PracticalDermatology

Endo Aesthetic’s Qwo (collagenase clostridium histolyticum-aaes or CCH) became the first injectable treatment for moderate to severe cellulite of the buttocks in adult women when the FDA approved it last summer. The product is launching in coming months.

Qwo targets and lyses collagen septae that tether the skin to reduce dimpling and smooth skin.

Ahead, clinical trial investigator Joely Kaufman, MD discusses that treatment and shares how she plans to market it in her practice.

With the launch of Qwo imminent, what do you foresee as the role for this agent in your practice? How are you planning to market the treatment?

Joely Kaufman, MD: Not only is cellulite common, but a recent Harris Poll survey of 2,006 women revealed that nearly half of those affected are bothered “a great deal” or “a lot” by their cellulite. As a dermatologist, I hear these complaints, and, in the past, have had little to offer for a solution. Creams and devices have been inconsistently effective with only short-term improvements. I think that once the word gets out that we have a treatment for cellulite that has been studied in the largest clinical trial to date, women will want to try it.

We use social media and other digital avenues to reach our patients, especially right now in the time of COVID. I also think that once patients have been treated they will spread the word among their friends.

I think I can confidently say as a physician in aesthetics that we are all very excited to have a new and effective treatment for cellulite. Qwo is the first FDA approved injectable for the treatment of cellulite in the buttocks of adult women. This should be available in our offices in the spring of this year.

What is treatment like for the patient? How much training do injectors need?

Dr. Kaufman: As one of the investigators in the Qwo trials for the last four years, I have had the opportunity to inject and see the results first-hand. The injection process is fairly quick and is done with a very small needle, so it does not require anesthesia of any kind. Since there are various types of cellulite, injectors need to be trained on identifying those patients who would benefit from treatment with Qwo. Those patients with dimple type cellulite respond the best to the injections.

Any limitations on who can get treatment? Is there downtime or a recovery period?

Dr. Kaufman: In the clinical trials, the majority of patients experience bruising with the first treatment session. This is related to the action of the CCH itself and not to the process of injection. There is no need to limit activity as the bruising is related to the mechanism of action of QWO (reorganization of subdermal tissue may lead to reduced structural support and breakage of blood vessels) and not the needle injection. After QWO is injected, Enzymatic Subcision and Remodeling, or ESR™ begins. There are three components of ESR: enzymatic lysing of mature, collagen-rich septae, stimulation of neocollagenesis and fat lobule reorganization.

ESR is believed to initiate as the enzyme works on the collagen in the fibrous septae to release the cellulite dimple. With the fibrous septae detached, fat lobules begin to reorganize and spread more evenly. This enzymatic activity stimulates neocollagenesis. This collagen support network rebuilds itself in the extracellular matrix with thinner, smaller septae.

These subdermal changes reduce the tension and help thicken the dermis, which yields a smoother appearance.

How will you educate patients about treatment? What is the typical treatment regimen?

Dr. Kaufman: Recommendations are for a total of three sessions spaced approximately 21 days apart. The bruising decreases with each session, so really it’s the first session that patients need to be counseled for. In the studies, bruising was resolved by the next treatment session in most patients.

Do you foresee combining Qwo with any other cellulite treatments or leg treatments?

Dr. Kaufman: Qwo targets the dimples associated with the appearance of cellulite. Other components, such as skin laxity, which may accompany cellulite, would be best addressed with other treatments like radiofrequency.