Compare leading Botulinum Toxins — Nuceiva, Letybo, Botox, Bocouture, Relfydess, Alluzience & Azzalure
Understanding Botulinum Toxin Type A
Botulinum Toxin Type A is a cornerstone of modern aesthetics, used to soften dynamic lines, sculpt facial features, and prevent wrinkle formation. While all brands share the same active neurotoxin, differences in formulation, purity, onset, duration, and usability can significantly affect treatment outcomes, workflow, and cost efficiency.
This guide helps practitioners choose the most suitable toxin based on clinical goals, patient needs, and practice economics.
Quick Comparison Table
Brand | Format | Reconstitution | Average Onset | Duration | Protein Profile | Product License | Value for Money / Efficacy |
Botox | Powder | Required | 3–7 days | 3–4 months | Complexing proteins | Glabellar Crows feet & forehead | + |
Bocouture | Powder | Required | 3–5 days | 3–4 months | No complexing proteins | Glabellar only | +/- |
Azzalure | Powder | Required | 2–4 days | 3–4 months | Contains proteins | Glabellar & Crows feet | + |
Nuceiva | Powder | Required | 2–3 days | 3–5 months | With complex proteins | Glabellar | ++ |
Letybo | Powder | Required | 2–5 days | 3–4 months | With complex proteins | Glabellar | + |
Reflydess | Liquid (ready-to-use) |
| 2–4 days | 3–4 months | Protein-free | Glabellar & Crows feet | + |
Alluzience | Liquid (ready-to-use) |
| 1–2 days | Up to 6 months | Protein-free | Glabellar & Crows feet | + |
NoDetailed brand overview
Botox
Manufacturer: Allergan
Format: Lyophilised powder
Why choose: The gold standard in toxin treatments — backed by 30+ years of data, predictable outcomes, and trusted by clinicians worldwide.
Best For: Practitioners seeking proven reliability, especially in new or high-end clinics.
Considerations: Higher cost; requires reconstitution.
Botox, developed by Allergan Aesthetics, is the world’s most recognised and clinically researched Botulinum Toxin Type A. Approved for both medical and aesthetic use, Botox has become the gold standard in neuromodulator treatments for reducing dynamic facial wrinkles and fine lines.
Since its introduction into aesthetic medicine in the early 2000s, Botox has been trusted by millions of practitioners worldwide for its predictable results, safety profile, and precision. Its longevity and consistency make it the benchmark against which all other toxins are compared.
How it works
Botox works by temporarily blocking the release of acetylcholine, a neurotransmitter responsible for muscle contraction. When injected into targeted muscles, this relaxation softens dynamic facial lines such as frown lines, crow’s feet, and forehead wrinkles — delivering a smoother, more refreshed appearance.
Results typically begin within 3–5 days, with full effect visible around 2 weeks, and lasting for approximately 3–4 months.
Common Aesthetic Uses
- Glabellar frown lines
- Crow’s feet
- Forehead lines
- Brow lift
- Jawline slimming / masseter reduction
- Neck rejuvenation (platysmal bands)
Bocouture
Manufacturer: Merz Aesthetics
Format: Powder, protein-free
Why choose: The only “pure” botulinum toxin — no complexing proteins, lowering immunogenicity risk over long-term use.
Best for: Maintenance clients and toxin-regulars; advanced practitioners.
Considerations: Similar duration to Botox but potentially cleaner profile for repeat users.
Bocouture, manufactured by Merz Aesthetics, is a highly purified Botulinum Toxin Type A designed for precise, reliable aesthetic results. It is the only botulinum toxin formulation free from complexing proteins, setting it apart as one of the purest neuromodulators available on the market today.
This pure formulation minimises the risk of antibody development — making Bocouture a preferred choice for practitioners seeking long-term patient safety, consistent results, and smooth injection performance.
Since its introduction, Bocouture has built a strong reputation among medical professionals for its clinical reliability, low immunogenicity, and natural-looking aesthetic outcomes.
How it works
Bocouture works by inhibiting the release of acetylcholine at the neuromuscular junction, temporarily relaxing targeted facial muscles responsible for dynamic wrinkles.
This relaxation smooths facial lines such as glabellar frown lines, crow’s feet, and forehead wrinkles — creating a refreshed, rejuvenated appearance without altering natural facial expression.
- Onset: Typically 2–3 days
- Peak effect: 1–2 weeks
- Duration: Approximately 3–4 months
Common Aesthetic Uses
- Glabellar frown lines
- Forehead lines
- Crow’s feet (lateral canthal lines)
- Bunny lines
- Perioral lines and lip lift
- Jawline contouring and masseter relaxation
Azzalure
Manufacturer: Galderma
Format: Powder
Why choose: Slightly quicker onset and a wider diffusion — ideal for treating broad facial zones.
