Which Toxin is Which?

Updated 2026 

For the longest time, Botox has dominated the aesthetics market when it comes to botulinum toxin — so much so that the name has become ubiquitous, and basically synonymous with the treatment itself. But there are plenty of other brands out there, and for years there were three main ones quietly competing for space.

The last few years, though, have brought a genuine flurry of new arrivals. When I first wrote this article there were three toxins to keep straight; now there are closer to nine, and — for the first time — they no longer all work in quite the same way. We've had the arrival of ready-to-use liquid toxins, and, most excitingly for the science nerds among us, a completely new type of toxin that behaves unlike anything we've injected before. The names and characteristics get confusing for patients and clinicians alike, so let's set things straight.

Most importantly: for safety reasons it is vital to know which products are actually licensed for use here in the UK, and how to recognise when you might be getting an illegal or counterfeit product. So this time I've included a table you can save and refer back to.

First, a quick bit of science

All botulinum toxins do fundamentally the same job: they temporarily block the chemical signal (acetylcholine) that tells a muscle to contract. Relax the muscle, and the overlying skin creases less — which is why we use them to soften frown lines, forehead lines and crow's feet. But there are a few layers of detail that explain why the brands differ.

Serotypes: the type A family, and the new type E

Botulinum toxin comes in several natural “serotypes,” labelled A to G. Almost every aesthetic toxin you've ever heard of — Botox, Azzalure, Bocouture and the rest — is serotype A. These work by cleaving a protein called SNAP-25 inside the nerve ending, and because the type A fragment lingers, the effect builds over a few days to two weeks and lasts roughly three to four months.

The brand-new arrival, Boey, is serotype E — the first of its kind approved anywhere for aesthetics. Type E also targets SNAP-25, but it is taken up by the nerve far more quickly and its active portion has a much shorter half-life. In plain terms, it switches on fast and switches off fast: onset in as little as eight hours, and wear-off in around two to three weeks. That's a fundamentally different pharmacology, not just a different brand — more on why that's interesting below.

The molecule: complexing proteins and “naked” toxins

The part that actually does the work is a core 150 kDa neurotoxin. In most products this core sits surrounded by accessory (“complexing”) proteins. Some toxins — Bocouture, and the newer purified formulations — strip these away to leave the “naked” toxin. In theory, fewer foreign proteins could mean a lower chance of the immune system learning to recognise and resist the toxin over time. I'll be honest: at the doses we use for cosmetic treatment this remains largely theoretical and unproven, and the complexing proteins fall away within minutes of injection anyway. So while it's a nice talking point, I wouldn't over-weight “purity” in your decision — what makes it work is the toxin, which is essentially the same molecule across the board.

The format: powder versus ready-to-use liquid

Traditionally, toxins arrive as a freeze-dried powder that your practitioner reconstitutes with saline before injecting. The newest innovation is the ready-to-use liquid toxin, which removes the reconstitution step entirely. That means more consistent, reproducible dosing (no room for dilution error) and a bit more convenience in clinic. Alluzience was the UK's first liquid toxin; Relfydess is the newest.

One safety point that applies across all of them: units are not interchangeable between brands. “20 units” of one product is not the same dose as “20 units” of another — Azzalure, for instance, is measured in its own Speywood units. This is exactly why who injects you, and what they're trained on, matters as much as the brand on the vial.

The Original Three

These are the toxins that built the category, and they remain the workhorses of most UK clinics.

Botox — by AbbVie (Allergan)

•   The USP: Heritage and evidence. Around since the 1990s, it has been in use the longest and has by far the largest body of research behind it. It's the product everyone pictures when they think of “getting Botox,” and for many practitioners it remains the default gold standard.

•   The science: onabotulinumtoxinA, a serotype A toxin stabilised with human albumin and sodium chloride. Supplied as a refrigerated powder.

•   UK status: Licensed.

Azzalure / Dysport — by Galderma

•   The USP: Speed and spread. Reported by many to kick in a touch faster, which suits patients who like to see movement soften quickly. It's a smaller protein complex and tends to diffuse a little more widely from the injection point — useful in some areas, something your injector should account for in others.

•   The science: abobotulinumtoxinA, stabilised with human albumin and lactose. Azzalure is the aesthetic twin of Dysport (the name used in the US and for medical indications), and their Speywood units are interchangeable with each other — but not with other brands.

•   UK status: Licensed.

Bocouture / Xeomin — by Merz

•   The USP: The “naked” toxin. It carries the fewest accessory proteins, which some read as a more “pure” product and a theoretically lower resistance risk over years of treatment (again, unproven). A genuine practical perk: it doesn't need refrigeration, which is convenient for clinics.

•   The science: incobotulinumtoxinA, stabilised with human albumin and sucrose. Its therapeutic-use sister product is Xeomin.

•   UK status: Licensed.

