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 Ultherapy
Microneedling works on the surface. Fine needles wound the skin so it heals and makes new collagen, which helps acne scars, rough texture and fine lines. Ultherapy works deep. It heats a layer far below the surface to lift early sagging at the brow, chin and neck. Microneedling is cheap enough to repeat; Ultherapy is one visit and is famously painful.
At a glance
| The difference | Microneedling | Ultherapy |
|---|---|---|
| Downtime | Red like a moderate sunburn, 1 to 3 days | Essentially none |
| How much it hurts | Numbing cream makes it tolerable | The main complaint patients report |
| Cost | Paid per session, and it is a course | One session, paid out of pocket |
Ultherapy
Ultherapy is guided by ultrasound. Gel is spread first so the applicator can image the layers underneath and place the energy at a set depth.
Side by side
The differences that matter
What you actually do
Microneedling
3 to 6 visits, about 4 weeks apart
A motorised pen of fine needles makes thousands of tiny channels in the skin. Numbing cream goes on first. The number of visits is clinic habit, not a fixed rule.
Ultherapy
Usually one visit, then months of waiting
A handpiece focuses ultrasound to a point under the skin, like a magnifying glass focusing sunlight. The operator can see the tissue layer on a screen before firing.
How it works, illustrated
Microneedling
Ultherapy
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
Ultherapy
Wrinkles and Fine Lines
Focused ultrasound heats a deep layer to tighten it, aimed at the jaw, neck and brow rather than at lines. The change is modest and takes three to six months to show, and it is nothing like a surgical lift. It can be uncomfortable, and results vary enough that it is worth seeing a provider's own before-and-after photographs.
How deep it goes
Microneedling
Up to about 2.5 mm, into the dermis
The needles adjust from 0 to 2.5 mm. No energy is involved. The whole effect is injury plus healing.
Ultherapy
About 1.5, 3.0 and 4.5 mm
The deepest setting reaches the SMAS, the muscle-and-fascia layer a surgeon lifts. Tiny columns of collagen are heated at that point, while the surface is spared.
What you can expect to see
Microneedling
Shallower scars, smoother texture
Atrophic acne scars, rough texture, fine lines and the look of large pores.
Ultherapy
A lift at the brow, chin and neck
Loose tissue under the chin and on the neck, the brow, and lines on the chest.
What it will not do
Microneedling
It does not tighten or lift
It does not reach or heat the fat layer, so it has no contouring effect. A clinic offering microneedling for jowls or a double chin is offering something it cannot do.
Ultherapy
It does not resurface
Nothing breaks the skin, so there is no way to treat texture or get a product into the dermis. Rare risks include temporary nerve injury affecting the smile or brow, and loss of fat under the skin.
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
Ultherapy
Botulinum toxin
Strong evidence for lines caused by movement, and no effect on laxity. Frequently done alongside rather than instead.
Downtime
Microneedling
Red like a moderate sunburn, 1 to 3 days
Mild swelling and pinpoint bleeding on the day.
Ultherapy
Essentially none
Redness, swelling and tenderness, sometimes bruising or numbness. Most people go back to normal the same day.
How much it hurts
Microneedling
Numbing cream makes it tolerable
The cream goes on first, and most people find the session manageable.
Ultherapy
The main complaint patients report
The skin is never broken, but the heat at each point is felt. That discomfort is the well-known drawback of this treatment.
Cost
Microneedling
Paid per session, and it is a course
Insurance does not cover it. Budget for the whole course, not one visit.
Ultherapy
One session, paid out of pocket
Insurance does not cover it either.
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 blunt quickly, and a blunt needle does more damage. This is not a cheaper version of the same treatment.
Ultherapy
No home version exists
Home tightening wands put a fraction of the power into the surface. They never reach the depth the clinic device works at, and that depth is the point.
Who tends to be happy with it
Microneedling
- Best for — Acne scars, rough texture and early fine lines, in someone who can accept a few days of redness each time.
- The mindset — A course of small treatments that changes the skin's surface.
Ultherapy
- Best for — Early jawline and neck laxity, in someone who cannot take downtime and can sit through an uncomfortable hour.
- The mindset — One demanding appointment, then wait.
Before you book microneedling
Microneedling
Microneedling opens thousands of channels in the skin, and that is what matters for infection.
The fine print
Ultherapy
Ultherapy is cleared to lift the eyebrow, lift lax tissue under the chin and on the neck, and improve lines and wrinkles of the decollete. A February 2025 clearance added skin laxity on the abdomen and arms.
Both devices have indications that match what they are sold for, which is unusual in aesthetics. The Ultherapy depths above are transducer focal depths named by convention, not wording quoted from FDA labelling.
Common questions
Questions Patients Ask
Can microneedling lift my jawline?
No. Mechanical microneedling works in the dermis and does not meaningfully tighten lax tissue or reach the deeper layers that hold the jawline. Ultherapy is the one authorised for lifting lax tissue under the chin and neck.
Does Ultherapy help acne scars?
No. Nothing breaks the skin, and the energy is focused below the surface, so it does not resurface or remodel scars. Microneedling is the option with a named acne-scar indication.
Which hurts more?
Ultherapy, during the treatment - discomfort is the complaint patients report most. Microneedling is generally tolerable with numbing cream, but it is the one that leaves you red for a day or two afterwards.
Which has less downtime?
Ultherapy, clearly. It has essentially none beyond temporary redness and tenderness. Microneedling leaves redness like a moderate sunburn for roughly one to three days after each session.
Is one of them FDA-cleared and the other not?
Both are authorised, and both went through the De Novo route: SkinPen in 2018, Ultherapy in 2009. What is unusual is that both have indications that match what they are marketed for. That still says nothing about how well either works for you.
How many sessions will I need?
Microneedling is a course, commonly three to six sessions about four weeks apart. Ultherapy is typically a single session with results building over the following months. Both figures are practice convention rather than labelled instructions.
Can I do both?
They are commonly treated as separate treatments for separate problems rather than as alternatives. That is a conversation to have with the person treating you, since timing and skin recovery matter.
Safety to keep in mind
Both devices went through the FDA's De Novo route. That is a marketing authorisation, not a statement that the treatment works well. SkinPen's DEN160029 was granted in March 2018, the first microneedling device authorised in the US. Ultherapy's DEN080006 was granted in September 2009, creating product code OHV.
SkinPen is cleared for facial acne scars and neck wrinkles under K202243, April 2021. Dermapen 4's clearance covers facial acne scars and has no neck indication.