Ron Shemesh, MD

You may have had some spread of the product to an unintended part of the eye which can also happen with Botox.  Perhaps the answer is to stay more lateral on the crows feet for you next time.  The fatigue is an unusual complaint which I have not experienced having preferred Dysport over Botox.  If it is related, it should resolve soon as will the lines under the eyes.

Yes hysterectomy clients can be helped.  We have the FemTouch CO2 laser for internal and external rejuvenation and collagen stimulation.  This painless 15-20 minute in office procedure will help with laxity, vaginal dryness, lubrication, mild urinary incontinence, and shrinkage of the external labia minora.  Women with moderate to severe incontinence or vaginal prolapse would be better suited for pelvic floor surgery, however.  Results without surgery, pain, and down time.

The FemTouch laser by Lumenis improves tone, tightens, and increases lubrication while correcting the PH balance and resolving vaginitis.  This treatment not only improves vaginal dryness and painful intercourse during menopause, but it can also eradicate minor urinary incontinence.  The labia minora also shrink back to a more youthful appearance.  Lastly, I have had several clients report improved orgasm from stimulation of the G-spot by the laser which improves collagen and tone in the area !!!!   All this in 3 sessions (4 weeks apart) or less.  Non-invasive, no pain, and without surgery!!!  Can't ask for more.  The effects of a vaginoplasty with muscle tightening should last for many years. Some individuals will become lax earlier than others but the procedure usually has a lasting effect.

The "FemTouch" laser by Lumenis is an easy 15 minute, painless office procedure for vaginal rejuvenation.  Some women notice change after one treatment.  Faster results do seem to come with youth, however we have VERY successfully treated our menopause patients within 3 treatments all reporting increased moisture and resolution of urinary incontinence and no more need for a pad during sports.  Visually there was a significant decreased size of the labia minora and increased supple appearance of the inner vaginal mucosa noted on speculum exam.  This is a great, painless option for those wanting to avoid use of hormones to improve vaginal integrity plus the laser provides extra benefits that hormones can not offer.

Nasal labial folds are a symptom and the cause is the cheeks falling down.  I love Restylane Lyft or Voluma for their lifting ability and would start with the cheeks first then address any left over sagging in the NLFs by adding some there if needed.  I would use Restylane or Juvederm to the marionettes at the corners of the mouth as well.  The later two are softer for the lower face.  I suspect you will need 3-4 syringes for full correction without looking fake or overdone.