The Rise of Ready-to-Use Liquid Toxins: A Deep Dive Into RelabotulinumtoxinA

Earlier this year, the FDA accepted the resubmission of a biologics license application (BLA) for relabotulinumtoxinA (Relfydess), a next-generation neuromodulator developed by Galderma for the temporary improvement of moderate to severe glabellar lines and lateral canthal lines in adults. If approved, the product would enter an increasingly competitive US neuromodulator market while introducing a novel liquid formulation designed to simplify administration and potentially improve treatment performance.

WATCH THE INTERVIEW: Bill Andriopoulos, PhD: Inside the PEARL Technology and Phase 3 Results of Relfydess, How Galderma Is Modernizing Aesthetic Trends and Patient Outcomes Around the World

Innovation Through Liquid PEARL Technology

RelabotulinumtoxinA is distinguished by its first and only ready-to-use liquid format, eliminating the need for reconstitution—a long-standing step associated with variability in neuromodulator preparation. The formulation is produced using proprietary PEARL technology (precipitation-free extraction and activity-preserving refined liquid), a multistep purification platform designed to maintain toxin stability and molecular integrity while removing complexing proteins and other impurities. According to Bill Andriopoulos, PhD, head of global medical affairs at Galderma, the technology represents a departure from manufacturing approaches that have remained largely unchanged for decades.

“While neuromodulators have been used to improve wrinkles for more than 30 years, there has been a historic lack of innovation in this time, meaning patients and health care professionals have had to settle for traditional manufacturing and reconstitution processes that can limit performance, ease of use, and reliability,” Andriopoulos told Dermatology Times.

Unlike traditional neuromodulators supplied as lyophilized powders, relabotulinumtoxinA is manufactured and maintained in liquid form throughout production. This design supports volumetric dosing and removes the need for dilution before injection, which may help reduce variability associated with reconstitution practices and streamline workflow in clinical settings.

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Clinical Evidence From the READY Program

The BLA resubmission is supported by data from the READY (RElabotulinumtoxin Aesthetic Development studY) clinical development program, a phase 3 program comprising 4 trials and enrolling more than 1900 participants with moderate to severe dynamic facial lines. Across these studies, relabotulinumtoxinA demonstrated a rapid onset of action, with some patients showing visible improvement as early as day 1 after treatment. Clinical benefits were maintained for up to 6 months, suggesting the potential for longer intervals between retreatment compared with conventional neuromodulator timelines.

Post hoc subgroup analyses presented at the TOXINS 2026 8th International Conference from January 14-17, 2026, in Madrid, Spain, showed high responder rates and sustained efficacy across patients with moderate or severe baseline wrinkle severity. In addition to physician-assessed end points, patient-reported outcome measures indicated improvements in psychological well-being following treatment, reflecting growing interest in evaluating aesthetic interventions through broader patient-centered metrics.¹

Safety findings from the program were consistent with established neuromodulators. Reported eyelid ptosis rates were low and comparable to existing products, and investigators found no evidence of remote toxin spread. Additional preclinical research examined the pharmacologic properties of relabotulinumtoxinA compared with onabotulinumtoxinA (Botox) in an in vivo rat model at clinically relevant dose ratios. Both agents produced expected muscle inhibition with similarly limited diffusion to adjacent muscles, supporting the safety profile observed in phase 3 trials.²

“This was a very interesting abstract,” Andriopoulos said. “Overall, the preclinical results in this in vivo model help reinforce the safety and performance we’re observing in our clinical trials, but also in the real world.”

Global Availability and Regulatory Outlook

RelabotulinumtoxinA has received marketing authorization in more than 20 countries, including the European Union, the United Kingdom, Australia, and several Asian regions. Regulatory submissions remain ongoing in additional markets as Galderma continues to expand its global neuromodulator portfolio.

In the US, however, the product remains investigational pending FDA review. If approved, relabotulinumtoxinA would represent the first ready-to-use liquid neuromodulator available in the US aesthetic market, potentially addressing injector demand for products that combine rapid onset, sustained duration, and simplified preparation.

“We pioneered the development of relabotulinumtoxinA to address the growing demand for faster-acting and longer-lasting antiwrinkle solutions. We’re excited about the potential to bring this innovative neuromodulator to the US, offering advanced performance and ease of use and building on our portfolio of neuromodulators that meet the full spectrum of injector and patient needs,” Baldo Scassellati Sforzolini, MD, PhD, global head of research and development and corporate development at Galderma, said in a news release announcing the BLA acceptance.³

Shifting Perspectives in Aesthetic Medicine

Beyond the introduction of this neuromodulator technology, Andriopoulos noted that aesthetic medicine is undergoing a broader conceptual shift. Increasingly, treatment success is evaluated not only by wrinkle reduction but also by measures of patient satisfaction, emotional well-being, and perceived skin quality.

“Broadly, we’re moving beyond the question [of] ‘Does it work?’ to a much more holistic understanding of patient experience and satisfaction,” Andriopoulos said. “Efficacy is foundational, of course, but how patients feel about their results is just as important.”

This perspective aligns with a growing emphasis on comprehensive aesthetic care that extends beyond single treatments. Neuromodulators are increasingly incorporated into long-term self-care and maintenance strategies, often combined with other injectable and regenerative therapies. Together, these developments illustrate how innovation in neuromodulators such as relabotulinumtoxinA, alongside evolving treatment philosophies, continues to reshape the landscape of aesthetic dermatology.

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References

1. Kaufman-Janette J, Ablon G, Schlessinger J, et al. RelaBoNT-A treatment of glabellar lines and lateral canthal lines of different baseline severity: subgroup analyses of pooled phase III study data. Presented at: TOXINS 2026 8th International Conference; January 14-17, 2026; Madrid, Spain. Abstract 0080.

2. Nicodèm E. Similar and limited in vivo diffusion for relaBoNT-A and onaBoNT-A. Presented at: TOXINS 2026 8th International Conference; January 14-17, 2026; Madrid, Spain. Abstract 0103.

3. Galderma announces US FDA acceptance of relabotulinumtoxinA biologics license application resubmission. News release. Galderma. February 2, 2026. https://www.businesswire.com/news/home/20260201157212/en/Galderma-Announces-U.S.-FDA-Acceptance-of-RelabotulinumtoxinA-Biologics- License-Application-Resubmission