What Happens to Elisabeth and Sue?

There’s a major price to pay for youth and beauty in The Substance.

Written and directed by Coralie Fargeat, The Substance — which premiered in September 2024 and earned five Oscar nominations — follows Elisabeth Sparkle (Demi Moore), an aging Hollywood actress who is fired from her job as a TV aerobics instructor when she’s deemed too “old” by her sexist boss Harvey (Dennis Quaid).

After a car wreck nearly kills her, Elisabeth is presented with a unique opportunity: to participate in a black market, body-enhancement program known as “The Substance.” Elisabeth can’t resist the program’s promises of youth, beauty and perfection, so she injects herself with a mysterious slime-green liquid.

In a rather gruesome spine-splitting sequence, Elisabeth “births” Sue (Margaret Qualley) — a flawless, “better version” of herself. But there’s a catch: Elisabeth and Sue must switch bodies every seven days, with no exceptions. While one is awake in the world, the other is in a comatose state generating the fluid necessary for their counterpart to stay alive.

When Sue becomes greedy with her time, exceeding seven days on the outside, Elisabeth suffers the consequences, and things take a dark and twisted turn.

So, how did The Substance end? Here’s everything to know about the movie’s final minutes.

Warning: The Substance spoilers ahead!

What happened at the end of The Substance? 

Soon after Sue’s conception, she lands Elisabeth’s old job on TV and skyrockets to fame. She becomes desperate for more time on the outside, so she selfishly steals enough stabilizing fluid (an injection she must give herself once a day) from Elisabeth’s spine to last her three months.

By now, audiences have learned that mere hours past the seven-day deadline has crippling physical effects on Elisabeth’s body, so when Sue is forced to switch bodies after several months, Elisabeth emerges unrecognizable. The elder of the duo then decides to terminate the experience and the program provides a serum that will kill Sue.

Midway through injecting Sue with the serum, Elisabeth has second thoughts and attempts to revive her counterpart. This causes a glitch, allowing both women to be awake at the same time. Sue is furious and ultimately kills Elisabeth.

Without her lifeline, Sue’s body begins to deteriorate — she loses her teeth and her ear — just before she’s set to host a New Year’s Eve show in Los Angeles. She rushes home to inject herself with the original slime-green liquid in the hopes that she will transform again into another, younger, more beautiful self. Instead, this triggers a mutation and Sue gives birth to a disfigured and grotesque monster (Monstro Elisasue).

This terrifying amalgamation of Sue and Elisabeth takes the stage at the New Year’s Eve show, where it is ridiculed by the audience. The monster loses its head (only to grow another) before losing its arm, which sprays the audience with 36,000 gallons of fake blood, according to an Entertainment Weekly interview with Fargeat.

Following the bloody scene, the monster stumbles outside where it explodes — leaving only Elisabeth’s face to slowly crawl to her star on the Hollywood Walk of Fame. It’s there that she finally fades away to nothing but a pool of blood.

What is the monster in The Substance? 

The monster is a mutated version of Elisabeth and Sue — a result of the latter injecting herself with the original activator serum. Its name, Monstro Elisasue, is simply a fusion of both character names.

While speaking to Vulture in February 2025, Fargeat described the ghastly creature as “liberation from the tyranny of image.”

“It’s the moment where [Elisabeth] finds some relief when she has almost no human shape. It’s the first time she looks at herself in the mirror and she doesn’t judge herself in a harsh way,” she continued. “She’s not scared. It’s the moment where she has, for the first time, some tenderness for herself.”

Did Sue and Elisabeth share the same consciousness? 

Elisabeth and Sue are the same person biologically. However, it becomes clear that they don’t share the same consciousness. If that were the case, Sue would be more concerned with Elisabeth’s well-being and refrain from abusing the seven-day switch rule.

“The idea was to suggest a kind of reincarnation. They are the same person, but their minds are different due to their new bodies, which changes their relationship with the world,” Fargeat explained to Nerdophiles in September 2024.

What is the message behind The Substance?

The Substance explores body image and societal expectations for women related to aging — something Moore told The Guardian in September 2024 that she is all too familiar with.

“How violent we can be towards ourselves, how just brutal,” Moore said, recalling the extreme lengths it takes to remain youthful and thin as a young actress and model in Hollywood.

“Self-judgment, chasing perfection, trying to rid ourselves of ‘flaws’ … all of us, if we start to think our value is only with how we look then ultimately we’re going to be crushed,” she added.

For Fargeat, a crisis of self-worth in her 40s ultimately led her to create The Substance.

“I started to have these crazy, violent thoughts that my life was going to be over — it’s the end of being interesting, it’s the end of having any value in society,” she told the Los Angeles Times in February 2025. “It made me realize that if I wasn’t doing something with [those thoughts], it could destroy me.”

“The movie is not about just aging,” Fargeat continued. “It’s about how you’re supposed to look and behave to conform to the idea that society has built of what it is to be a woman. And a huge part of it has been, I think, defined through the eyes of men.”