Mechanism of Action

There are three primary factors involved in the development of cellulite:

Depiction of fibrous septae, fat lobule protrusion and dermal thinning.
  1. Fibrous Septae
    These collagen-rich bands tether the dermis to the underlying fascia and segment the fat layer into lobules.7,8
  2. Fat Lobule Protrusion
    The fat lobules push up against the dermis; however, due to the septae tethering, they form mattress-like protrusions on the surface of the skin.7-9
  3. Dermal Thinning
    Dermal thinning occurs, providing less support to contain the underlying soft tissues.7

The exact mechanism for the treatment of moderate to severe cellulite is unknown.1 It is believed that Qwo® initiates a process called Enzymatic Subcision and Remodeling (ESR™), which includes three steps:2

Depiction of enzymatic subcision. #1.

Enzymatic Subcision

QWO treats cellulite by enzymatically subcising the fibrous septae.1,2


Fat Lobule Reorganization

After subcision of fibrous septae, the fat lobules begin to reorganize and spread more evenly.2

The tension at the subdermal junction is released, allowing for fat lobules to be reorganized.2

Depiction of fat lobule reorganization. #2.
Depiction of collagen creation and dermal thickening. #3.

Collagen Creation & Dermal Thickening

The enzymatic breakdown of the collagenous fibrous septae stimulates a wound healing-like reaction that results in the creation of new collagen, which helps thicken the dermis and rebuilds the collagen network.2,10

Over time, the fibrous septae may reform with new collagen, but will be thinner and smaller.2

ESR is believed to minimize cellulite dimples, giving the appearance of smoother skin.2

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Qwo® is indicated for the treatment of moderate to severe cellulite in the buttocks of adult women.

Important Safety Information for QWO


QWO is contraindicated in patients with a history of hypersensitivity to collagenase or to any of the excipients or the presence of infection at the injection sites.

Warnings and Precautions

Hypersensitivity Reactions

Serious hypersensitivity reactions including anaphylaxis have been reported with the use of collagenase clostridium histolyticum. If such a reaction occurs, further injection of QWO should be discontinued and appropriate medical therapy immediately instituted. Advise patients to seek immediate medical attention if they experience any symptoms of serious hypersensitivity reactions.

Injection Site Bruising

In clinical trials, 84% of subjects treated with QWO experienced injection site bruising. Subjects with coagulation disorders or using anticoagulant or antiplatelet medications (except those taking ≤150 mg aspirin daily) were excluded from participating in Trials 1 and 2.

QWO should be used with caution in patients with bleeding abnormalities or who are currently being treated with antiplatelet (except those taking ≤150 mg aspirin daily) or anticoagulant therapy.

Substitution of Collagenase Products

QWO must not be substituted with other injectable collagenase products.

QWO is not intended for the treatment of Peyronie’s Disease or Dupuytren’s Contracture.

Adverse Reactions

In clinical trials, the most commonly reported adverse reactions in patients treated with QWO with an incidence ≥ 10% were at the injection site: bruising, pain, nodule and pruritus.

View Full Prescribing Information for QWO.