Comparison

Microneedling vs Botox

Microneedling changes the skin itself; botulinum toxin relaxes the muscle that folds it. No study has ever compared them, and they are aimed at different problems.
Written & medically reviewed by the Dermapedia team
At a Glance

These two are not rivals. They fix different problems. Microneedling makes thousands of tiny channels in the skin so it heals with new collagen. Botulinum toxin (Botox) relaxes a specific muscle so it stops folding the skin above it. One works on the skin itself. The other works on muscle.

So "which is better" has no answer. There is no published study comparing microneedling with botulinum toxin, and no trial of the two used together. Asking which wins is like asking whether a haircut beats a dye job.

The useful question is what your line is made of. If a line only appears when you frown, squint or raise your brows, it is a movement line, and that is what botulinum toxin was approved for. If the problem is scarring, roughness or crepey texture that is there when your face is completely still, that is skin, and microneedling is the one aimed at it.

They are often used together, and clinics do combine them. No trial has tested the combination, so sequencing and spacing are your provider's judgement, not a research finding.

Microneedling
needles only, no energy
Botox
botulinum toxin, a prescription drug

What it is

A pen of fine needles that punches thousands of microscopic channels into the skin

There is no energy source. The whole effect is controlled injury plus healing.

An injected prescription drug that temporarily relaxes a targeted muscle
Both
One is a device that wounds the skin on purpose. The other is a drug that quiets a muscle. They are not two versions of the same treatment.

How it works

Micro-injury triggers the normal healing cascade — growth factors, fibroblasts, new collagen and elastin
The treated muscle stops contracting, so the skin above it stops being creased

What it is best at

Atrophic acne scars, texture, fine surface lines and the look of large pores

It does not meaningfully tighten loose skin, and it does not reach or affect fat.

Lines caused by movement — the ones that deepen when the face moves
Both
A line visible when your face is completely still is a different problem from a line that only appears when you move. Many people have both.

What it is cleared or approved to treat

Facial acne scars. SkinPen is also cleared for neck wrinkles, but only in Fitzpatrick skin types II–IV

SkinPen Precision was authorised in March 2018 (De Novo DEN160029) for facial acne scars in adults aged 22 and over; a 2021 clearance added the neck wrinkle indication. Dermapen 4 is cleared for facial acne scars in Fitzpatrick I–V only, with no neck indication.

Lines caused by movement — the ones that deepen when the face moves

Botox Cosmetic is a prescription drug with an FDA drug approval for specific facial movement lines. We were not able to confirm the approval dates or the exact indication wording, so they are not quoted here; ask your prescriber which lines the product is approved for.

Both
This is the sharpest real difference between them. A drug approval requires trials showing the product works for that specific use. Device authorisation is a different standard: SkinPen's De Novo created a new category, and later microneedling pens are cleared by showing they are much like SkinPen. Same agency, different standard of proof.

Sessions

A course. Clinics commonly do 3 to 6 sessions about a month apart

That schedule is clinical convention, not a figure from the FDA labelling.

Repeated, because the effect is temporary

Who tends to be happy with it

Best for
People whose main complaint is scarring, roughness or texture.
The mindset
A course of appointments that changes the skin slowly.
Best for
People whose main complaint is a line that appears or deepens when the face moves.
The mindset
A short appointment with a temporary, repeatable effect.

Why there is no head-to-head answer

A search of the published literature finds no study comparing microneedling with botulinum toxin, and no randomised trial of the two combined. What exists nearby is not the same question: one 2025 systematic review of 29 studies looked at collagen-stimulating injectables combined with botulinum toxin, fillers and energy devices, and reported side effects including redness, bruising and nodules in 15% to 30% of cases, with rare severe events. Its own conclusion was that the methods were too varied and the samples too small to draw firm conclusions.

So if a clinic tells you one is "more effective" than the other, ask what that is based on. There is no trial behind it.

What microneedling will not do

It will not lift or tighten lax skin, and it has no effect on fat. It also will not soften a frown line that is driven by muscle movement. Being clear about that up front saves a course of treatments aimed at the wrong target.

Before you book microneedling

Tell your provider if you get cold sores. Antiviral medication is started in advance, not after a blister appears, so this has to come up at booking. Note that this precaution is imported from laser resurfacing practice — there is no study measuring cold sore reactivation after microneedling specifically.

Be careful about what goes onto freshly needled skin. A 2025 systematic review of granulomatous reactions after microneedling found 15 reported cases, with motorised microneedling pens and topical vitamin C application implicated in most of them. These are lumpy inflammatory reactions that did not reliably clear with treatment. Anything applied into open channels is going deeper than a normal serum ever would.

Get emergency help now

  • Fever, spreading redness, or pus from the treated skin — these are signs of infection that is not staying put and need urgent care

Call your provider if

  • Redness, swelling or pain increases after day three instead of settling
  • A cluster of small painful blisters appears — a cold sore flare needs prompt treatment
  • Marks in the pattern of the needle array are still visible after about a week
  • New firm lumps or bumps develop in treated skin over the following weeks
  • Skin darkens in the treated area, especially after sun exposure

Related

Questions people 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.