Compare · Procedures

Botox vs Fraxel

Botox: An injection that temporarily weakens specific facial muscles, so the lines those muscles make soften. It wears off in about three to four months. It does not fill, lift, or improve the quality of the skin.

Fraxel: A laser that heats thousands of microscopic columns in the skin and leaves the skin between them untouched. Used for sun damage, acne scars, and rough texture. It takes a course of treatments and a few days of looking sunburned each time.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
Last updated: 10/22/2026
Editorial illustration for Botox, based on the entry’s treatment or equipment reference.Editorial illustration for Fraxel, based on the entry’s treatment or equipment reference.
Choose ifKey differencesWhat is it?What it treatsTreatment areasSkin tonesHow it worksBefore your treatmentDay of treatmentAfter your treatmentRisksCostQuestionsRelated

Choose Botox if…

Choose for lines that appear when you move — frowning, squinting or raising your brows.

  • Frown lines, crow's feet, forehead lines
  • You want no downtime
  • You're fine with a visit every 3–4 months

Choose Fraxel if…

Choose for acne scars or sun damage with a few days of downtime per session instead of the week-plus of ablative lasers.

  • Rolling or boxcar scars
  • Sun spots and rough texture
  • You can plan 3–5 sessions
Often combined

Can you have both?

A common pairing: Fraxel improves texture and fine lines while Botox relaxes expression lines. Space them about 2 weeks apart.

Key differences

● Botox
● Fraxel
DowntimeNone → 2+ weeks
None
3–7 days
PainMinimal → Needs anesthesia or sedation
Minimal
Moderate
Results showImmediately → 3+ months
Within days
1–3 months
How long it lastsWeeks → Years or permanent
3–6 months
Years or permanent
Visits neededOne → Every few months
Every few months
A longer series (4–6+)
Cost per visit$ → $$$$$
$$
$$$
ReversibleYes, can be undone → No, permanent
No, wears off
No, permanent

What is it?

Botox

Fraxel

What is it?

It is a botulinum toxin.

Botox is the brand name for onabotulinumtoxinA, given by a trained clinician.

It relaxes selected muscles.

Its effect on muscle activity is temporary.

It is not a filler.

It does not add volume.

Health history matters.

Neuromuscular disease, swallowing problems, pregnancy and previous toxin treatment should be discussed.

It is a nonablative fractional laser.

Fraxel heats microscopic zones while sparing skin in between.

Platforms differ.

Wavelength and device determine the treatment.

It is not CO2 resurfacing.

It is less intensive than ablative lasers.

It is not risk-free.

Burns, redness and pigment changes can occur.

What it treats

Evidence level
Botox
Fraxel
Strong evidenceMost established uses
A relaxed forehead with faint shallow horizontal fine lines.

Wrinkles and Fine Lines

Smooths frown lines and crow's feet.

Moist palms with visible perspiration.

Hyperhidrosis

Stops underarm sweating for months.

Acne scarring on light skin. Small sharply cut pits and broad shallow dips across a cheek, several sitting inside faint flat pink marks, with no active spots.

Acne Scarring

Improves rolling and boxcar scars.

AI-generated educational illustration of Sun Spots: 1. Sun Spots Header — Light Skin; Lighter skin. Not a clinical photograph.

Sun Spots

Clears sun damage.

Moderate evidenceSome supportive research
—
A relaxed forehead with faint shallow horizontal fine lines.

Wrinkles and Fine Lines

Smooths texture.

Limited evidenceEarly or small studies
Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Small studies show less flushing.

Flat tan patches with soft irregular edges across the forehead and upper cheek of an adult with light skin, the surface completely smooth.

Melasma

Low settings may help some.

Little evidence
A relaxed forehead with pronounced deep horizontal furrows.

Deep Wrinkles

Lines at rest may need filler.

Ice Pick Scars on light skin.

Ice Pick Scars

Too deep for most sessions.

Not effective
Sagging Skin on light skin.

Sagging Skin

Doesn't lift loose skin.

Volume Loss on light skin.

Volume Loss

Doesn't add volume.

—
Can make it worse
—
Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Can worsen redness.

Treatment areas

Treatment areas

Forehead, between the brows, crow’s feet and underarms.

Face and hands.

Skin tones

Skin tone
● Botox
● Fraxel
Lighter skin
Low risk
No pigment change expected.
Low risk
Redness and swelling for days.
Medium skin
Low risk
No pigment change expected.
Some risk
Dark marks possible; lower settings help.
Deeper skin
Low risk
No pigment change expected.
Some risk
Safer than ablative lasers at lower density with an experienced provider.

How it works

Botox

Fraxel

How it works
Botox mechanism diagram. Placed near nerve endings: A clinician injects botulinum toxin into selected muscles. Reduces signal release: The treated nerve ending releases less acetylcholine. Muscle activity relaxes: Movement-related lines can soften as contraction decreases.
Fraxel DUAL diagram: 1927 nm reaches up to 0.3 mm and 1550 nm up to 1.6 mm, depending on settings.
Diagram explanation

Placed near nerve endings: A clinician injects botulinum toxin into selected muscles. Reduces signal release: The treated nerve ending releases less acetylcholine. Muscle activity relaxes: Movement-related lines can soften as contraction decreases.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

Fractional heat zones leave surrounding tissue untreated. Superficial 1927 nm treatment helps fade uneven pigmentation; deeper 1550 nm treatment triggers repair and collagen remodeling.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

Before your treatment

Botox
Fraxel
2–4 weeks before

Planning: Timing: Allow at least 2 weeks before an important event; results settle in 10–14 days and bruises may last a week.

