A new FDA-approved injectable is hitting the market next year.

By: Hannah Baxter
If those obnoxious paparazzi photos of celebrities at the beach have taught us anything, it’s that even the rich and famous have cellulite. In fact, anywhere from 93 to 98 percent of women deal with skin dimpling and puckering—the number varies, as not everyone is willing to shout it from the rooftops—but it’s safe to say that the majority of women around the world have it. And even though we’re learning to love our bodies, wrinkles, bumps, and weird hairs included, there’s no point in pretending like your inner critic doesn’t speak out on occasion. It happens to all of us.

Today, however, is a major milestone when it comes to minimizing the appearance of cellulite, as the FDA just approved a new injectable treatment called QWO for moderate to severe cases of cellulite on the buttocks. Collagenase clostridium histolyticum-aaes, as it’s otherwise known, has been developed by EndoAesthetics and involves a series of injections administered every 21 days for three treatment visits. The brand disclosed that “an open-label, Phase 2 extension study has been completed and published [which demonstrated] that QWO treatment provided durable improvement in cellulite appearance.” As to how long the effects of the injections last, we were unable to find a determinable amount of time in the brand literature. The pricing is also still to be finalized, but “aims to be priced appropriately” for widespread use and accessibility. It will be available in spring 2021.

The brand released a statement on Monday evening, stating, “When injected into the treatment area, QWO is thought to release the fibrous septae enzymatically by specifically targeting Types 1 and 3 collagen, which may result in smoothing of the skin and an improved appearance of cellulite.” To accomplish this, the treatment contains a mixture of two naturally occurring collagenase enzymes, AUX-I and AUX-II, which is injected into the skin under the dimple and breaks down the buildup of collagen that causes cellulite. By releasing the fibrous bands, the tension that pushes the surrounding fat upwards is lessened and the dimpling effect is reduced.

Regardless of whether you’re one of the few people on the planet that lack cellulite on their butt or thighs, the fact remains that 60 percent of women feel like it’s their fault that they have it in the first place, according to a Harris Poll survey, which is categorically untrue. Cellulite is at least in part genetic, but according to Dr. David Shafer, a double board-certified plastic surgeon, women’s higher levels of estrogen makes us all particularly susceptible to developing cellulite, at least compared to men. “The skin is thinner and weaker, which leads to a breakdown of the integrity of the skin [during] changes such as weight gain and loss, pregnancy, and even just with time and age.” (An incredibly rude statistic if there ever was one.)

For anyone who thinks that enough diet and exercise will cure their cellulite, we’re sorry to say that your septae won’t allow that to happen. Still confused by that term? According to board-certified plastic surgeon Dr. Adam Kolker, these “cord-like tethers affix the skin to the underlying connective tissue and muscle planes beneath. Intervening pockets of fat may bulge around the tether points of these multiple septae within the skin, creating a localized dimple effect.”

Dr. Shafer equates the effect to a roll of bubble wrap. “Imagine the walls of the individual bubbles as the septae. If the septae are torn, stretched, damaged, or deformed for any reason, it can change the appearance of the overlying skin, leading to the appearance of cellulite.”

In terms of eliminating cellulite altogether, there are very few options on the market that all plastic surgeons agree are effective. Some, like board-certified plastic surgeon Dr. Steven Levine, feel that there are zero treatments for patients with visible dimpling. “Increasing muscle mass may improve the appearance, but I have never been impressed with any of the devices and topicals that claim to treat cellulite.”

Others, like Kolker, have seen moderate improvement via subcision, or releasing of the fibrous septae between the fatty tissues via procedures like Cellulaze (which uses a laser) or Cellfina (which uses a small oscillating blade under local anesthesia). But be advised—both of these treatments involve the insertion of an instrument beneath the skin, and they will not achieve long-term results.

Dr. Shafer believes that a topical treatment, a body-contouring lotion called BodiFirm from Revision Skincare, shows promise in improving skin firmness. “It contains a blend of peptides, antioxidants, botanical extracts, and a prebiotic to help support the body’s natural production of dermal-epidermal junction (DEJ) proteins, collagen and elastin, [plus] caffeine and glucosamine to help with texture.”

However, all three plastic surgeons agree that making healthy lifestyle choices, maintaining a healthy diet and weight, and not smoking will increase your odds of having even, firmer skin. And regardless of whether you want to explore options to treat the appearance of your cellulite with the new QWO treatment or otherwise, Dr. Shafer likes to remind his patients to not focus on terms like “remove” or “get rid of.” He prefers to use language like “improve” or “soften,” which are better for both managing your expectations of your chosen procedure and acknowledging that we are all far from perfect—and that that is 100 percent OK.

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