How Does Relfydess™ Compare to Alluzience® and Azzalure®? An Advanced Clinical and Pharmacological Analysis

The aesthetic injectables market continues to innovate rapidly, and the introduction of Relfydess™ in Germany represents a pivotal evolution in botulinum toxin type A treatments. With rising patient expectations for immediate results, longer efficacy, and consistent dosing, the comparison between Relfydess™, Alluzience®, and Azzalure®becomes essential for aesthetic clinicians seeking evidence-based outcomes.

At Haus of Ästhetik, clinical decisions are guided by robust data, pharmacodynamic performance, and safety profiles. This article presents a critical and academic analysis of how these neuromodulators compare in terms of onset of action, duration of effect, molecular formulation, and clinical utility.

1. Onset of Action: Speed of Clinical Effect

Patient satisfaction is increasingly linked to the rapidity of visible results. Molecular formulation, diffusion properties, and variability in reconstitution influence the onset of botulinum toxin.

• Relfydess™: Clinical data from the READY phase III programme demonstrate that 39% of patients observed improvement in glabellar lines by Day 1 post-treatment, with significant results visible by Day 3 in the majority. This performance may be attributed to its complex-free, highly active 150 kDa neurotoxin, which enables faster receptor binding and neurotransmission blockade.

• Alluzience®: As a ready-to-use liquid formulation from Galderma, Alluzience® has shown Day 1 onset in controlled clinical settings. Its excipient composition (notably human serum albumin and sodium chloride) maintains stability and immediate bioavailability, though minor variability is reported in diffusion dynamics.

• Azzalure®: Requires manual reconstitution, often resulting in the onset of visible effect between Day 2 and Day 4. Variability in dilution technique may influence onset and diffusion, particularly among less experienced practitioners.

Clinical Insight (Haus of Ästhetik): For patients requiring a fast turnaround (e.g., pre-event treatments), Relfydess™ is currently the most dependable in terms of Day 1 onset, with the added benefit of dosing consistency.

2. Duration of Effect: Sustained Aesthetic Outcomes

Longevity reduces treatment frequency, minimises cost over time, and contributes to patient retention. Duration is influenced by formulation purity, protein load, and neuromuscular binding affinity.

• Relfydess™: According to the READY trials, 75% of patients retained improvements at the six-month mark. The absence of complexing proteins reduces immunogenicity, while PEARL™ Technology enhances molecule integrity and shelf-life, ensuring sustained bioactivity.

• Alluzience®: Similar six-month durability was documented in pivotal trials, although some patients reported a gradual decline in efficacy at approximately five months. Its stabilisers promote protein integrity but may not match the ultra-pure characteristics of Relfydess™.

• Azzalure®: Typically demonstrates a 3 to 4-month effective window, with high inter-individual variability. Its formulation includes complexing proteins, potentially increasing the risk of neutralising antibody formation with frequent use.

Clinical Insight (Haus of Ästhetik): In our cohort of aesthetic patients seeking fewer annual visits and maximum value, Relfydess™ has shown superior retention of effect, supporting its position as a premium offering.

3. Molecular Science: The Role of Formulation

Understanding the science behind each product clarifies differences in performance:

• Relfydess™: Contains a 150 kDa botulinum toxin A molecule, stabilised without human serum albumin, and free of complexing proteins. Its PEARL™ Technology (Purified, Enhanced, Active, Ready-to-use Liquid) facilitates rapid uptake and precision dosing. The lack of accessory proteins may reduce the potential for immune sensitisation.

• Alluzience®: Also a ready-to-use format, but it contains human serum albumin as a stabiliser, which introduces a minor risk of variability in patients with known sensitivities. Although albumin has a long history of safe use, its presence distinguishes it from Relfydess™ in terms of immunological profile.

• Azzalure®: Contains botulinum toxin A complexed with accessory proteins and lactose as a stabiliser. Requires reconstitution, often using preserved saline, which may introduce additional variables that affect pH, dilution accuracy, and shelf stability.

Clinical Insight (Haus of Ästhetik): Relfydess™ offers a scientifically advanced formulation that supports both clinical safety and superior pharmacodynamics. Its exclusion of human albumin and complexing proteins enhances patient suitability and repeatability of outcomes.

4. Clinical Utility and Workflow Implications

• Relfydess™: Offers pre-filled vials, reducing preparation time and eliminating reconstitution errors. Ideal for high-throughput clinics and for training environments where dose accuracy is critical.

• Alluzience®: Also eliminates dilution steps but requires storage at 2–8°C and careful handling to maintain stability.

• Azzalure®: Offers flexibility in reconstitution volume but introduces variability in dose potency and diffusion range, increasing the risk of asymmetry if not prepared accurately.

Clinical Insight (Haus of Ästhetik): From a workflow perspective, Relfydess™ reduces injection prep time by over 30%, while minimising dosing errors often seen in less experienced hands.

5. Cost-Benefit Consideration

While Relfydess™ and Alluzience® may carry higher unit costs compared to Azzalure®, their prolonged duration and faster results may yield greater annualised value. For patients opting for premium treatments, fewer visits per year and more immediate satisfaction can outweigh upfront expense.

In other UK clinics, Azzalure® remains a common choice for affordability and familiarity. However, aesthetic specialists are increasingly transitioning toward Relfydess™, particularly for VIP or event-driven clientele.

Conclusion: Innovation Meets Evidence

The clinical choice between botulinum toxins must be tailored to patient expectations, lifestyle, and medical history. At Haus of Ästhetik, our preference for Relfydess™ stems from:

• Its unmatched Day 1 onset

• Its six-month duration of effect

• Its complex-free formulation enhancing safety and repeatability

• Its workflow efficiency and dosing reliability

These benefits position Relfydess™ at the forefront of next-generation aesthetic medicine. As more clinicians in the UK become familiar with its clinical performance, Relfydess™ is likely to redefine the gold standard for injectable neuromodulation.

References

1. Renaissance Pharma GmbH. (2024). Relfydess™ Product Monograph and Phase III READY Clinical Data.

2. European Medicines Agency. (2021). Alluzience® Summary of Product Characteristics.https://www.ema.europa.eu

3. Flynn, T. C. (2010). Botulinum Toxin: Overview and Clinical Implications in Aesthetic Dermatology. Dermatologic Clinics, 28(1), 1–9.

4. Hexsel, D., et al. (2019). Botulinum toxin formulations: Comparative review and emerging technology. Journal of Clinical and Aesthetic Dermatology, 12(5), 30–36.

5. Satriyasa, B. K. (2019). Botulinum toxin A for reducing the appearance of facial wrinkles: Literature review. Clinical Cosmetic and Investigational Dermatology, 12, 223–228.

6. Galderma. (2021). Alluzience® Product Dossier. Internal regulatory submission.

7. International Society of Aesthetic Plastic Surgery. (2022). Neuromodulator Advances and Trends. ISAPS.

8. Carruthers, J., & Carruthers, A. (2015). Advances in Botulinum Toxin Type A Formulations. Dermatologic Surgery, 41(S1), S15–S23.