Microneedling
The microneedling pen is held upright and stamped across the skin in rows. The needles go straight in and out, and the depth is set on the pen.
← All comparisons
Dermapedia / CompareProcedures
Microneedling vs Botox
These two treat different problems. Microneedling works on the skin surface — acne scars, rough texture and the look of large pores. Botox works on muscle. It relaxes the muscle that folds your skin, so it suits lines that only show up when you move your face. Neither one is a substitute for the other.
At a glance
| The difference | Microneedling | Botox |
|---|---|---|
| Cost | Paid as a course, not one visit | Paid again each time it wears off |
Botox
An injectable treatment being placed in the face. A neurotoxin is given with a very fine needle in small amounts, and each spot takes only a few seconds.
Side by side
The differences that matter
What you actually do
Microneedling
A course of clinic visits
A pen of fine needles makes thousands of tiny channels in the skin. There is no heat or energy. The whole effect comes from that small injury and the healing after it. Clinics usually do 3 to 6 sessions about a month apart.
Botox
A short appointment, repeated
A prescription drug is injected into one target muscle. The effect wears off, so it is repeated.
How it works, illustrated
Microneedling
Conditions treated
Microneedling
Ice Pick Scars
Narrow and deep, like a puncture. A needle passing over the surface cannot reach the bottom of the tract. These need TCA CROSS, punch excision, or a laser.
1 / 10→
Stretch Marks
Fine needles make controlled micro-injuries that prompt new collagen in the scarred layer. Improvement is modest and needs a course of sessions, but it carries a lower risk of leaving dark marks than lasers do, which makes it the more sensible first device on deeper skin tones. It works on both red and white marks.
←2 / 10→
Acne Scarring
Fine needles injure the skin just enough to trigger new collagen. It does most for rolling and shallow boxcar scars, and very little for icepick ones. It is the gentlest of the resurfacing options, which also makes it the slowest — expect four to six sessions and judge it at a year, not at a month.
←3 / 10→
Male Pattern Hair Loss
Fine needles rolled or stamped into the scalp, used alongside minoxidil rather than instead of it. The small trials that exist favor the combination over minoxidil alone. Sessions are spaced weeks apart, and doing it too often or too deeply irritates the scalp without adding anything.
←4 / 10→
Wrinkles and Fine Lines
Fine needles make controlled injuries that prompt the skin to lay down collagen. Improvement in fine lines and texture is modest and builds over three to six sessions. Its advantage here is a lower risk of pigment problems on deeper skin tones than lasers or deep peels carry, which makes it a common first choice.
←5 / 10→
Post-Inflammatory Hyperpigmentation
Fine needles make controlled channels that help topical treatments penetrate and encourage the skin to remodel. It is mainly a scarring treatment, and its effect on pigment alone is small. It is a reasonable choice when true scars and dark marks sit together, but it can inflame reactive skin, so conservative depths are used on deeper skin tones.
←6 / 10→
Melasma
Fine needles make temporary channels that help tranexamic acid or other treatments reach deeper, and that combination is where the evidence sits — not needling on its own. It has to be done gently. Aggressive needling inflames the skin, and inflamed skin with active pigment cells makes more pigment, not less.
←7 / 10→
Dark Circles Under the Eyes
Thickens the skin slightly over a course of sessions, which can make the vessels underneath a little less visible. The evidence around the eye is thin and the change is subtle. It will not fill a hollow, and on deeper skin tones it carries its own risk of leaving marks, so it is not a first choice here.
←8 / 10→
Rolling Scars
←9 / 10→
Boxcar Scars
←10 / 10
Botox
Hyperhidrosis
A grid of small injections that block the nerve signal reaching the sweat glands in that patch of skin. It starts working within a few days to a week and lasts several months before it needs repeating. Underarm injections are well tolerated; palms and soles hurt more and are usually done with numbing, and palm injections can cause temporary weakness of grip. It is an approved medical treatment for severe underarm sweating, not a cosmetic one, and insurance often covers it once antiperspirants have been tried and documented.
1 / 3→
Rosacea
Very small amounts injected into the surface of the skin, not the muscle, to reduce flushing and background redness. Early studies are encouraging and dermatologists do use it for stubborn flushing. It is off-label for rosacea, it is not usually covered, and it wears off in a few months.
←2 / 3→
Wrinkles and Fine Lines
The reliable treatment for lines caused by movement — frown lines, forehead lines and crow's feet. It relaxes the muscle that folds the crease, so the line softens over about two weeks and returns as the effect wears off at three to four months. It does nothing for lines that are already there at rest, and nothing for sagging.