The New Generation (still type A)

These are the newer type A brands. Some are well established elsewhere in the world and have only more recently reached the UK; others are genuinely novel formulations.

Nucevia (Jeuveau) — by Evolus

•   The USP: Built purely for aesthetics. Sometimes nicknamed “Newtox,” it was developed specifically with cosmetic frown-line treatment in mind, rather than adapted from a medical product. Performance is broadly comparable to Botox.

•   The science: prabotulinumtoxinA, a serotype A powder. Known as Jeuveau in the US.

•   UK status: Licensed.

Letybo — by Hugel / Croma

•   The USP: A global heavyweight arriving here. Made by Hugel, it is one of the best-selling toxins in South Korea (a huge, discerning aesthetics market) and comes with large, well-run glabellar-line trials behind it.

•   The science: letibotulinumtoxinA, a serotype A powder.

•   UK status: Licensed.

Alluzience — by Galderma

•   The USP: The UK's first ready-to-use liquid. No reconstitution means more consistent dosing straight from the vial, a reportedly quick onset, and — in some patients — longer-lasting results.

•   The science: a liquid formulation of abobotulinumtoxinA (the same toxin family as Azzalure/Dysport), supplied ready to inject.

•   UK status: Licensed.

Relfydess — by Galderma

•   The USP: Next-generation liquid, engineered for purity. A ready-to-use liquid made with Galderma's proprietary PEARL technology, which yields a highly active, protein-free formulation free of human- or animal-derived material. Clinical data point to rapid onset (results from around day one to two) with effect sustained up to six months in the majority of patients.

•   The science: relabotulinumtoxinA, a serotype A toxin — notably, a genuinely new active ingredient rather than a reformulation of an old one.

•   UK status: Licensed (a recent addition, authorised in early 2025).

Daaxify — by Revance

•   The USP: Long duration, novel stabiliser. Its headline claim is a longer-lasting result — up to six months for some patients — achieved using a proprietary peptide stabiliser instead of human serum albumin.

•   The science: daxibotulinumtoxinA, a serotype A powder.

•   UK status: Not licensed in the UK. It is approved in the US but is not currently MHRA-authorised here, so you should not be offered it in a UK clinic.

The New Frontier: a different kind of toxin

Boey — by AbbVie (Allergan)

Boey is the one that genuinely breaks the mould, because it isn't a type A toxin at all. As covered above, it's the first serotype E toxin approved for aesthetics — and that changes what it's for.

•   The USP: “Try before you commit.” Onset in as little as eight hours and wear-off within about two to three weeks make it a genuinely short-acting option — a way for the toxin-curious to preview the effect, or to soften a frown for a specific moment, without a three-to-four-month commitment.

•   The science: trenibotulinumtoxinE, a serotype E toxin. It targets SNAP-25 but with rapid neuronal uptake and a short-lived light chain, giving fast onset and short duration. It was approved for moderate-to-severe frown lines in adults following two Phase 3 trials, with side effects (mainly temporary eyelid or brow droop) reported in well under 1% of people treated.

•   UK status: Not licensed in the UK. Boey received European Commission approval across the 30 EEA countries in July 2026 (and Canadian approval earlier that year), but — and this is the Brexit catch — an EU approval no longer automatically applies to Great Britain. It would need a separate MHRA licence before it could be offered here, so for now it is not a UK treatment.

So, what's actually licensed in the UK?

Here's the quick-reference version. As it stands, there are seven botulinum toxins licensed by the MHRA for aesthetic use in the UK, with two notable products (Daxxify and Boey) available elsewhere in the world but not here.

Status correct as of July 2026. Licensing changes over time, and a product's approval in the US, EU or Canada does not mean it is licensed in the UK.

A word on safety

This licensing question isn't academic — it's the single most important safety check a patient can make. If a product isn't MHRA-licensed for use in the UK, being injected with it here should be a red flag. Be especially careful about illegal or counterfeit products obtained by non-medics who have no legitimate route to a prescription. Botulinum toxin is a prescription-only medicine, and it should always be prescribed and administered by a qualified, regulated medical professional after a proper consultation. If you're a patient wanting to understand the rules, do have a read of my article on the legalities around getting Botox.

The good news is that we're spoilt for choice with genuinely excellent, licensed options — and the science is finally getting interesting again. Whether the right pick for you is a tried-and-tested classic, a convenient liquid, or (once it's licensed here) a short-acting type E, the honest answer is that it should be a conversation, not a brand loyalty. Your practitioner should be choosing the product to suit your face, your goals and your history — not the other way around.

A note on this article: This piece is for general information and education only and is not medical advice. Product names and regulatory status are correct to the best of my knowledge as of July 2026 and may change. Botulinum toxin is a prescription-only medicine with potential side effects and is not suitable for everyone; always seek advice from a qualified medical practitioner.