4 weeks before: Sun: Avoid tanning, self-tanner and sunburn.

Pigment preparation: For deeper skin tones, providers may prescribe a pigment-lowering cream for 2–4 weeks and test near the ear.

The week before

Preparation: Medicines and alcohol: Ask about fish oil, vitamin E and ibuprofen; avoid alcohol for 24 hours.

A few days before: Bruising and alcohol: Never stop a prescribed blood thinner on your own.

Cold sores: Tell your provider; preventive antiviral medicine often starts the day before.

Hair removal: Stop waxing, threading and hair-removal creams.

Actives: Stop retinoids, retinol and acids 3–7 days before.

Day of treatment

Botox
Fraxel
Before you arrive

What to bring: Arrive with a clean face, reference photos and clear treatment goals.

Arrive with clean skin and no makeup.

Arrange a ride if you will have strong settings or oral pain medicine.

Arrival & prep

You say what bothers you while the injector watches your face move.

Skin is cleaned and photographed. Numbing cream stays on for 45–60 minutes.

Treatment

The skin is cleaned, then small injections go into the chosen muscles, a few in each area.

The visit runs 10 to 20 minutes. Each point is a sharp sting, then it is over — most people rate it below a blood test. The forehead and between the brows are the most sensitive.

The laser passes over the skin while cold air cools it.

Expect prickly heat that builds with each pass, often strongly uncomfortable—especially on the forehead and around the mouth.

Before you leave

Small raised bumps like insect bites settle within about 20 to 30 minutes.

Skin feels hot, red and swollen. Ice packs and a bland ointment are usually applied.

After your treatment

Botox
Fraxel
First 24 hours

Days 1 to 3: A few people bruise, usually near the eyes.

Days 1–2: Redness and swelling, especially around the eyes.

Days 2–7

Days 3 to 5: Movement feels different — heavy, or a muscle that will not quite fire.

Days 10 to 14: The true result.

Days 3–7: Rough, bronzed skin flakes away. Do not scrub or pick.

Beyond 1 month
Not specified

1–3 months: Time to results.

Scar improvement can last years; sun damage can return with sun exposure.

Time to results

Starts in 3–5 days, full at 2 weeks

Not specified
How long results last

3–4 months

Not specified

Risks

Risks
  • A droopy upper eyelid
  • A heavy or dropped brow
  • Unevenness
  • A headache or a flu-like day or two
  • A lump or bruise that is not settling
  • Dry, gritty eyes or double vision
  • Dark patches
  • Worsening redness
  • Cold sores
  • Acne or white bumps
  • Lighter patches

Cost

Per session

In the US it is priced per unit or per area.

About $900–1,500 for a full face in the US. Smaller areas cost less.

Insurance

Insurance does not cover cosmetic use.

Cosmetic treatment is not covered. Coverage for surgical or injury scars is uncommon.

Full course
Not specified

Several thousand dollars. Packages may reduce the per-session price.

Questions

Botox

Fraxel

Individual Questions
How long does it last?

Three to four months for most people and areas. The jaw muscle and underarm sweating last longer. Fading is gradual, so movement returns over a few weeks.

Does it hurt?

A sharp sting for a second or two per injection, several times. Most people find it easier than expected and skip numbing.

Will I look frozen?

Only if the dose says so. Amount and placement decide how much movement you keep, and a lighter dose at a first appointment is reasonable. You can add more at two weeks; you cannot take any away.

What if I do not like the result?

There is no antidote, so it has to wear off over weeks to a few months. Some problems can be balanced with a few extra units elsewhere, which is why starting conservatively is safer.

Is it safe long-term?

Decades of medical use at doses far larger than cosmetic ones, with no pattern of lasting harm. The main reported change is treated muscles getting somewhat weaker over years, which is the intended effect.

How many units do I need?

That depends on the muscle and the face, not a standard number. As a rough reference, frown lines between the brows are commonly treated with about 20 units of one common brand. Units are not comparable between brands, so ask which product is used.

How many Fraxel sessions will I need?

Three to five, two to four weeks apart. Sun damage sometimes needs fewer, acne scars usually need the full course, and deeper skin tones are treated at lower settings, which means more sessions.

Does Fraxel get rid of acne scars?

It improves them rather than removing them. Studies of nonablative fractional lasers show partial improvement in scar depth and appearance over a course. Deep icepick scars respond least and are often better treated by combining the laser with subcision or filler.

How much downtime is there really?

Plan for a week. Two days of redness and swelling, then a few days of rough, bronzed skin that flakes off. Most people cover it with makeup from day three and look normal by day seven.

Does it hurt?

With an hour of numbing cream and cold air, most people call it hot and strongly uncomfortable rather than unbearable, and it stops as soon as the laser does. The forehead and around the mouth are the worst.

Is it safe for deeper skin tones?

It can be done, but differently. The main risk is temporary dark patches. Lower settings, more sessions, pre-treatment creams and strict sun protection all lower that risk, and the provider experience with your skin tone matters more than the device.

Is Fraxel the same as CO2 laser?

No, though one device sold under the Fraxel brand is a carbon dioxide laser. The Fraxel most people mean is nonablative, heating the skin without removing the surface. A carbon dioxide laser removes tissue, does more per session, and brings one to two weeks of downtime and more pigment risk.

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