Genocide: Frisk goes back, and throughout the journey they realize they did it wrong and try to eliminate chara (Boss fight).
Neutral: All fights become harder, especially Sans', making it almos impossible to fight them. (Maybe a union of Sans and Undyne in a fight against human. Flower doesn't try to kill you but jokes about how you fell down "You have enough power to defeat me and 6 human souls but can't avoid a f**king hole".
Pacifist: You try to defend your friends against lots of people that think monsters should die.