Comparison

Microneedling vs Ultherapy

Microneedling wounds the dermis with needles to build collagen; Ultherapy focuses ultrasound to as deep as 4.5 mm without breaking the skin. One works on texture and scars, the other is authorised for lifting.
Written & medically reviewed by the Dermapedia team
At a Glance

These two do not do the same job, and depth is why. Microneedling works in the dermis by wounding it. Ultherapy works below the dermis by heating it, without breaking the skin at all.

Microneedling drives fine needles up to about 2.5 mm into the skin. The controlled injury triggers normal healing - fibroblasts activate, new collagen and elastin are laid down. SkinPen, the device that created the category, is authorised for facial acne scars in all skin types and neck wrinkles in Fitzpatrick II-IV.

Ultherapy focuses ultrasound to a point beneath the surface, like a magnifying glass focusing sunlight. Tissue at that focal point reaches coagulation temperature while the epidermis and everything above the focus are spared. Its transducers focus at about 1.5, 3.0 and 4.5 mm, and the deepest reaches the SMAS - the muscle-and-fascia layer a surgeon lifts. Microneedling never reaches that layer.

So the trade is texture versus lift. Microneedling can change the surface - scarring, texture, fine lines - and cannot lift. Ultherapy is authorised for lifting the brow and the lax tissue under the chin and neck, and cannot do anything for surface texture or scars.

Microneedling
mechanical, needles, no energy
Ultherapy
micro-focused ultrasound, Merz

What it is

A motorised pen of fine needles that makes microscopic channels

The category was created by SkinPen's De Novo, DEN160029, granted March 2018 - the first microneedling device authorised in the US.

A handpiece that focuses ultrasound to a point under the skin

Also a De Novo: DEN080006, granted September 2009, creating product code OHV.

Both
Both are marketing authorisations. Neither is a statement that the treatment works well.

How deep it goes

Up to about 2.5 mm, into the dermis

SkinPen's protrusion is adjustable from 0 to 2.5 mm; its pivotal study used a 2.5 mm maximum. There is no energy source - the whole effect is mechanical injury plus healing.

About 1.5, 3.0 and 4.5 mm, chosen by transducer

The 4.5 mm transducer reaches the SMAS, and small columns of denatured collagen form at the focus. These are transducer focal depths named by convention, not wording quoted from FDA labelling.

Both
Ultherapy is the only device here with real-time ultrasound imaging, so the operator can see the tissue layer before firing.

What it is best at

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

It does not meaningfully tighten lax skin.

Lift and laxity - brow, under-chin and neck

It cannot treat surface texture or scarring, and nothing can be layered into the skin through it because there are no channels.

What it is cleared to treat

Facial acne scars, all skin types; neck wrinkles, Fitzpatrick II-IV only

That is SkinPen's exact wording (K202243, April 2021). Dermapen 4's clearance covers facial acne scars in Fitzpatrick I-V and has no neck indication.

Lift the eyebrow; lift lax submental and neck tissue; improve lines and wrinkles of the decollete

A February 2025 clearance added skin laxity on the abdomen and arms.

Both
Unusually for aesthetics, both of these devices have indications that match what they are sold for. That is not true of most energy devices.

Downtime

Redness like a moderate sunburn, roughly 24-72 hours

Mild swelling and pinpoint bleeding on the day. Clinical convention, not a labelled figure.

Essentially none

Temporary redness, swelling and tenderness; occasional bruising or numbness. Most people go back to normal the same day.

Comfort

Numbing cream makes it tolerable
The main complaint patients report

Nothing is broken, but the heat at each focal point is felt, and the discomfort is the well-known drawback of the treatment.

Sessions

Commonly 3 to 6, about 4 weeks apart

Clinical convention, not a labelled figure.

Typically one, with results building over months

Session counts here are practice convention rather than labelled instructions.

Who tends to be happy with it

Best for
Acne scarring, rough texture, 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.
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.

Which problem are you actually trying to fix

The useful question is not "which is better" but which layer your concern lives in.

  • Scars, roughness, enlarged-looking pores and fine surface lines are dermal and epidermal. Microneedling can reach them. Ultherapy cannot.
  • Sagging along the jawline, under the chin and on the neck is a deeper, structural problem. Ultherapy is authorised for it. Microneedling is not, and does not claim to be.

If both bother you, they are not rivals - they address different things and are often done as separate treatments rather than as a choice between two.

What each one does not do

Microneedling does not tighten. It also does not reach or heat the fat layer, so it has no contouring effect at all. If a clinic offers mechanical microneedling for jowls or a double chin, that is outside what it can do mechanically, never mind what it is authorised for.

Ultherapy does not resurface. Because nothing breaks the skin, there is no channel to treat texture through, and no way to deliver anything topical into the dermis. It also has documented, if rare, risks: temporary nerve injury affecting the smile or the brow, and loss of fat under the skin.

Before you book microneedling

Microneedling opens thousands of channels in the skin, which is the part of it that matters for infection.

  • If you get cold sores, say so at booking, not on the day. Antiviral medicine is started in advance.
  • Avoid applying serums and actives that were not intended for freshly needled skin. A systematic review of granulomatous reactions after microneedling found topical vitamin C implicated in most of the 15 reported cases, and those reactions did not reliably clear with treatment.
  • This does not apply to Ultherapy, where the skin surface is never broken.

Get emergency help now

  • Fever, spreading redness that expands hour by hour, or pus from skin treated with microneedling - these are signs of infection that need urgent care.

Call your provider if

  • Redness, swelling or pain is increasing after day three instead of settling
  • A cluster of small painful blisters appears after microneedling - a cold sore flare needs prompt treatment
  • Skin blisters, crusts or scabs more than you were told to expect
  • After Ultherapy, your smile or brow looks uneven, or an area feels persistently numb
  • After Ultherapy, an area looks hollow or sunken in the weeks afterwards

Related

Questions people 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.