Qwo Cellulite Injections

Qwo Cellulite Injections

First FDA-Approved Treatment for Cellulite in the San Diego Area

Dr. Melanie Palm is an expert in the use of Qwo, the first FDA-approved injectable product for the treatment of cellulite. Dr. Palm was one of a select few dermatologists and plastic surgeons across the country chosen to serve as clinical investigator and speaker; she participated in the FDA-trials that led to Qwo’s approval. Dr. Palm offers cellulite treatment at her practice, which is located in Solana Beach, CA just north of San Diego.

What is Qwo?

Qwo (collagenase clostridium histolyticum-aaes, Endo Aesthetics) is the first FDA-approved drug device for cellulite treatment in women. It is a solution of liquid collagenase, an enzyme that breaks down and remodels collagen, a key protein in fibrous bands that creates cellulite dimples. It is FDA-approved in adult women for the treatment of moderate to severe cellulite dimples of the buttocks.

Is Qwo Available in the U.S.?

Qwo was FDA-approved in July 2020 for the treatment of moderate to severe cellulite in adult women. It is expected to be available for patient treatment sometime around Spring 2021. A similar product to Qwo, under the trade name of Xiaflex, is already FDA-approved to treat two other medical conditions, Dupuytren’s contracture and Peyronie’s disease.

What is Dr. Palm’s experience with Qwo?

Dr. Palm served as one of the U.S. clinical investigators in the phase 3B FDA trial for Qwo. This FDA study investigated the real-world effectiveness and safety of Qwo for the treatment of thigh cellulite in women. She is one of only a handful of U.S. physicians to gain early expertise in the injection of Qwo prior to its FDA-approval.

What causes cellulite?

Cellulite is created by a combination of factors. However, the main structural cause of cellulite is how connective tissue is arranged in women differently than men.

Men versus women with cellulite
art of skin md qwo cellulite injectable
Collagenase injection for cellulite FDA approved
Qwo cellulite injectable california

Women have connective tissue bands in our fat layer called “fibrous septae” that are oriented perpendicular to our skin’s surface (in men they are parallel). These fibrous bands in women pull down or tether the skin’s surface, causing a tell-tale dimple. Fat around this dimple herniates over time, accentuating the indentation. This gender-unique fat/connective tissue architecture explains why women are disproportionately affected by cellulite compared to men.

Cause of celllulite

How Does Qwo work?

Qwo works on the structural cause of cellulite, fibrous bands (septae) that tether the skin down, causing a cellulite “dimple.” These fibrous septae are composed primarily of collagen. Qwo contains collagenase, an enzyme that breaks down collagen. Qwo targets type I and III collagen in these fibrous bands, enzymatically dissolving and releasing the fibrous bands. Release of the fibrous septae eliminates the skin tethering, smoothing the skin and softening or eliminating cellulite dimples.

Mechanism of action of Qwo for cellulite

Who is a good candidate for Qwo?

Cellulite affects the vast majority of women—approximately 90-95% of females past puberty. Cellulite causes unsightly textural changes to the skin and has been found in studies to impact our daily activities and even sense of well-being. Women most ideal for Qwo treatment have distinct cellulite dimples. Qwo does not help wavy, textural changes sometimes referred to as cellulite, but are truly skin laxity/looseness.

Qwo Cellulite Injections FAQ

What areas of the body can be treated with Qwo?
Qwo is currently FDA-approved for cellulite dimple treatment of the buttocks in women. Real-world trials evaluating treatment of the thighs are ongoing, and Art of Skin MD was a clinical site for this study. However, in the future, it is possible that physician’s may use Qwo in other regions to address cellulite dimples.

What is Qwo treatment like?
Injectable treatment with Qwo is a short and no downtime in-office treatment. Here are the basic steps:

  1. Cellulite dimples are identified with the patient standing and sometimes flexing and relaxing their muscles to accentuate skin indentations.
  2. Marking of individual dimples targeted for treatment is completed with a nonpermanent skin marker.
  3. The area of treatment is cleansed with a sterile preparatory solution.
  4. Individual cellulite dimples are injected with a very small needle.

