The new ready-to-use botulinum toxin contains no pearls, oysters or expensive jewellery
Written by Injector Rick, founder and aesthetic practitioner at BONAVADA Aesthetics in Worthing.
A client recently asked me about “Botox with pearl in it”. It sounded like botulinum toxin had been given the champagne-and-caviar treatment, but I think they almost certainly meant Relfydess.
Relfydess is real. PEARL™ Technology is real. The pearls are not.
The quick answer
Relfydess is a newer prescription-only botulinum toxin type A made by Galderma. Its active substance is relabotulinumtoxinA. It is licensed in the UK for temporarily improving moderate-to-severe frown lines and crow’s feet, alone or together, in adults under 65 when the lines have an important psychological impact (Galderma, 2025).
It is not BOTOX®, which is a different brand of botulinum toxin. There are also no pearls in the vial. PEARL stands for Precipitation-free Extraction and Activity-preserving, Refined Liquid, the proprietary process used to manufacture it (Shridharani et al., 2024).
It is supplied ready to use, without mixing with saline. Trials support a median onset of two to three days and an effect lasting into month six for some people. That does not mean everybody sees a result on day one or remains fully treated for six months.
Relfydess is not currently offered at BONAVADA Aesthetics.
What is it?
Relfydess is a complex-protein-free botulinum toxin type A solution. It temporarily reduces selected facial muscle activity so expression lines appear softer.
The approved UK areas are frown lines between the eyebrows and lateral canthal lines, better known as crow’s feet. Treating the forehead or elsewhere would be off-label.
Its units cannot be swapped unit-for-unit with BOTOX, Bocouture, Dysport, Alluzience or another toxin. Toxin maths is not a pick-and-mix counter.
How does it work?
Nerves tell muscles to contract by releasing a messenger called acetylcholine. Botulinum toxin enters the nerve ending and disrupts SNAP-25, a protein needed to release that messenger. With fewer instructions arriving, the treated muscle contracts less strongly until the nerve connection recovers.
PEARL Technology concerns how the toxin is extracted, purified and kept in liquid form while preserving its core molecule. Laboratory research found high biological and enzyme activity, but this was in-vitro work, largely conducted by Galderma scientists. It explains the formulation, but does not prove clinical superiority over rival products (Ståhl et al., 2025).
Think ready-mixed paint, not pearl dust. The product arrives prepared, but the result still depends heavily on the person holding the brush.
What does the evidence actually show?
The UK authorisation was supported by the READY phase III programme. In READY-1, 297 adults with frown lines were randomised to Relfydess or placebo. At one month, 82.9% of treated participants achieved at least a two-grade improvement according to both participant and investigator, compared with none on placebo. Thirty-nine per cent reported some effect on day one (Shridharani et al., 2024).
At month six, 23.6% still had frown lines rated none or mild, while 58.1% retained at least a one-grade improvement. This explains the apparently conflicting claims that “up to 75%” maintained improvement for six months. Not returning fully to baseline is not the same as still having the full month-one result.
READY-2 studied 303 adults with crow’s feet. At one month, 51.8% achieved the two-grade combined response, compared with 1.4% on placebo. Thirty-four per cent noticed an effect on day one. At month six, 23.3% were still rated none or mild (Ablon et al., 2025).
The results are encouraging, but the pivotal studies used placebo, not established toxin brands. Claims that it is categorically “better than Botox” run ahead of the evidence.
What are the risks, limitations or unanswered questions?
Common reported effects include injection-site reactions, headache and, for frown-line treatment, eyelid droop. Brow droop, dry eye and muscle weakness can also occur. As with all botulinum toxins, unintended spread can very rarely cause swallowing, speech or breathing problems requiring urgent care (Galderma, 2025).
It is contraindicated with infection at the injection site, allergy to the product or certain neuromuscular conditions, and should not be used during pregnancy or breastfeeding. Intervals must be at least 12 weeks; repeated use has not been studied beyond 52 weeks.
