The Substance ending explained

What happens

Sue's body fails, and a second dose creates Elisasue, a monstrous composite sent on stage for the New Year's Eve crowd. They scream, and she is destroyed. Elisabeth crawls to her Hollywood star, dies imagining her glory days, and a cleaner washes her away.

The last image

A cleaner washes the remains off Elisabeth's star on Hollywood Boulevard, leaving the pavement clean.

What it says

The audience cannot love what the beauty standard has made. Elisabeth dies still chasing applause, and the city erases her without a thought. That is the film's point: it was never only Harvey's cruelty, but a hunger for approval that consumed her.