What is Qwo recovery like?
There is typically no downtime following Qwo treatment. Mild tenderness and swelling is expected. Nearly all patients will bruise following the first treatment, but bruising tends to lessen with subsequent treatment.

Are Results from Qwo Seen Immediately?
No. Qwo is administered as a series of injections, typically spaced about a three weeks apart. Serial treatment yields better results, which are achieved after several months.

Collagenase injection for cellulite to buttocks

How long does Qwo last?
Most of the clinical studies related to Qwo evaluated results through at least 6 months. However, Qwo directly targets the structural cause of cellulite, and so results are likely long-lasting.

Qwo cellulite smooth skin


What are the possible side effects and downtime following Qwo treatment?
The most common side effects from Qwo clinical trials were the following:

  • Injection site bruising
  • Pain in the area of treatment
  • Areas of hardness
  • Itching
  • Redness
  • Skin discoloration
  • Swelling in the treatment area
  • Warmth in the treatment area
  • Allergic (hypersensitivity) reactions, including anaphylaxis

Bruising is the most common side effect and is most noticeable during the first treatment, and tends to be more mild with subsequent treatments. Blood-thinning medications, supplements, or foods should be avoided if medically possible prior to treatment to avoid severe bruising.

Patients may experience temporary hyperpigmentation in the areas of treatment, especially if bruising was significant. Dr. Palm may recommend specific topical strategies to improve this possibility.

Hyperpigmentation is more common in skin of color. This pigmentation resolves over time, but could take several weeks to months to improve.

Is Qwo safe in skin of color?
Yes! Nearly 30% of those treated with Qwo in the clinical trials had richer skin tones, Fitzpatrick skin types IV, V and VI. These groups include but are not limited to Asian, Latino, Black, Indian, and Mediterranean skin types. This means that all skin types and ethnicities can safely be treated Qwo.

Are Qwo injections painful?
Pain is mild to minimal during the Qwo procedure. Patients at our clinic during the FDA trial found the procedure well-tolerated. The level of discomfort should be similar to having Botox or facial fillers.

How Does Qwo Differ from Cellfina?
Qwo creates an enzymatic degradation and release of fibrous septae that contribute to cellulite dimpling. Cellfina takes a physical or mechanical approach. It uses a microblade to cut and release the band under local anesthesia. Both have about a the same degree of bruising and little to no downtime. Qwo is an injectable; Cellfina is a minimally-invasive microblade surgical release of fibrous septae.

Who should not receive treatment with Qwo? Are there any contraindications?
You should not receive treatment with Qwo if you have any of the following:

  • Allergy to collagenase
  • Allergy to any other ingredients in Qwo
  • Active infection in the area of treatment
  • You should inform your healthcare provider if you have any of the following:
  • Bleeding disorder
  • Pregnancy
  • Nursing or planning to nurse

Can I use Qwo with other procedures?
Yes, a multi-procedure and layered approach to cellulite and skin textural changes often leads to synergistic results. Qwo and cellulite target cellulite dimples and fibrous septae that cause them, but much of “cellulite” is due to either thinning skin, skin laxity, or loss of fat or muscle tone. The following can be used with Qwo to address all that encompasses cellulite more holistically:

Skin Thinning and Crepiness:

Skin Laxity:

Loss of Fat:

  • Sculptra Aesthetic Injections
  • Autologous Fat Transfer

Loss of Muscle Tone:

How much does Qwo cost?
Prices of Qwo have not been announced by Endo Aesthetics, the manufacturer of the product. Endo has stated it “aims to price [Qwo] for widespread adoption.” Patients should keep in mind that price will be determined by the series of treatments and the severity and number of cellulite dimples to be treated.

If you are looking a Qwo cellulite injection expert in the San Diego area to treat your cellulite, call Dr. Melanie Palm at 858.792.SKIN (7546) to schedule your appointment.