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Unlike Elisabeth—who is consumed by insecurity and self-loathing nostalgia—Sue (played by Margaret Qualley) is brimming with the fearless confidence of youth and beauty. At first, her creation seems to be a successful attempt by Elisabeth to regain her lost glory. However, as the film progresses, it becomes clear that Sue is not simply a new vessel for her creator’s consciousness. Rather, she is her own person, and she has no intention of living for Elisabeth if she can help it. 

From the moment Sue emerges from Elisabeth’s body, the film makes it clear that she’s got the star quality that Elisabeth fears she has lost. People stop to stare at her as she walks, and her shining waist-length hair bounces as she walks through the tangerine-filtered LA sunlight. While Elisabeth views herself as a victim of an industry that has discarded her, Sue sees opportunity everywhere. She has no reason to believe she shouldn’t be able to do or get exactly what she wants. When she auditions to replace Elisabeth on television, she doesn’t hesitate or question whether she deserves the role—she simply takes it because it’s offered to her. Her success comes easily because she’s exactly what men like Harvey and the auditioning producers want. She possesses Elisabeth’s previous beauty and talent without any of its baggage. She’s a shiny, perfect mannequin for the world of Hollywood to pose and admire.  

Sue’s rapid rise to stardom happens on the back of Elisabeth’s concurrent decline. While Elisabeth becomes a recluse, resentful and self-loathing, Sue explodes into a life full of fame and adoration. The stark difference between their personalities suggests that youth alone does not explain Sue’s dominance over Elisabeth—she is not just a younger Elisabeth, she’s someone entirely different. She does not fear irrelevance because she has never experienced it. 

Sue’s fatal flaw, however, is her arrogance. As the two “versions” of Elisabeth switch consciousness each week, Sue gets very impatient, very quickly. She does not want to share her body or her life, especially not with Elisabeth, whom she sees as pathetic. The stabilizer fluid that she extracts from Elisabeth’s spine allows Sue to remain in control over her body. However, by exceeding the seven-day maximum and stealing more than her allotted amount of consciousness, she accelerates Elisabeth’s deterioration. She justifies her actions to herself by framing Elisabeth as weak and self-pitying, shouting in one angry scene that Elisabeth is wasting her time being alive. Sue is terrified of losing the life she has created. 

She refuses to believe she and Elisabeth are “one,” The Substance’s cardinal rule. Sue distances herself further from Elisabeth and her recklessness escalates. She stockpiles stabilizer fluid, leaving Elizabeth unconscious in her hidey-hole and ignoring the consequences. When she eventually has to switch back—Elizabeth now reduced to a haggard, near-death crone—Sue refuses to surrender. The moment Elisabeth hesitates in killing her, Sue seizes the opportunity and eliminates her without remorse. When she bludgeons Elisabeth to death it’s as though she’s taking out her anger and frustration for Elisabeth’s self-hatred on her pulverized corpse.  

Without Elisabeth’s body producing stabilizer fluid, Sue’s own form begins to deteriorate at an accelerated rate. She attempts to fix the problem by using the activation serum again, despite the clear, repeated warnings that it can only be used once. The result is catastrophic. Instead of restoring herself, Sue transforms into a monstrous fusion of both her and Elisabeth—"Monstro Elisasue," a grotesque and deformed figure that is neither young nor old, neither Sue nor Elisabeth. This horrifying mutation is the literal representation of Sue’s and Elisabeth’s soul-destroying fixation on achieving an unchangingly beautiful body.

Sue, once the glowing embodiment of youthful perfection, ends up as an unrecognizable monster. Sue’s story is an indictment of the same industry that created Elisabeth’s tragic flaws. Where Elisabeth represents the inevitable pain of actresses discarded by Hollywood after they “age out” of roles, Sue represents the illusion of effortless success. She embodies everything that society values—beauty, youth, and charm—but her fate proves that these qualities alone are fleeting. She is just as much a victim in The Substance as Elisabeth, not because she ages, but because she believes she is above the rules. 

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