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Treatments to reverse the signs of aging like ultherapy and microneedling are growing in popularity, but how do the results compare to Botox? Goodboy Picture Company/Getty Images
  • Alternatives to Botox that can reverse the signs of aging are gaining popularity.
  • Two of the most popular are ultherapy and microneedling.
  • While these alternatives can have an effect on your skin’s appearance, experts say it’s important to set expectations that the results will be different from Botox.

Move over, Botox. Alternative anti-aging procedures are having a moment.

In fact, dermatologist Dr. Shereene Idriss (who has nearly half a million followers on Instagram) recently went on “The Rachael Ray Show” to discuss trendy “alternatives to Botox.”

Two that she mentioned in particular, ultherapy and microneedling, have been gaining popularity in recent years. But how well do they work and how do these alternatives compare to Botox?

Healthline asked experts for their insights on these anti-aging treatments and the potential results they can offer.

Dr. Bradley Glodny, a dermatologist in New York City focusing on delivering the most comprehensive general and cosmetic dermatologic care, tells Healthline there aren’t many alternatives to Botox that will actually have the same effect as botulinum toxin in treating dynamic lines of the forehead, mid-brow, and sides of the eyes.

“To attain the amazing effects of Botox,” Glodny says, “the muscle contraction beneath the skin must be diminished or stopped entirely — similar to what happens with Botox treatments.”

So besides Botox competitors including Dysport, Jeuveau, Xeomin, and Daxxify, he says nothing else on the market can attain the same effects.

That being said, treatments such as ultherapy can still have desired anti-aging effects such as skin laxity or tightness, he says.

“And while microneedling can be an effective treatment for various skin concerns, it’s also important here to have realistic expectations,” adds Dr. Rahi (Raheleh Sarbaziha), who is a Beverly-Hills-based integrative aesthetics doctor who provides microneedling services.

“Results may vary depending on individual factors and the specific condition being addressed,” she says.

Glodny explains that ultherapy works by utilizing ultrasound technology to break down collagen deep in the skin so that your body can rebuild it.

“This results in tighter, more youthful skin,” he says.

“In some areas like around the eyes, ultherapy can provide results reminiscent of Botox, but essentially different,” he adds. “At times both Botox and ultherapy can be used in a synergistic way to maximize results,” Glodny tells Healthline.

Rahi tells Healthline that microneedling is a minimally invasive cosmetic procedure that involves creating tiny punctures in the skin using a specialized device with fine needles.

“These micro-injuries stimulate the body’s natural healing response, leading to the production of collagen and elastin, which are essential components of healthy skin,” she explains.

Glodny says microneedling is also a nice cosmetic procedure, but its results are more surface-level.

“It can help with a variety of skin concerns such as hyperpigmentation, pore size, and very superficial textural changes,” he notes.

“Microneedling will not be able to give you the same results in the forehead, midbrow, or crow’s feet area that Botox can provide,” he tells Healthline.

The role of collagen in microneedling

“Collagen provides structure and support, while elastin allows the skin to stretch and bounce back,” says Rahi.

“As we age, the production of collagen, elastin, and hyaluronic acid in the skin decreases, resulting in the formation of fine lines, wrinkles, and enlarged pores,” she explains. “Microneedling helps address these signs of aging by promoting the regeneration of these vital skin components,” she says.


When it comes to ultherapy, pain is a consideration.

“Ultherapy has a reputation for being rather uncomfortable if not pretreated with oral analgesics and or other pain relieving techniques,” Glodny explains. “The cost can range anywhere from 2-5 thousand dollars.”

However, this upside is that recovery time with ultherapy is essentially zero since the technology is non-ablative. “Results can last for many years since your body’s own collagen is being stimulated,” he adds.


When it comes to microneedling, Rahi says the procedure is typically performed in a series of sessions, usually spaced about four weeks apart. “The number of sessions required depends on the individual’s skin condition and desired results, but it generally ranges from three to six treatments with each session lasting about 15 to 30 minutes.”

“Before the microneedling procedure, a medical-grade numbing cream is applied to minimize discomfort (for 30-45 minutes),” Rahi tells Healthline.

“During the treatment, the microneedling device is gently rolled or stamped over the skin, creating controlled micro-injuries,” she explains. “The process is generally well-tolerated, but some individuals may experience mild discomfort or sensitivity.”

“After microneedling, it is normal to experience redness and mild irritation, similar to a sunburn, which typically resolves within a few days,” she says. “Proper aftercare is important, including avoiding sun exposure and applying recommended skincare products as advised by your provider.”

Rahi says the cost of microneedling can vary depending on factors such as the location, provider, and additional treatments combined with the procedure.

On average, the cost ranges from $500 to $1500 per session, says Rahi.

“Maintenance sessions every three to six months may be recommended to prolong the results and maintain overall skin health.”

Experts say ultherapy is considered safe and the procedure provides more standardized results across different providers.

“Microneedling is much more user-dependent, and in the wrong hands can definitely lead to bad outcomes,” says Glodny.

“For example, if the device used to penetrate goes too deeply into the skin, then scarring and darkening of the skin can result,” he says. “Less often, there are reports of blood vessel growths developing after microneedling,” he adds.

“In terms of safety, microneedling is generally considered safe when performed by a trained and experienced professional,” says Rahi.

However, she agrees there are potential risks if the procedure is not done correctly.

Risks to microneedling include improper technique or inadequate sterilization which can lead to complications such as infection, scarring, or skin discoloration.

“It is essential to choose a reputable provider and ensure proper hygiene and sterilization protocols are followed,” says Rahi.

Rahi adds that certain individuals may not be suitable candidates for microneedling in particular.

People who may not be suitable for microneedling, for example, she says, include individuals with:

  • active skin infections
  • open wounds
  • certain medical conditions such as blood clotting disorders or compromised immune systems
  • need for taking blood-thinning medications

She adds that it’s recommended to discuss microneedling with a provider for individualized screening to see if you are a good candidate.

In addition to cosmetic procedures, Rahi tells Healthline it is important to focus on overall skin health and adopt a comprehensive approach to anti-aging.

Expert tips from Rahi include: