Relfydess vs Botox: How the Liquid Neuromodulator Compares
Relfydess (relabotulinumtoxinA) is a ready-to-use liquid botulinum toxin approved in many countries but not the US. How its trial results, onset and duration compare with Botox Cosmetic's label, and where it stands with the FDA.
Relfydess (relabotulinumtoxinA) is a botulinum toxin type A made by Galderma. Unlike Botox Cosmetic, it comes as a ready-to-use liquid, so it doesn't need to be mixed before injection. The short answer: it's approved for frown lines and crow's feet in many countries, but as of October 2026 it is not FDA-approved in the US.
This article is for educational purposes only and is not medical advice. We have no commercial relationship with the brands mentioned, and this article is not sponsored. Talk to your dermatologist about your situation.
We don't compare prices or name a winner. Both are prescription treatments; the right choice depends on availability, your provider and your response.
Quick comparison
| Feature | Relfydess | Botox Cosmetic |
|---|---|---|
| Active ingredient | RelabotulinumtoxinA | OnabotulinumtoxinA (label) |
| Form | Ready-to-use liquid (Shridharani et al., Aesthet Surg J, 2024) | Powder reconstituted before use (label) |
| US status | Not FDA-approved; FDA issued a Complete Response Letter in July 2026 (Galderma) | FDA-approved (label) |
| Approved elsewhere | 33 markets as of July 2026 (Galderma) | Widely approved |
| Frown line dose in trials | 50 units (Shridharani et al., Aesthet Surg J, 2024) | 20 units on the label (label) |
The Botox label states its units can't be compared to or converted into units of any other botulinum toxin, so dose numbers can't be compared directly (Botox label).
Relfydess trial results
Frown lines (READY-1): 297 adults were randomized to Relfydess or placebo (Shridharani et al., Aesthet Surg J, 2024):
| Outcome | Relfydess | Placebo |
|---|---|---|
| 2-grade improvement at month 1 (investigator and patient) | 82.9% | 0% |
| None or mild lines at month 1 | 96.3% | 4.5% |
| Reported onset on day 1 | 39% | not applicable |
| Still improved at day 169 | 75% | not applicable |
| Treatment-related side effects | 3.6%, mostly mild | not applicable |
Crow's feet (READY-2): 303 adults (Ablon et al., Dermatol Surg, 2025):
- 2-grade improvement at month 1: 51.8% vs 1.4% with placebo
- Onset on day 1 reported by 34%
- Median time to return to baseline: 24.7 weeks
- Treatment-related side effects: 6.1% vs 5.5% with placebo
Longer follow-up (RELAX, company-reported): in 132 adults, investigator-rated improvement was 98% at month 1, 57% at month 6 and 28% at month 9 (Galderma).
How this compares with Botox
Botox Cosmetic is FDA-approved for frown lines (20 units), crow's feet (24 units), forehead lines and neck bands from the platysma muscle (label). No head-to-head trial comparing Relfydess and Botox has been published that we found, so we can't say one works better.
FDA status explained
- October 2023: first Complete Response Letter, citing manufacturing items.
- February 2026: FDA accepted a resubmission for review.
- July 2026: a second Complete Response Letter, related to a manufacturing site inspection and analytical methods. Galderma said the safety and efficacy parts of the application drew no deficiencies (Galderma).
Until it's approved, Relfydess can't legally be marketed in the US. Be wary of any US clinic offering it.
Side effects of botulinum toxins
All botulinum toxin products carry a boxed warning about distant spread of toxin effect, which can cause swallowing or breathing problems (Botox label). On the Botox Cosmetic label, the most common side effects were eyelid drooping (3%) for frown lines, eyelid swelling (1%) for crow's feet, and headache (9%) and brow drooping (2%) for forehead lines (label). Choose a licensed, experienced injector.
Other US options
Several other botulinum toxins are FDA-approved for frown lines, including Dysport, Xeomin, Jeuveau, Daxxify and Letybo. Each has its own label and dosing; check the label at DailyMed or FDA for any product you're offered.
Frequently asked questions
Is Relfydess available in the US? Not as an approved product as of October 2026.
Does a liquid toxin work faster? In trials, about a third of patients reported onset on day 1. Without head-to-head trials, we can't compare onset with Botox directly.
How long does Relfydess last? In READY-1, 75% were still improved at about six months.
This article is for educational purposes only and is not medical advice. Talk to a board-certified dermatologist about your situation.
Sources
- Shridharani SM et al. Efficacy and safety of relabotulinumtoxinA, a new ready-to-use liquid formulation botulinum toxin: results from the READY-1 phase 3 trial in glabellar lines. Aesthet Surg J. 2024. PubMed
- Ablon G et al. Efficacy and safety of relabotulinumtoxinA liquid botulinum toxin in the treatment of lateral canthal lines: results from the phase 3 READY-2 study. Dermatol Surg. 2025. PubMed
- Galderma. US regulatory update, July 1, 2026; RELAX trial results, January 2025
- DailyMed. Botox Cosmetic prescribing information
