Botox vs Ultherapy

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.

Ultherapy: Focused ultrasound delivered through the skin to heat small points in the deeper layers, so the body lays down new collagen over the following months. It gives a mild tightening of loose skin on the brow, jawline and neck. It is not a facelift, and the treatment itself is painful.

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 Ultherapy, based on the entry’s treatment or equipment reference.

Choose if Key differences What is it?What it treats Treatment areas Skin tones How it works Before your treatment Day of treatment After your treatment Risks Cost Questions Related

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 Ultherapy if…

Choose for a mild lift of the brow, jaw or neck without surgery or downtime — not a facelift, and the treatment hurts.

Early, mild sagging
No downtime is essential
You accept a modest, gradual result

Often combined

Can you have both?

A common pairing: Ultherapy lifts sagging skin while Botox relaxes lines. Many clinics do Ultherapy first and Botox afterwards.

Key differences

● Botox

● Ultherapy

DowntimeNone → 2+ weeks

None

PainMinimal → Needs anesthesia or sedation

Minimal

Significant

Results showImmediately → 3+ months

Within days

1–3 months

How long it lastsWeeks → Years or permanent

3–6 months

6–12 months

Visits neededOne → Every few months

Every few months

Yearly top-ups

Cost per visit$ → $$$$$

$$$$

ReversibleYes, can be undone → No, permanent

No, wears off

No, fades slowly

What is it?

Botox

Ultherapy

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 uses focused ultrasound.

Ultherapy heats selected tissue depths under visualization.

It targets skin laxity.

It is used for selected concerns about loose skin.

It is not a facelift.

It does not remove excess skin.

Operator skill matters.

Energy placed in the wrong tissue can cause injury.

What it treats

Evidence level

Botox

Ultherapy

Strong evidenceMost established uses

A relaxed forehead with faint shallow horizontal fine lines.

Wrinkles and Fine Lines

Smooths frown lines and crow's feet.

Hyperhidrosis

Stops underarm sweating for months.

—

Moderate evidenceSome supportive research

—

Sagging Skin

Mild lift of brow and jaw.

Limited evidenceEarly or small studies

Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Small studies show less flushing.

—

Little evidence

A relaxed forehead with pronounced deep horizontal furrows.

Deep Wrinkles

Lines at rest may need filler.

Deep Wrinkles

Limited change on deep folds.

Not effective

Sagging Skin

Doesn't lift loose skin.

Volume Loss

Doesn't add volume.

Volume Loss

Doesn't add volume.

Acne Scarring

Doesn't change scars.

Treatment areas

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

Brow, jawline and neck.

Skin tones

Skin tone

● Botox

● Ultherapy

Lighter skin

Low risk

No pigment change expected.

Low risk

Not a pigment-based treatment.

Medium skin

Low risk

No pigment change expected.

Low risk

Energy bypasses the surface.

Deeper skin

Low risk

No pigment change expected.

Low risk

Safe across skin tones.

How it works

Botox

Ultherapy

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.

Ultherapy mechanism diagram. Ultrasound locates tissue planes: Imaging helps the clinician view the treatment area. Focused energy creates heat points: Ultrasound concentrates energy at selected depths. Repair remodels support tissue: Collagen changes develop gradually; lifting effects vary.

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.

Ultrasound locates tissue planes: Imaging helps the clinician view the treatment area. Focused energy creates heat points: Ultrasound concentrates energy at selected depths. Repair remodels support tissue: Collagen changes develop gradually; lifting effects vary.

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

Before your treatment

Botox

Ultherapy

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.

Not specified

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.

Until the visit: Skin care: Nothing to stop, and no pre-treatment cream needed.

Day of treatment

Botox

Ultherapy

Before you arrive

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

An hour before: Pain relief: Ask what is on offer.

Arrival & prep

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

Photos and a ride: Photographs first — the change is gradual and modest, so photos are the only reliable way to judge it.

Photographs are taken, areas marked, and the provider decides which depths and how many lines of energy each area gets.

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.

Gel goes on and the handpiece is pressed to the skin.

The provider checks the imaging screen and delivers a line of energy: seconds of deep heat and sharp pain, then a pause. Swapping the transducer changes depth. Face and neck take 60 to 90 minutes, smaller areas about 30. It is worst over the jawbone and brow and stops when the treatment does.

Before you leave

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

Skin is flushed and slightly swollen, sometimes with small raised lines along the path.

After your treatment

Botox

Ultherapy

First 24 hours

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

Days 1 to 7: The area is tender to press and can ache when chewing if the jaw was treated.

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.

Not specified

Weeks 2–4

Not specified

Weeks 1 to 4: Swelling gone, sensation returning, skin looking the way it did before.

Weeks 4 to 8: Remaining numbness or tenderness usually resolves.

Time to results

Starts in 3–5 days, full at 2 weeks

2–3 months, building to 6

How long results last

3–4 months

About 1 year

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

Most of what happens is mild and short-lived
Numbness lasting more than a couple of months
Weakness or asymmetry of the face
A hollow or dented area
A raised line or ridge
A cold sore outbreak

Cost

Per session

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

In the US a single smaller area such as under the chin, the brow or the chest runs about $1,000 to $2,000, and a full face and neck about $2,000 to $4,500, varying a lot by city and practice.

Insurance

Insurance does not cover cosmetic use.

Insurance does not cover it.

Questions

Botox

Ultherapy

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.

Does Ultherapy hurt?

Yes — one of the more painful non-invasive treatments, worst along the jaw and brow where bone sits underneath. The pain comes in bursts with each line of energy and stops when the treatment ends. Ask about pain control before booking: a painkiller beforehand, a nerve block, or a mild sedative.

How much lift will I actually get?

A mild one. In somewhat loose skin it shows as a slightly crisper jawline and a small lift at the brow, visible in side-by-side photographs more than in the mirror. Heavy sagging does not respond.

When will I see it, and how long does it last?

Nothing for the first month, change from around two to three months, peak at about six. It then fades over roughly a year to eighteen months.

Is it the same as the HIFU offered at a spa?

Not necessarily. Ultrasound devices differ in energy and design, and most cheaper machines have no imaging screen, so the operator cannot see the tissue layers. Ask what device is being used and who is operating it.

Can nerve damage happen?

Rare, and reported — usually temporary weakness of a facial muscle or numbness recovering over weeks to months. It is the main reason to care who is holding the handpiece.

Is it safe on deeper skin tones?

Yes, and one of the better energy options for deeper skin tones, because ultrasound is not absorbed by pigment the way laser light is. Settings do not change.

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