Cellulite is the bane of most women’s existence. Over 85% of women above the age of 21 have some form of it regardless of dieting, exercise and BMI. Cellulite manifests as a cottage cheese appearance of the skin of the buttocks, thighs and abdomen.
It is caused by two things:
1. tethering between the dermis (undersurface of the skin) and the deeper fascial layers beneath and
2. hypertrophy or growth of the fat cells just underneath the skin, creating small convexities or bulges.
These two phenomena together create the telltale stigmata of cellulite with dimples or concavities and bulges or convexities. It can worsen with age due to thinning of the skin, making these irregularities more visible.

Historically, treatments for cellulite have possessed modest efficacy and have not produced permanent correction. A litany of skin or “body firming” creams exist all of which produce subtle, temporary improvement. Massage or manual manipulation combined vacuum suction (Endermologie®) has been tried. External application of radiofrequency energy has been tried to tighten the skin and camouflage the contour irregularities (Velashape, Thermage). A specific application of ND:YAG laser energy used in liposuction (Smartlipo) has been re-engineered to target the fibrous bands of cellulite with modest results. More recently, a combination of subcision (aka cutting) and internal radiofrequency energy (Cellfina) has been used to again target fibrous bands. While more effective than past treatments, it does require local and/or tumescent anesthesia, has a moderate downtime, and can leave unsightly scars all over the buttocks.
Surgical solutions for cellulite have likewise produced only average results. I have personally used “pickle fork” cannulas in conjunction with fat grafting of the buttocks (aka BBL) with B-B+ results. Fat grafting alone with improve cellulite, but in some instances, the extra fat can exacerbate it. I do lots of body contouring and probably have the busiest BBL practice in the Carolinas. I have been patiently waiting for a non-invasive solution for cellulite that is safe, effective (with potentially permanent results) and with minimal downtime. That day has finally arrived!

QWOTM is a FDA-approved, injectable treatment for moderate to severe cellulite. QWO, much like Botox, uses the cellular end product of a bacterium (in this case clostridium histolyticum-aaes) to achieve its clinical endpoint. QWO uses a collagenase derived from clostridium histolyticum-aaes to chew up and dissolve the fibrous bands at the core of cellulite. The injection process is as innocuous as a Botox injection. Very fine needles are used to inject each cellulite dimple from three different angles. It is virtually painless, requiring no form of anesthetic. Three treatments are typically required. Downtime is non-existent. Complications are very rare. Most patients see bruising and have slight discomfort (one of our patients likened it to bumping ones’ behind into a countertop). Allergic or hypersensitivity reactions and local reactions can occur, including anaphylaxis, and patients with allergies to collagenases and/or constituents of QWO.

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