It is subject to additional UK safety monitoring, normal for a newly authorised medicine.
What should clients know or ask?
Ask which toxin is recommended and why, whether the area is licensed, and what happens if you develop asymmetry, eyelid heaviness or another complication.
If your current toxin gives you a result you like, a shiny new acronym is not automatically a reason to abandon it.
What should practitioners learn?
Ready-to-use does not mean ready-for-anyone-to-use. Practitioners need product-specific training, an appropriate prescription, consent, insurance, cold-chain control and a complication plan.
Its doses, units and licensed areas must be learned from its own product information, not converted from another brand. Each vial is for one patient and one session.
Frequently asked questions
Is Relfydess the same as Botox?
No. BOTOX is Allergan’s brand containing onabotulinumtoxinA. Relfydess contains relabotulinumtoxinA and has its own formulation, doses and units.
Does Relfydess contain pearls?
No. PEARL is the name of Galderma’s manufacturing technology, not an ingredient.
How quickly does Relfydess work?
The median onset in the UK product information is two to three days. In the main trials, 39% noticed an effect on day one for frown lines and 34% for crow’s feet.
Does Relfydess really last six months?
Some effect can remain for six months. Fewer than one quarter still had lines rated none or mild then, so it is not a universal promise.
Is Relfydess better than Botox?
No robust head-to-head clinical trial has proved that. Different products, doses and trial designs cannot be treated as one league table.
My honest opinion
Relfydess is not a gimmick. It is an authorised toxin with good phase III evidence, a practical liquid formulation and interesting onset and duration data.
I am less persuaded by turning “some noticed it on day one” into “it works instantly”, or “some improvement remained at six months” into “everyone only needs treatment twice a year”. Those are marketing upgrades the evidence did not ask for.
Relfydess is not currently offered at BONAVADA Aesthetics. I will watch the real-world evidence, particularly direct comparisons with established products. New is interesting. Better still needs proving.
Written by Injector Rick, founder and aesthetic practitioner at BONAVADA Aesthetics in Worthing.
No oysters were harmed in the making of this blog.
References
Ablon, G., Bank, D., Kontis, T.C., Ibrahim, S.F., Palm, M., Cox, S.E., Rivers, J.K., Grunebaum, L., Goldman, M.P., Humphrey, S. and Coquis-Knezek, S. (2025) Efficacy and Safety of RelabotulinumtoxinA Liquid Botulinum Toxin in the Treatment of Lateral Canthal Lines: Results From the Phase 3 READY-2 Study. Dermatologic Surgery, 51(3), 277-283.https://doi.org/10.1097/DSS.0000000000004470
Accessed 19 August 2026
Galderma (2025) Relfydess 100 units/mL solution for injection: Summary of Product Characteristics. Electronic Medicines Compendium.https://www.medicines.org.uk/emc/product/100710/smpc
Accessed 19 August 2026
Shridharani, S.M., Moradi, A., Donofrio, L., Gold, M.H., Biesman, B., Chiang, M., George, R., Polder, K., Solish, N., Schwarcz, R., Lin, X., Axén, E. and Prygova, I. (2024) Efficacy and Safety of RelabotulinumtoxinA, a New Ready-to-Use Liquid Formulation Botulinum Toxin: Results From the READY-1 Double-Blind, Randomized, Placebo-Controlled Phase 3 Trial in Glabellar Lines. Aesthetic Surgery Journal, 44(12), 1330-1340.https://doi.org/10.1093/asj/sjae131
Accessed 19 August 2026
Ståhl, U., Lekholm, E., Hamnevik, E., Fredriksson, R., Shridharani, S.M., Taghetchian, K., Cohen, J.L., Nestor, M.S. and Liljegren Sundberg, Å. (2025) RelabotulinumtoxinA, a Ready-to-Use Formulation Neuromodulator Manufactured with PEARL™ Technology to Maintain High Biological and Specific Activity. Toxins, 17(10), 501.https://doi.org/10.3390/toxins17100501
Accessed 19 August 2026