David Owers, MD

Belotero, although new to the United States, has been used in Canada and Europe extensively.  In fact, like the Juvederm family of products, there are a wide variety of Belotero fillers.  Unfortunately, only Belotero Balance is offered in the United States. After studying the physical properties of a number of fillers, I have found that cohesivity is an important property that distinguishes the Belotero line.  Belotero Balance has been used in lips, fine lines, and delicate areas like tear troughs.  My experience with this product has been very positive, and when used correctly, will not cause any lumpiness.  I highly recommend it, and use it extensively in my practice.  

Xeomin, although newer to the United States, has been used in millions of people around the world.  Botox has had a longer history in the United States.  Essentially, Botox has an active core that is surrounded by extraneous proteins.  Xeomin, has a very similar active core, with far less extraneous protein content that Botox.  This would make the Xeomin product less reactive because it is in effect a more pure formulation.  The word toxic, in my opinion, does not apply here at all.  It would be interesting to note just what it is that has caused you to formulate an opinion that it is toxic and doesn't work well.  Further, with the millions of Botox treatments being performed in the United States, why are you not thinking that doctors aren't pushing Botox on the public?  What makes Xeomin any different?  I would be interested to know your answers.

Xeomin, although newer to the United States, and less popular than other neurotoxins, is actually very widely used in the rest of the world.  The active core molecule resembles that of Botox, athough unlike Botox, does not need the additional protein complexes surrounding it.  From a pure chemistry point of view, this is an over-simplification, but is practically rather accurate.  The onset of action and duration of treatment, as well as the dosing and placement, is officially the same between the two.  Some people will note that the Xeomin-effect starts earlier than Botox. Incidentally, the average duration to maximal effect of Botox is 10-14 days, not generally seven.  

Both products are quoted as lasting three-to four months.

The issues that you describe are experienced by many couples.  This is not to diminish the challenges that you have listed above.  It is only to say that even lesser life events can cause what you are experiencing.  ThermiVa can change both the physical appearance and functionality of the vaginal area.  The question that I cannot answer is whether the degree of physical change that you experience after the usual 3 initial treatments will address the sadness that you expressed.  Again, this is not to sound over-simplistic, but is merely to suggest that we must delineate between effecting a physical change and effecting the degree of wellness that addresses your entire situation.  Sometimes, the physical change can be the catalyst for healing this delicate situation.

There is a theory that one can develop antibodies with consistent Botox use.  The theory describes this phenomenon as occurring with too small a dose, and too frequent an interval, of treatment. I have not seen this clinically in my practice; but have seen the "Wow" effect diminish in certain individuals that use Botox as the only modality to address an issue.  Without knowing much about your lifestyle habits, I cannot speak specifically to you.  Perhaps something of what I say will resonate.  The rate at which an individual ages is genetically determined and influenced by environment and lifestyle choices.  For instance: appropriate "sun savvy" regimens; a valuation of loss of volume in the area; UV damage to the skin itself; and how the entire face appears and interacts as an expressive unit should all be considered.

Lastly, even if none of the aforementioned plays a role, the placement of the Botox needs to be altered by a few millimeters from time to time.  This can be challenging in that you do not want to stray too far from the placement to achieve your optimal effect - experienced hands come into play here.