A practical guide to UK-licensed botulinum toxin products for new injectors
First, the Basics
All aesthetic botulinum toxin products contain the same active ingredient: botulinum toxin type A, a protein produced by the bacterium Clostridium botulinum. Injected in tiny, precisely targeted doses, it temporarily blocks the nerve signal that tells a muscle to contract. The muscle relaxes, and the overlying skin smooths out. The effect lasts 3–6 months depending on the product, dose, area, and patient.
What varies between brands is not the core mechanism, it’s the formulation, the protein complex surrounding the active toxin, the unit system, and the clinical behaviour. These differences matter practically, and understanding them is essential before you treat anyone.
The UK-Licensed Products
As of 2026, there are five botulinum toxin type A products licensed for aesthetic use in the UK:
| Brand | Generic name | Manufacturer | Vial size | Unit type | Key notes |
|---|---|---|---|---|---|
| Botox® | OnabotulinumtoxinA | Allergan / AbbVie | 50u, 100u | International units (IU) | Longest track record. Contains 900kDa complex. Requires refrigeration. |
| Azzalure® | AbobotulinumtoxinA | Galderma / Ipsen | 125u | Speywood units | Slightly quicker onset and wider diffusion than Botox. Aesthetic-specific licence. Requires refrigeration. |
| Bocouture® | IncobotulinumtoxinA | Merz | 50u, 100u | International units (IU) | Only product free of complexing proteins (naked 150kDa neurotoxin). Room temperature storage. 1:1 ratio with Botox. |
| Alluzience® | AbobotulinumtoxinA | Galderma | 125u ready-to-use | Speywood units | Same molecule as Azzalure, in ready-to-use liquid form, no reconstitution needed. |
| Relfydess® | RelabotulinumtoxinA | Galderma | 150u | International units (IU) | Ready-to-use liquid form, no reconstitution needed. Fastest onset (24–48 hrs). Duration up to 6 months in studies. |
| Nuceiva® | PrabotulinumtoxinA | Evolus | 100u | International units (IU) | UK-licensed product. Well established in North America and Asia. Requires reconstitution and refrigeration. |
| Letybo® | LetibotulinumtoxinA | Croma-Pharma (Hugel) | 50u, 100u | International units (IU) | Newer to UK. Market leader in South Korea. EMA-approved. Requires reconstitution. |
A note on Dysport®: it’s the same molecule as Azzalure and Alluzience (abobotulinumtoxinA) but in the UK is licensed for therapeutic use only, hyperhidrosis and muscle spasticity. Azzalure and Alluzience are the UK aesthetic licences for this molecule.
The Most Important Rule: Units Are NOT Interchangeable
The approximate conversion between the two unit systems is:
| Botox / Bocouture (IU) | Azzalure / Alluzience (Speywood) | Clinical notes |
|---|---|---|
| 4 IU | 10 Speywood | Equivalent glabellar dose per site (approximate) |
| 20 IU | 50 Speywood | Typical glabellar total dose (approximate) |
| 20 IU | 50 Speywood | Typical forehead total dose (approximate) |
These are approximations only, not precise equivalents. The exact dose you need may vary between patients, areas, and your clinical technique. Start conservatively, especially when using a new product, and review at two weeks.
A Word on ‘Grey Market’ Products
Which Product Should New Injectors Start With?
This is genuinely a matter of training, clinic preference, and what your prescriber uses. Most Foundation courses teach one product first so you build familiarity and confidence before switching. The key principles for new injectors:
- Learn one product thoroughly before switching between brands
- Know the unit system for the product you’re using, before you reconstitute, not after
- Dose conservatively and review at two weeks. You can always top up; you can’t take it back
- Read the SmPC for every product you use. It’s not optional.
- If your clinic switches products, treat it as a relearning exercise, don’t assume the same doses apply
Product knowledge, including reconstitution, dosing, storage, and unit systems, is covered in depth on all Acquisition Aesthetics Foundation and Intermediate courses. You won’t be left to figure this out on your own.
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