Best For: Treating forehead lines, lateral canthal lines, and patients wanting softer, more natural results.
Considerations: Diffusion means less precision in small, targeted areas.
Azzalure is a premium Botulinum Toxin Type A developed through a partnership between Ipsen and Galderma, two leading names in medical aesthetics and pharmaceuticals. Specially formulated for facial aesthetics, Azzalure is a refined version of Dysport, designed to deliver effective, natural-looking wrinkle reduction with smooth, predictable results.
Azzalure has become one of Europe’s most widely used toxins in clinical practice, trusted by practitioners for its proven efficacy, diffusion profile, and consistent patient satisfaction.
Its fast onset and reliable performance make it a go-to choice for practitioners aiming to combine precision with efficiency in aesthetic treatments.
How it works
Azzalure works by temporarily blocking the release of acetylcholine at the neuromuscular junction, leading to relaxation of specific facial muscles that cause dynamic wrinkles.
This results in a smoother, more youthful appearance while preserving natural facial expression.
- Onset: 2–3 days
- Full effect: Around 14 days
- Duration: Typically lasts 3–4 months
Azzalure is supplied as a lyophilised powder for reconstitution and is available in 125-unit vials, allowing for versatile use in upper and lower face treatments.
Common Aesthetic Uses
- Glabellar frown lines
- Crow’s feet
- Forehead lines
- Brow lift
- Bunny lines
- Masseter relaxation
Nuceiva
Manufacturer: Evolus
Format: Powder
Why choose: Designed specifically for aesthetics with smooth consistency and a clean injection profile.
Best for: Glabellar lines, frown lines; clinics wanting a “modern alternative” to Botox.
Considerations: Slightly newer brand; competitive price point; fast onset in 2–3 days.
Nuceiva (Botulinum Toxin Type A) is a next-generation neuromodulator developed by Evolus, designed specifically for aesthetic use. Often referred to as “the modern alternative to Botox,” Nuceiva delivers reliable, precise, and natural-looking results backed by advanced manufacturing standards and extensive clinical data.
Launched in Europe and the UK as part of a new wave of refined toxins, Nuceiva offers high purity, predictable onset, and consistent potency, giving practitioners the confidence to achieve precise aesthetic outcomes and patient satisfaction.
With its balance of efficacy and value, Nuceiva is quickly becoming a favourite among modern injectors seeking both performance and affordability without compromise.
How it works
Nuceiva works by blocking the release of acetylcholine at the neuromuscular junction, temporarily reducing muscle activity that causes dynamic wrinkles.
This relaxation smooths fine lines and expression wrinkles, delivering a rejuvenated, yet natural appearance.
- Onset of action: 2–3 days
- Full results: 7–10 days
- Duration: Approximately 3–4 months
Its consistent molecular structure and potency make dosing and performance highly predictable, simplifying treatment planning for practitioners.
Common Aesthetic Uses
- Glabellar frown lines (frown area)
- Forehead lines
- Crow’s feet (lateral canthal lines)
- Bunny lines
- Brow shaping and lift
- Masseter reduction and jawline contouring
Letybo
Manufacturer: Hugel
Format: Powder
Why choose: Clinical performance similar to Botox at a lower cost, making it appealing for high-volume clinics.
Best for: Forehead lines, frown lines, and cost-conscious practices.
Considerations: Less long-term global data but positive early outcomes.
Letybo is a Botulinum Toxin Type A developed by Hugel Pharma, one of South Korea’s leading biotechnology companies and a global leader in aesthetic medicine. Renowned for its precision, purity, and performance, Letybo delivers natural, smooth, and consistent results — making it an increasingly popular choice among aesthetic practitioners across Europe and the UK.
Originally launched in Asia under the name LetibotulinumtoxinA, Letybo has undergone extensive clinical testing and now holds European Medicines Agency (EMA) approval, confirming its safety and efficacy. It’s designed to meet the demands of modern aesthetic practice — combining proven science with exceptional patient satisfaction.
How it works
Like other Botulinum Toxin Type A products, Letybo works by blocking the release of acetylcholine at the neuromuscular junction, temporarily relaxing targeted facial muscles responsible for dynamic wrinkles.
This muscle relaxation softens expression lines, creating a refreshed, natural look without freezing facial movement.
- Onset of effect: 2–4 days
- Peak results: 1–2 weeks
- Duration: Around 3–4 months
Letybo is available in 50-unit and 100-unit vials, giving practitioners flexibility for a range of facial treatments.
Common Aesthetic Uses
- Glabellar (frown) lines
- Forehead lines
- Crow’s feet
- Bunny lines
- Lip lines and smile refinement
- Jawline slimming and facial contouring
Alluzience
Manufacturer: Galderma
Format: Ready-to-use liquid formulation
Why choose: Next-generation liquid toxin — very fast onset (within 24–48 hours) and duration up to 6 months in some studies.
