Botox®, Dysport®, Xeomin® And Relfydess® Explained: Does Brand Actually Matter?
Updated: 7 days ago
Are there any differences between different brands of Botox®?
Anon, Huapai.
The short answer is yes, but probably not in the way the marketing would have us believe. Botulinum toxin comes in many forms, manufactured differently by different brands. ‘Botox®’ was a clever name coined by Allergan and is still readily available today.
The four Medsafe-approved brands available in New Zealand are Botox® by Allergan, Xeomin® by Merz, and Dysport® and Relfydess® by Galderma. All four use botulinum toxin type A, but their formulation, preparation, approved uses and product-specific dosing are not identical.
Every brand will tell you theirs is best, for the simple reason that they want people to use their product. Interestingly, research around individual brands often returns to the same practical point: dose matters. A higher effective dose generally lasts longer, but it also creates a stronger initial reduction in movement, so the name on the vial cannot be separated from how much is used, where it is placed and what you want your face to do. I think of the brand as one tool in an injector’s toolbox; good tools have different features, but the hand using them still does the work.
Are all Botulinum Toxin brands Medsafe-approved for the same uses?
No. Medsafe approval applies to a particular brand and indication, not botulinum toxin generally. In New Zealand, Botox® is approved for upper facial lines, chronic migraine and primary axillary hyperhidrosis, as well as several other medical conditions.
Dysport® is approved for frown lines, crow’s feet and axillary hyperhidrosis, along with certain spasticity and movement disorders.
Xeomin® is approved for frown lines, crow’s feet and horizontal forehead lines, as well as cervical dystonia, blepharospasm and upper-limb spasticity.
Relfydess® is currently approved for moderate to severe frown lines and crow’s feet.
A doctor may prescribe an approved medicine for a use that is not listed in its data sheet, which is known as off-label use. When this occurs, the reason for using it, the supporting evidence and any relevant safety considerations should be explained as part of informed consent.
What is different about Relfydess®?
Relfydess® is the new arrival and the fourth botulinum toxin brand approved by Medsafe in New Zealand. It contains relabotulinumtoxinA and is approved for the temporary improvement of moderate to severe frown lines and crow’s feet in adults.
Botox®, Dysport® and Xeomin® are each supplied as a powder in a vial and must be reconstituted with saline before use. Relfydess® comes as a ready-to-use solution at a fixed concentration and is also free from complexing proteins. This simplifies preparation, but the injector still has to choose the dose, muscles, injection sites and depth for the face in front of them.
Relfydess® may look similar to Dysport® on a dose chart because the recommended cosmetic dose numbers are the same: 50 units for frown lines and 60 units for crow’s feet. However, the injected volumes differ and the units cannot be converted between brands. ‘More units’ on the label does not mean more toxin or a stronger treatment.
The headline features are its reported quick onset and potential longer duration. The New Zealand data sheet reports onset within one day in up to 39% of people treated for frown lines and 34% treated for crow’s feet, with a median onset of two to three days, and states that an effect was demonstrated for six months. Those figures are encouraging, but ‘up to six months’ is not the same as six months for everyone: in the pivotal trials, the median time before a ‘none or mild’ response was lost sat at roughly 20 to 24 weeks, depending on the study and area treated.
The other catch is that the pivotal READY trials compared Relfydess® with placebo, not equivalent Botox® or Dysport® treatment. They show that Relfydess® works; they do not prove it is automatically better or longer lasting than the established brands. So it is always important to take everything new with a grain of salt; as new products such as Relfydess are indeed intriguing, however aren’t necessarily a magic upgrade.
How do Botox®, Xeomin® and Dysport® differ?
Botox® has the longest and most familiar track record of the group and a wide range of cosmetic and medical indications. That depth of experience is valuable, although it does not mean the brand will automatically create a better cosmetic result when compared with another approved product used at an appropriate dose.
Xeomin® is formulated without complexing proteins, so it is often described as a more purified form of botulinum toxin. Some injectors prefer this option because reducing the amount of foreign protein may theoretically reduce the chance of neutralising antibodies developing over time and subsequent resistance to treatment, although the real-world clinical importance of this difference remains debated.
Dysport® is formulated and dosed differently from Botox® and Xeomin®, and some injectors feel that it diffuses more broadly, which may be useful across a larger treatment area. Others argue the brands behave similarly when their product-specific dose, concentration and injection technique are taken into account. The honest answer is that spread is influenced by several things, including volume, dose, depth and placement, so it cannot be reduced to ‘Dysport spreads and the others do not’.
