Relfydess in Clinical Practice: Six-Month Real-World Reflections

My Relfydess Clinical Experience extends since May 2025 here in the UK. I introduced Relfydess into my practice just over six months ago. Since then, I have treated a broad range of patients within the licensed indications – glabellar lines (GL) and lateral canthal lines (LCL) – and have gathered sufficient real-world experience to form a clear view of how the product is performing outside of the clinical trial environment.

Reassuringly, the outcomes I am seeing in practice mirror those reported in the READY-1 and READY-2 trials, both in terms of onset and duration, as well as patient satisfaction. For any clinician adopting a new neuromodulator, it is always reassuring when published data align closely with everyday experience. In this respect, Relfydess has behaved exactly as expected.

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Onset: What Patients Are Reporting

The onset of action has generally been quicker than many patients anticipate. Some have even mentioned noticing changes on the way home after treatment, although most begin to see visible effects within 48–72 hours.

In practice, I usually explain to patients that:

• Most people experience a noticeably quicker onset of action with Relfydess compared to their previous neuromodulator.
• I am always keen to hear their experience, as individual feedback helps refine expectations for future patients.
• Importantly, I have also seen a small number of outliers in whom the onset has been slower than their usual toxin, so it is vital not to overpromise.

A key clinical observation in my Relfydess Clinical Experience has been in patients whose traditional toxin takes 1–2 weeks to take effect. Relfydess often brings their onset forward by about one week, which in itself contributes to an overall longer period of visible effectiveness.

This earlier activity, while not universal, has been a helpful advantage when discussing treatment timelines.

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Duration: Consistent and Predictable

So far, the longest duration reported in my practice is 5.5 months, with many patients comfortably achieving 4½–5 months before returning for retreatment.

When counselling patients, I emphasise that:

• Most people experience a longer duration of effect, usually 4–6 weeks longer than their previous neuromodulator.
• However, it is essential not to promise “six months of full effect.”
  Patients often interpret this as six months of complete correction, which can lead to dissatisfaction when natural softening begins earlier – as it always does with any toxin.
• Duration varies by individual biology, treatment area, and muscle strength.

The trends I am observing in clinic align well with those seen in Phase III studies, which is reassuring. For many patients who have historically described their toxin as “wearing off too quickly,” this degree of consistency has been particularly valuable.

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Patient Experience and Acceptability

The most frequent comment is a brief stinging sensation during injection, similar to the experience of polynucleotides or Profhilo. Allowing the product to warm to room temperature and injecting more slowly has significantly improved comfort.

Once past this momentary discomfort, patients consistently describe satisfaction both with the natural look and the longevity of the results.

In clinical trials, around 70% of patients preferred the aesthetic outcome at one month compared to their previous toxin. In my Relfydess Clinical Experience, over 90% have reported a preference for their Relfydess result after the first month, compared to their usual neuromodulator (usually Azzalure/Dysport).

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Integration Into Practice

The ready-to-use liquid format has brought several operational advantages:

• No reconstitution
• Faster workflow
• Reduced wastage
• Consistent dosing due to fixed concentration

This has improved efficiency without compromising safety or precision.

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Off-Label Indications: Early Observations

Although my primary use of Relfydess has remained within licensed areas, I have begun to explore off-label territories cautiously, as many clinicians routinely do with other neuromodulators. These observations are early, evolving, and should not be interpreted as definitive guidance.

1. Frontalis Treatment – Still a Work in Progress

The frontalis is widely accepted as one of the most technically challenging areas to treat with any neuromodulator due to the delicate balance required between:

• Avoiding brow ptosis
• Maintaining expression
• Achieving a smooth yet natural aesthetic
• Ensuring durability

My initial approach used similar doses to Azzalure, but with injection points placed approximately 1 cm higher than the convergence line to minimise ptosis risk.

However, over time I observed that:

• Relfydess behaves differently from Azzalure, particularly in terms of field of effect.
• It appears to have a slightly smaller field of effect, meaning that my usual Azzalure injection maps did not produce identical outcomes.
• To reproduce the desired aesthetic effect, I have needed to use more injection points (typically 6–8).
• I have found myself using higher total doses than with Azzalure (40–50 units) to achieve equivalent or improved softening.

This area remains under active refinement, and no consensus yet exists on optimal frontalis dosing patterns for Relfydess. I am continuing to adjust parameters to strike the right balance between longevity and natural expression.

2. Lower Face – Parameters Still Being Evaluated

I have also begun limited exploration of lower face indications off-label, including selective perioral and masseteric treatments.
At present, I am still evaluating dosing behaviour, spread, and durability in these anatomically sensitive regions.

Once sufficient data and consistency have been achieved, I will share further insights. For now, I would recommend that clinicians approach lower-face treatments with particular caution and thorough anatomical considerations, as with any neuromodulator.

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Ideal Patient Profiles Emerging in Practice – Relfydess Clinical Experience

Although Relfydess performs well across a wide range of patients, certain groups appear to benefit especially:

• Patients with historically shorter duration responses.
• Those seeking predictable longevity.
• Patients who value a refined aesthetic outcome with natural dynamism.

So far, in my Relfydess Clinical Experience I have not encountered any safety findings that differ from what would be expected of botulinum toxin type A when used responsibly.

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Looking Forward to developing Relfydess Clinical Experience

Six months into integrating Relfydess into daily practice, my experience has been consistently positive. The alignment between clinical trial data and real-world performance has been reassuring, and patient-reported satisfaction has exceeded expectations.

I will continue to document and refine best-practice approaches, particularly for off-label areas, as more experience and collaborative learning accumulate.

I really do welcome comments on this topic which should help all clinicians enhance their understanding of this new botulinum toxin-A.

(C) Ravi Jain 2025

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