Best for: Premium clients or those seeking fewer appointments per year.
Considerations: Higher cost, but long-lasting results may increase profitability per patient.
Alluzience works by temporarily blocking acetylcholine release at the neuromuscular junction, preventing muscle contraction and relaxing targeted facial muscles.
This results in the reduction of dynamic wrinkles and expression lines, restoring a more youthful, refreshed appearance — while maintaining natural expression.
Onset of effect: 2–3 days (some see results in 24 hours)
Full effect: 1–2 weeks
Duration: Up to 6 months (longer than most traditional toxins)
Common Aesthetic Uses
Because it is supplied as a liquid, Alluzience eliminates the need for dilution — providing optimal precision, dosing accuracy, and reproducibility between treatments.
Glabellar (frown) lines
Crow’s feet
Forehead lines
Bunny lines
Brow lift and facial balancing treatments
Relfydess
Manufacturer: Galderma
Format: Ready-to-use liquid — no reconstitution required
Why choose: Time-saving, consistent, and eliminates dilution errors. Convenient for busy clinics.
Best for: Practitioners prioritising workflow efficiency and consistent dosing.
Considerations: Slightly higher cost per vial but reduced prep time and waste offset expense.
How It Works
Relfydess® works by blocking the release of acetylcholine at the neuromuscular junction, temporarily relaxing the targeted muscles that cause dynamic facial wrinkles.
This relaxation results in smoother skin and softened facial lines, while maintaining natural expression and balance.
Onset: Typically within 2–4 days
Full results: Around 7–14 days
Duration: 3–4 months on average
Relfydess® is supplied in 100-unit vials, allowing flexible dosing and precise administration for different treatment areas.
Common Aesthetic Uses
- Glabellar frown lines
- Forehead lines
- Crow’s feet
- Bunny lines
- Perioral (lip) lines
- Jawline slimming and masseter relaxation
Key differences & how to choose
Based on the above, here are some of the main decision points for practitioners when selecting which toxin to use:
- Need for speed / onset
- If you need visible improvement quickly (e.g. client before an event), then Nuceiva, Alluzience, or Letybo may offer slightly faster onset in some cases.
- Treatment Duration
- Alluzience (in some data) shows longer duration (up to ~6 months) which can mean fewer retreats. Reflydess is newer but its ready-to-use format may help with consistency.
- Workflow & Preparation
- Ready-to-use liquids (Alluzience, Reflydess) save time, reduce preparation error. Powder forms require reconstitution and more hygiene/control.
- Cost & Value
- Newer brands often enter with competitive pricing vs established names. Consider cost per unit, onset/number of retreatments, patient satisfaction. Consider Nuceiva / Letybo based on cost.
- Unit Conversion & Safety
- Always remember units are not interchangeable. You cannot simply translate “Botox units = X units of Letybo or Alluzience.” Dosing protocols differ. SmPCs and clinical training are essential.
- Clinical Evidence & Experience
- Older brands (Botox, Azzalure, Bocouture) have decades of longer term data. Newer ones are promising, but long-term safety, comparative studies (especially head-to-head), and real-world usage are still emerging.
Choosing the right Botulinum Toxin for your Clinic
| Goal | Best Options | Why |
| Proven & Reliable Results | Botox, Bocouture | Trusted safety record, consistent results |
| Faster Onset | Alluzience, Nuceiva, Letybo | Visible results in 1–3 days |
| Longer Duration | Alluzience | Up to 6 months duration |
| Time Efficiency | Reflydess, Alluzience | Ready-to-use, no dilution required |
| Cost-Effective | Letybo, Nuceiva | Lower vial price, comparable efficacy |
Practitioner tips
- Never convert units between brands. Each has its own potency and clinical profile.
- Stay updated with CPD training on new toxins entering the market.
- Stock multiple brands to tailor treatment plans to patient preference and budget.
- Use ready-to-use options for reduced prep time and increased appointment capacity.
- Track patient feedback — onset, duration, satisfaction — to refine product selection.
Profitability insight
- Average client treatment: £120–£250 per area.The average cost for one area of Botox in the UK is typically between £150 and £350, with prices varying based on the clinic, location, and practitioner’s experience. Some clinics may offer lower prices, with costs as low as £120 for specific areas like the forehead or frown lines, while other areas like the masseters (jaw) or a gummy smile may have higher costs.
- Average cost per 100iu vial: £100–£140
- Gross profit margins:aim for 70–80%, depending on brand and clinic model
Choosing the right toxin impacts workflow efficiency, client satisfaction, and overall clinic profitability — making your purchasing decision a strategic one.
