The Substance ending explained: what happens to Elisabeth and Sue?

Demi Moore in The Substance
Demi Moore in The Substance (Image credit: Mubi)

If there was a contest for the most outrageous 2024 new movie, we might have to call it after seeing The Substance. The body horror movie starring Demi Moore and Margaret Qualley, written and directed by Coralie Fargeat, is something you have to see to believe. But even if you've seen it, it's totally reasonable to have some questions about what the heck happens. So let us help with a breakdown of The Substance ending.

Fair warning, we are getting into key SPOILERS for The Substance, so if you haven’t yet watched the movie go ahead and do that and then come back and read this piece. And if you need any final convincing to see the movie, read our glowing review for The Substance.

The Substance stars Moore as Elisabeth Sparkle, an actress whose career is being phased out now that she has turned 50. Distraught at her fate, she is told about a mysterious product, "the substance," that is said to create a "more perfect you." Believing she has no other options, Elisabeth takes the substance, which creates a new version of herself, a younger and unrecognizable self, known as Sue, played by Qualley. (The substance is supposed to take the best parts of you and enhance them, which explains why Qualley doesn’t look like a young Demi Moore)

There's a trick to making sure this Faustian bargain works, though. While Sue is awake, Elisabeth's body is unconscious but provides stabilizing fluids for Sue. That lasts for seven days, at which time Sue goes unconscious and Elisabeth wakes back up for her own seven-day period. The mysterious company behind the substance stresses that the seven day balance must be respected for optimum results; they also note Elisabeth and Sue are not different people, they are one.

Sue makes the most of her seven days. She gets Elisabeth's old job as a TV fitness instructor from TV network executive Harvey (Dennis Quaid) and quickly becomes a sensation. Meanwhile, Elisabeth uses her seven days to mostly stay out of sight, save for going to get refills of the nutrition needed when she is unconscious.

As Sue gets more famous, she begins to want more time than just the seven days. She decides to do one more day, taking another injection of stabilizer from Elisabeth. However, when they switch the next day, Elisabeth notices one of her fingers has aged dramatically, looking like an old woman's. She calls the company and they explain the extra day caused that and it can't be reversed, but if she respects the balance then it shouldn't be a problem.

But as Sue gets more confident, Elisabeth becomes more isolated, even refusing to go out on a date because she can't overcome her self-doubt over her looks, especially compared to Sue. This leads to each side resenting each other, and Sue eventually opting to add more days to her rotation, causing Elisabeth to age even more.

So how does it all play out and what does it all mean? Read on for our explanation.

What happens to Elisabeth and Sue?

Demi Moore in The Substance

Demi Moore in The Substance (Image credit: Mubi)

Sue's career continues to skyrocket, including getting to host the network's New Year's Eve show. Fed up with how she feels Elisabeth is treating herself and wanting to bask in her new found fame as much as she can, Sue makes the decision to not switch at all for three months, continuously taking the necessary stabilizing fluid from Elisabeth.

That is until the morning of the New Year's Eve show. Sue begins to feel the effects of the stabilizer wearing off, but when she goes to get more there isn't any left. She calls the company and they tell her she can't just get more stabilizer fluid, she has to switch and let the fluid regenerate inside Elisabeth. Sue has no choice, making the switch. When Elisabeth wakes up, she is fully transformed into a decrepit woman, bald and creaky. Furious, Elisabeth calls the company to end the cycle, which as the main host (or matrix, as the company refers to her), she alone can do.

She gets the necessary equipment, drags Sue's body into the living room and plunges the syringe into her. But Elisabeth can't go through with it. Instead, she begins the switching process to save Sue. This works, but now they are both awake. When Sue sees the syringe and realizes Elisabeth tried to kill her, she goes berserk, ultimately killing Elisabeth.

The show must go on for Sue, as she heads to the studio to prepare for the New Year's Eve show. However, with Elisabeth dead and no stabilizer left, Sue begins to deteriorate; literally, her teeth and other parts of her begin to fall off. That's when Sue gets an idea.

She rushes home and finds the original vial of the substance. Ignoring the warning label that it should only be used once, Sue injects herself in the hope it will recreate her beautiful self in time for the show. But that's not what happens. Instead, it creates a deformed being with multiple eyes, arms in the wrong place and even Elisabeth's original face on its back. Still, this new version wants to perform on the New Year's Show, using a cutout of Elisabeth's face to hide her grotesque new appearance.

Once on stage, the mask falls off and the audience reacts in horror, with members of the audience attempting to kill her and spewing blood all over the audience. However, the substance allows her to regenerate. She eventually is able to escape the studio and onto the Los Angeles streets.

But without stabilizing fluid, this new version breaks down and eventually explodes. The last bit that survives is Elisabeth's face, which lands on the Elisabeth Sparkle Walk of Fame Star before deteriorating and being wiped up by a sidewalk sweeper the next morning.

What does The Substance ending mean?

As for what The Substance is trying to say, our read of the movie is a takedown of female beauty expectations and ageism, particularly in the world of entertainment.

Before Elisabeth takes the substance, she is being phased out and largely ignored simply because she is 50 and no longer fits into what the TV world defines as beautiful and/or sexy. But as soon as Sue comes onto the scene, entirely out of nowhere, the red carpet is rolled out because her sex appeal is obvious (and something the TV network exploits). Elisabeth then constantly compares herself to Sue, crippling her self confidence.

On the issue of ageism, again, Elisabeth is 50, but the world is seemingly telling her that her time is over. After Sue becomes a star, Elisabeth is rarely spoken of, and if she is it is often negatively. It is this negative treatment that leads to her taking the substance in the first place and putting this gory journey into motion. All of which leads to Elisabeth and Sue's mutual destruction as they have been forced into believing that your value decreases as you age and you no longer meet the male-defined standard for beauty.

You can now watch The Substance exclusively in movie theaters in the US and UK.

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Michael Balderston

Michael Balderston is a DC-based entertainment and assistant managing editor for What to Watch, who has previously written about the TV and movies with TV Technology, Awards Circuit and regional publications. Spending most of his time watching new movies at the theater or classics on TCM, some of Michael's favorite movies include Casablanca, Moulin Rouge!, Silence of the Lambs, Children of Men, One Flew Over the Cuckoos Nest and Star Wars. On the TV side he enjoys Only Murders in the Building, Yellowstone, The Boys, Game of Thrones and is always up for a Seinfeld rerun. Follow on Letterboxd.