Doctors Share Their Concerns About Qwo, The New FDA-Approved Cellulite Treatment


What in case you may eliminate cellulite in a number of months, with no life-style adjustments and no invasive procedures? That’s the promise of Qwo, the primary and solely injectable remedy for cellulite authorised by the Meals and Drug Administration.

Qwo was authorised in July 2020 and was first provided across the nation at dermatologists’ workplaces and medi-spas in late spring 2021. It goals to scale back the looks of cellulite in three rounds of injections, every 21 days aside. And whereas the medicine itself isn’t new, this utilization of it’s. (It was beforehand used to deal with a hand situation that we’ll speak about beneath.)

Whereas some docs really feel it’s a protected, noninvasive remedy choice, others are ready to see its long-term results earlier than leaping on board.

How Qwo Works

Cellulite, dimpled-looking pores and skin the place fats accumulates on the physique, impacts 90% of ladies and 10% of males, in accordance with Scientific American. Cellulite isn’t prompted a lot by the fats itself, however by the strain between muscle tissue and pores and skin that squeezes the fats to the floor.

“Our pores and skin is hooked up to the underlying muscle mass by tight fibrous bands, and in between the bands is fats,” stated Kristen Rezak, a board-certified plastic surgeon at Duke Well being. “Over time, the pores and skin can loosen up or we acquire fats, and that causes dimpling areas as a result of these tight bands don’t stretch, and that’s what causes cellulite. It normally is focused in areas just like the butt and outdoors of the thighs.”

The principle substances in Qwo are two types of collagenase, an enzyme derived from micro organism that breaks down collagen, the principle element of these fibrous bands. As soon as these bands are damaged, the dimples will launch and the pores and skin will look clean once more. Collagenase (below the title Xiaflex) has been utilized in medication for years to deal with Dupuytren’s contracture, a situation that impacts the arms and bends your fingers inward.

“Dupuytren’s is brought on by these fibrous bands that trigger the tip of the finger to bend towards the palm,” stated Peter W. Henderson, assistant professor of cosmetic surgery and a breast reconstructive surgeon at Mount Sinai Well being System. “The substance is one thing that’s well-known and is presently being utilized in different initiatives; they’ve simply recognized one other use for it, one with an even bigger market. The fabric is well-known and identified to be protected.”

“In each the Part II and Part III trials, round 60% of sufferers discovered they’d any diploma of enchancment. So, it’s statistically important however not an entire residence run.”

– Abigail Waldman, Brigham and Girls’s Hospital

Regardless of collagenase’s good observe document, Qwo nonetheless needed to endure all of the phases of FDA approval for the remedy of cellulite. Whereas it proved considerably efficient in trials, some docs say the change wasn’t dramatic.

“They did Part III research that enrolled over 800 ladies, and it confirmed an all proper impact,” stated Abigail Waldman, a medical director of the Mohs and Dermatologic Surgical procedure Heart at Brigham and Girls’s Hospital in Boston.

“The result was measured in whether or not sufferers had been barely happier or a lot happier, mainly. In each the Part II and Part III trials, round 60% of sufferers discovered they’d any diploma of enchancment. So, it’s statistically important however not an entire residence run.”

Whereas Qwo’s web site doesn’t specify how lengthy outcomes are anticipated to final, quite a lot of medi-spas providing the remedy declare they need to final a minimal of 1 yr.

Anaya Aesthetics, based mostly in Pasadena, California, states, “To-date, we have now knowledge to assist longevity for a number of years and can proceed to watch what number of years sufferers can count on to see the substantial enchancment.” DC Derm Docs’ web site says, “The FDA- authorised remedy for reasonable to extreme cellulite might final completely. You may count on your Qwo outcomes at the least one yr, however almost definitely, for much longer.”

Is Qwo simpler than different cellulite therapies?

Liposuction and CoolSculpting can scale back fats, however they don’t particularly goal cellulite. Other extra invasive procedures use chopping methods to sever the connective bands. Lasers, radiofrequency, retinol lotions and extra all declare to reduce cellulite’s look. However how does Qwo evaluate?

“It’s engaging as a result of it’s a straightforward, minimally invasive remedy choice for many who don’t need a extra invasive process,” stated Teo Soleymani, a medical well being sciences teacher and dermatologic surgeon at UCLA Well being. “There may be comparatively minimal downtime in comparison with different modalities. However, because of this, the outcomes is probably not as pronounced or chances are you’ll not have the ability to deal with as giant of an space.”

See beneath for an instance of a before-and-after photograph that Qwo promotes, and also you’ll see the distinction isn’t dramatic:

Henderson cited current research on Qwo’s outcomes that make it appear promising, however stated that because the researchers had been affiliated with the remedy, he’d prefer to see extra unbiased proof of its effectiveness over time.

