with 845 participants, and I REALLY love that about a third of the participants have skin of color.  So many procedures are only studies on white skin, and that’s not ok.  Darker skin types have different reactions- especially things like hyperpigmentation- that need to be carefully studied so we, dermatologists, can counsel those patients appropriately about the possible risks and side effects.

So what are the risks?

So far we’re seeing mainly tenderness, bruising, some discoloration which I’m SURE will be more common in skin of color, and of course swelling. This is probably a treatment you’re not going to want to do during the summer because a bruise in the buttock or thigh area can last up to 3 weeks and bruising seems to be pretty common. The protocol involved about 3 rounds of injections, spaced 3-4 weeks apart.

Cost?  Big question mark!  We shall see when it becomes commercially available—the thought is probably Spring 2021.

The studies are still ongoing to assess how long the results will last and to assess long term safety.

So what’s my take home?

I am very excited by the photos and clinical results I’ve seen thus far. It seems to be very effective even for severe cellulite. Here are some images the company shared with me:

I like that it’s an injectable.  I consider myself an expert injector, and I feel right at home with a syringe in my hand.  I can’t imagine incorporating this into my practice will be a challenge whatsoever from a skill and technique standpoint.

I like that it’s getting to the underlying root of the problem- the septae.  It has the potential to truly deliver long term results- we’re talking years if not permanent.

I’m worried about the cost—I suspect this will be pretty pricey, especially since there isn’t a competitor on the market yet in this space. Hopefully other companies will come out with competitive molecules, but until then, these guys are going to corner the market and that always leads to high prices.

Side effects: we need to really asses how severe the swelling, bruising and tenderness are, and how often it leads to hyperpigmentation – and how long it takes for those dark spots to lighten up.  My patients with skin of color who suffer from hyperpigmentation after a bug bite or scratch or pimple sometimes find the stain left over for months is worse than what caused it in the first place.

Stay tuned! I promise to update you guys on this as new info comes out.  For now, stick with self-tanners and cellulite creams and a cute skirt or flattering shorts!  And, please stop blaming yourself if you have cellulite.  WE ALL DO.  You’re in good company.

Check out my video with more info right here!

Dr. Whitney