←3 / 3
What you can expect to see
Microneedling
Smoother, more even skin
Healing builds new collagen and elastin. It works best on dented acne scars, rough texture, fine surface lines and the look of large pores.
Botox
Lines that stop deepening on movement
The treated muscle stops pulling, so the skin above it stops creasing.
What it will not do
Microneedling
Not for movement lines
It will not soften a frown line driven by muscle. It does not tighten loose skin, and it does not reach fat.
Botox
Not for scars or texture
It works on muscle, not on the skin surface. Scars and roughness are not what it is for.
Related topic illustrations
Microneedling
Fractional CO2 laser
Strong evidence, and the most effective single option for indented acne scars. In exchange it brings a week of real downtime, higher cost, and a genuine risk of lasting pigment change, especially on deeper skin tones.
1 / 4→
RF microneedling
Moderate evidence. Adds heat at depth, which does more for laxity and can do more for scars, at the cost of more discomfort, more downtime, and a higher price. Still safer on deeper skin tones than ablative lasers.
←2 / 4→
Subcision
Strong evidence for one specific job. It cuts the fibrous bands tethering rolling scars downward, which needling cannot reach. Often done alongside microneedling rather than instead of it.
←3 / 4→
Chemical peel
Strong evidence for pores and brown marks, none for indented scars. Superficial peels work on the surface and cannot lift a scar floor.
←4 / 4
Cost
Microneedling
Paid as a course, not one visit
Budget for the whole set of sessions.
Botox
Paid again each time it wears off
One visit. You pay again when it wears off.
The at-home or drugstore version
Microneedling
Rollers and home pens
A roller drags sideways instead of going straight in and out, so it tears more than it punctures. The needles are shorter, and they go blunt fast. A blunt needle does more damage than a sharp one. This is not a cheaper version of the clinic treatment.
Botox
There is no home version
Botulinum toxin is a prescription drug. A provider has to inject it. Nothing sold over the counter does the same thing.
Who tends to be happy with it
Microneedling
- Best for — People whose main complaint is scarring, roughness or texture.
- The mindset — A course of appointments that changes the skin slowly.
Botox
- Best for — People whose main complaint is a line that appears or deepens when the face moves.
- The mindset — A quick visit now and then, as the effect fades.
The fine print
Microneedling
Microneedling devices are authorised, not approved. SkinPen Precision was authorised in March 2018 through the FDA's De Novo route for facial acne scars in adults aged 22 and over. A 2021 clearance added a neck wrinkle indication. Dermapen 4 is cleared for facial acne scars, with no neck indication.
Botox
Botox Cosmetic is approved as a drug. It holds an FDA drug approval for specific facial movement lines. Ask your prescriber which lines the product is approved for.
Common questions
Questions Patients Ask
Which one should I get first?
It depends on the complaint, not on the order. If the concern is scarring or texture, microneedling is the treatment aimed at it. If a line only shows up when you move, botulinum toxin is. There is no published research on sequencing the two.
Does microneedling work on frown lines?
Not on the muscle that causes them. Microneedling changes the skin — collagen, texture, scars — so it can improve the surface, but it does not stop the muscle from folding the skin.
Is either of them FDA approved?
Microneedling devices are authorised, not approved. SkinPen went through the De Novo route (DEN160029, March 2018) — a pathway for a device with no existing equivalent, which created the microneedling category — and its authorisation names facial acne scars in all skin types and, since a 2021 clearance, neck wrinkles in Fitzpatrick II–IV. Most other microneedling pens are ordinary 510(k) clearances, which rest on being substantially equivalent to SkinPen. Botox Cosmetic is approved as a drug, which is a higher standard of proof than a device authorisation — a drug approval requires trials showing the product works for the specific use. We were not able to confirm the exact indication wording or the approval dates, so they are not quoted here.
Can I have both on the same day?
Clinics do combine them, but no published trial has tested the combination or the timing. Ask your provider what spacing they use and why.
Can microneedling be used to deliver botulinum toxin into the skin?
It has been tried. One 2024 pilot study of 20 patients used microneedling to deliver botulinum toxin, but it was combined with a laser treatment in the same protocol, so the microneedling delivery cannot be judged on its own. It is a small, low-level study, not established practice.
Which is better value?
There is no reliable published price for either treatment, so no figure is given here. What is worth knowing is that microneedling is normally sold as a course, while botulinum toxin is a single appointment repeated when it wears off.
Does microneedling tighten skin?
No. Mechanical microneedling has no energy source, does not heat the deeper dermis, and is not cleared for skin laxity. Devices marketed for tightening are a different category.