Botox®, Dysport®, Xeomin® and Relfydess® units cannot be compared directly
This is one of the most important differences and one of the easiest to miss when clinics advertise a price per unit. Each manufacturer measures potency using its own product-specific assay, and the New Zealand data sheets state that the units are not interchangeable. 50 Dysport® or Relfydess® units do not mean the same thing as 50 Botox® or Xeomin® units, so a lower price per unit does not necessarily make one brand cheaper. If you are comparing costs, ask for the total price of the proposed treatment area and plan rather than trying to convert the raw unit number yourself.
So, does the Botulinum Toxin brand actually matter?
Yes, in the sense that an injector must understand the formulation, approved uses, storage, preparation and dosing of the specific product they are using. However, once we are talking about a legitimate product from an approved distributor, the clinical assessment, dose and injection technique usually have more influence on whether the result is balanced and still looks like you.
At ALLOR, I primarily use Xeomin®, Botox® or Dysport® when clinically appropriate. Relfydess® is a newer option with interesting evidence, but I am not in the habit of changing a winning formula simply because a newer vial has arrived.
So there are still many ways to skin a cat. The most important considerations are that your injector uses a genuine product, stores and prepares it correctly, understands its particular dosing, and can explain why it suits your anatomy and goals. Ask what they use and why; if the answer is mostly a brand slogan rather than a plan for your face, that tells you something. Choose the hand holding the tool before the logo stamped on it, and you are far more likely to remain firmly in the driver’s seat.
Quick Answers:
What botulinum toxin brands are available in New Zealand?
The four Medsafe-approved botulinum toxin brands available in New Zealand are Botox® by Allergan, Xeomin® by Merz, and Dysport® and Relfydess® by Galderma.
Which botulinum toxin brand lasts the longest?
Relfydess® currently has product-specific evidence of activity towards five to six months, but there is not enough direct comparative evidence to declare one brand the universal winner. Duration also depends on dose, treatment area, muscle strength and the individual response.
Can Botox®, Dysport®, Xeomin® and Relfydess® units be compared?
No. Their potency units are product-specific and are not directly interchangeable, which also means that price-per-unit comparisons across brands can be misleading. Compare the total treatment plan and cost instead.
What matters more than the brand of Botox® used?
The skill and knowledge of the injector, correct dosing, proper storage, and using legitimate, approved products are more important than brand choice alone.
If you have a question for Dr. Heather you would like answered anonymously, please email askdrheather@allor.co.nz.
Written by Dr. Heather Anderson, MBChB, BSc, FRNZCUC, PGDip Cosmetic Medicine, NZSCM | ALLOR Cosmetic Medicine, Auckland
Updated 13 September 2026
References
Xeomin® (incobotulinum toxin) Prescription Medicine for the treatment of upper facial lines: glabellar frown lines, crow’s feet around the eyes, horizontal forehead lines. Xeomin® has risks and benefits. Ask your doctor if Xeomin® is right for you (incobotulinum toxin A, purified Botulinum toxin type A 50 Units and 100 Units). For product information check with your doctor or Consumer Medicine Information on www.medsafe.govt.nz. Click for further details. Merz, Sydney. Distributed by Healthcare Logistics, Auckland.
Dysport®, Prescription Medicine For the treatment of frown lines and crow’s feet around the eyes. Dysport® has risks and benefits. Ask your doctor if Dysport is right for you. Botulinum toxin type A 300 or 500 Ipsen Units. For product information check with your doctor or Consumer Medicine Information on www.medsafe.govt.nz. Click for further details. Galderma, Auckland.
Botox®, Prescription Medicine For the treatment of frown lines and crow’s feet around the eyes. Botox® has risks and benefits. Ask your doctor if Botox is right for you. Botulinum toxin type A 50, 100, 200 Units. For product information check with your doctor or Consumer Medicine Information on www.medsafe.govt.nz. Click for further details. Allergan, Auckland.
Relfydess®, Prescription Medicine containing 150 units of relabotulinumtoxinA for the treatment of frown lines and crow’s feet around the eyes. Relfydess® has risks and benefits. Ask your healthcare professional if Relfydess® is right for you and to explain the possible side effects. Tell them if any side effects concern you. Always follow the instructions you are given. For details on precautions and side effects, see the Consumer Medicine Information at www.medsafe.govt.nz. Unfunded for aesthetic indications. Product and treatment costs apply. Galderma Australia Pty Ltd. Distributed in New Zealand by Healthcare Logistics, 58 Richard Pearse Drive, Airport Oaks, Mangere 2022.