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Cellulite may not pose any medical risks to those who have it, but many people, especially women, suffer from this condition and feel self-conscious about their appearance. They may try a variety of cellulite treatment options on their own, including exercise, weight loss, massages, liposuction, plastic surgery, and topical creams, but those home remedies can have varying degrees of success.

Other women have turned to their doctors for surgical solutions to treat cellulite, but even those treatments only offer temporary results.

Recently, the FDA has approved a new injectable treatment for cellulite called collagenase clostridium histolyticum-aaes, or QWO. Clinical trials of this shot for cellulite have shown to smooth cellulite dimpling.

But you may be wondering: can an injection really cure cellulite? Is the injection safe, and are there any risks involved? And how much does this treatment cost?

Read on to learn more about QWO.

What is QWO?

QWO, or collagenase clostridium histolyticum-aaes, is an injectable prescription medication that treats moderate to severe cellulite on the buttocks of adult women. The FDA approved QWO cellulite treatment in 2021, and it’s currently the only FDA-approved injectable treatment on the market.

What is Cellulite?

Cellulite is a harmless skin condition that affects thousands of people. Women experience cellulite more frequently than men. Up to 90% of women can struggle with cellulite in their lives, regardless of their diet or exercise regimen.

Cellulite affects the skin on a person’s thighs, hips, buttocks, or abdomen and causes a lumpy, dimpled appearance.

Cellulite appears thanks to the fibrous bands, or septae, that hold the skin to the muscle beneath. Fat gets caught between the skin and the layers of muscle, and it pushes up against the skin while the septae pull down. This leaves an uneven or dimpled appearance on the surface of the skin.

While the precise cause of cellulite is unclear, several factors can contribute to its emergence. Diet and lifestyle are two such factors, but there exist more uncontrollable ones like genetics, hormones, and age as well. Many women who lead healthy lifestyles can still experience cellulite.

How it Works

QWO contains enzymes called collagenases. The collagenases target the fibrous septae beneath a patient’s skin to help release the strands that bind the skin and muscle together.

It’s believed that QWO not only releases that fibrous septae, but it also redistributes fat cells and stimulates new collagen growth.

What is ESR?

Enzymatic Subcision and Remodeling, or ESR, is the active mechanism of the QWO injection. When QWO is injected, it breaks down fibrous, mature septae strands that contribute to the emergence of cellulite.

QWO also helps stimulate new collagen, which can help smooth out dimpled skin.

Best Candidates

The FDA has approved QWO for adult women. The best candidates for QWO treatments are women with moderate to severe cellulite in the buttocks area. As of today, the FDA has not approved the treatment for men or for other areas of women’s bodies.

Anyone who is allergic to collagenase or any other active ingredient in QWO is not a suitable candidate for treatment. Patients should also talk to their doctor first if they have an active infection within the treatment area, if they have a bleeding condition, or if they are pregnant, nursing, or plan to become pregnant soon.

Potential Risks

The most common side effects of QWO injections are injection site bruising, pain, swelling, redness, itchiness, or formations of hard nodules in the treatment area.

Most patients who receive QWO treatments report that any pain they experience is minimal. These side effects dissipate within seven days of treatment for most patients who participated in clinical trials.

As with any treatment, though, QWO has the potential to induce more serious side effects including allergic reactions like trouble breathing, hives, a swollen face, or anaphylaxis.

Any patients who experience such severe reactions after undergoing QWO treatment should tell their medical provider or seek immediate medical attention.


Little to no downtime is mandated for those who undergo QWO treatment. That being said, each medical provider’s post-procedure instructions will be different.

Most doctors suggest refraining from strenuous activity for at least 24 hours following treatment. On the other hand, some doctors may encourage patients to exercise after the recovery period because staying active can help ease some potential side effects like soreness and nodules.

If a patient is experiencing pain or swelling, an over-the-counter pain medication like Tylenol or Ibuprofen can be taken. Patients are encouraged to not plan treatments before an event where they may wear something revealing, like a bathing suit, since bruising is common and may be noticeable.

In QWO’s clinical trials, bruising was most common and severe during patients’ first round of QWO treatment. In subsequent rounds, patients’ reactions were far more mild.

Frequently Asked Questions

Currently, the FDA has only approved QWO injections for adult women in the buttocks to treat moderate to severe cellulite.

QWO is the first FDA-approved injectable treatment for cellulite. Collagenase, the medication within the injection, is considered safe. It has been used for other applications for many years.

This procedure has undergone clinical studies with hundreds of patients. Adverse reactions during these trials were similar to those caused by other cosmetic treatments, such as pain and bruising around the injection site.

Although researchers confirmed the safety and efficacy of QWO during an extensive clinical trial involving over one thousand treatments, the long-term effects of the treatment are still unknown.

Patients taking part in the clinical trial were observed for a maximum of six months, and some long-term side effects could take longer to emerge.

QWO can drastically reduce the appearance of cellulite, but it cannot eliminate all of its symptoms. Regardless, most patients need multiple QWO treatments to experience lasting results.

Patients typically receive three QWO injections over the course of two to three months.

Like most cosmetic injectable treatments, the cost of QWO can vary depending on a variety of factors. The severity of the patient’s cellulite and the amount of QWO required to treat it are two of the most significant ones.

Most medical offices provide free consultations for patients who want to discuss treatment plans, and those providers typically offer price estimates at those meetings. Many offices also offer payment plans for their treatments.

Patients need to approach QWO with a healthy expectation based on what is known about the treatment. QWO works to decrease the appearance of moderate to severe cellulite, but patients shouldn’t expect it to provide a miraculous or instantaneous cure.


The world of modern medicine is constantly progressing, and recent developments have resulted in the creation of new treatments like QWO. Patients who’re interested in the procedure should seek out a medical provider in their area and schedule a consultation.

A good place to start would be speaking with a dermatology practitioner who can provide a referral to a licensed QWO physician.