“None of these items have been proven to be very efficient,” Henderson stated. “We don’t have an excellent medical resolution for cellulite up to now, so the actual fact we have now seen [Qwo] work in different elements of the physique makes this an intriguing risk.”

There’s severe bruising concerned with Qwo.

Qwo’s web site lists its attainable unintended effects, which embrace injection web site bruising, ache, redness, swelling and allergic reactions. A fast Google search will reveal earlier than and after pictures with bruises overlaying a big space, not simply on the injection websites. Ought to that be regarding?

“Collagen additionally composes the liner of blood vessel partitions, so we’re beginning to see bruising might be intensive with Qwo partly as a result of it could typically break down the very tiny blood vessels within the pores and skin or subcutaneous tissue. It’s not dangerous, however it’s visually bothersome,” Soleymani stated.

Henderson agreed, saying that whereas the fibrous bands answerable for cellulite aren’t the one issues made from collagen in that space of the physique, they’ve the very best focus, making them Qwo’s principal goal. Nevertheless, Rezak defined {that a} small proportion of people that expertise extreme bruising might by no means heal.

“The draw back is, when you will have that a lot intensive bruising, virtually at all times it normally simply goes away however it could take weeks to a month to appear to be pores and skin once more. A small proportion of individuals can have hemosiderin staining, which stains the pores and skin darkish. That’s not been related to Qwo, however is feasible with intensive bruising,” she stated.

Is Qwo protected? What are the long-term results?

Rezak and Waldman each questioned the dearth of range in Qwo’s Part III trial: all of its individuals had been ladies and the bulk had been white, so it’s “onerous to know if it may be utilized to a extra various inhabitants,” Waldman stated.

Qwo has not been accessible lengthy sufficient to know a lot about its long-term results, however some physicians surprise if the physique will deal with it equally to Botox.

“Within the research, virtually everybody developed antibodies to the collagenase, which is smart as a result of it’s a overseas micro organism enzyme,” Waldman stated. “I don’t know what the implications for which are. For different bacterial-derived injections, like Botox, meaning sooner or later it doesn’t be just right for you. I don’t know if the identical principle applies right here, the place in case you received Qwo once more sooner or later possibly it wouldn’t work.”

And whereas the bruising might subside, docs don’t but perceive if there are long-term penalties of collagenase breaking down collagen within the blood vessels or pores and skin across the injection space.

“We don’t actually know what the long-term implications of which are, which might be what makes me probably the most hesitant about this,” Waldman stated. “Because it hasn’t been FDA-approved for lengthy, we don’t know what long-term ramifications are to breaking down collagen in your connective tissue.”

“Clinician experience and having finished this makes a giant distinction. Some persons are extra delicate to this enzyme, so there’s an opportunity for atrophy of the pores and skin. I can see this taking place in unsupervised med spas.”

– Teo Soleymani, UCLA Well being

Till extra is thought about potential issues from Qwo, those that decide to strive it ought to rigorously take into account the supply.

“Theoretically, in case you inject it too shallow or not on the proper angle, you may place this collagenase within the dermis and that may trigger poor outcomes within the pores and skin,” Soleymani stated. “That’s the place clinician experience and having finished this makes a giant distinction. Some persons are extra delicate to this enzyme, so there’s an opportunity for atrophy of the pores and skin. I can see this taking place in unsupervised med spas.”

“Sadly, in academia, I take care of a whole lot of issues that come up from these sorts of therapies, like contour deformities and fats necrosis, they usually’re onerous to deal with. We will’t at all times predict the outcomes of those therapies,” Rezak stated.

Should you resolve to strive Qwo, these specialists agree that you must discover somebody who can take your medical historical past into consideration and is very certified to carry out the injections.

“For every type of injectables, I like to recommend getting them from a board-certified dermatologist or board-certified plastic surgeon. Unwanted side effects and issues are uncommon, however you need somebody accustomed to the anatomy who can handle issues,” Waldman stated.

Most significantly, speak to your Qwo supplier about whether or not the remedy is true in your physique. Every affected person, and every affected person’s cellulite, is exclusive.

“Sadly, it’s not a magic bullet for all cellulite,” Soleymani stated. “The appropriate affected person choice is essential, as it’s with each beauty remedy. It’s good for individuals who have a number of small drawback areas who don’t wish to endure larger, extra concerned procedures, however with the understanding that you just’re going to get much less efficient remedy total. Should you’re somebody who has a whole lot of dimpling or have already tried physique contouring or laser-assisted cellulite discount, this will likely not work nice for you.”


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