re: How does the OT feel about Botox?

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This is the base of my discussion every time the topic comes up. She does not need it.

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Why do you get to be the deciding factor on that?
Are all of her permissions you grant based solely on necessity? Do you both drive a piece of shite vehicle to get you purely from ___ to ____ because you don't NEED anything else? Do you not go on vacation because..well, you just don't need to. Do you not play golf, hunt, fish, have any hobbies? Do you never go see movies? Go out to eat?

Maybe consider that people do things all the time that they don't need because it makes them happy and you don't let your wife dictate to you what you need so maybe don't do the same to her.

We're not talking about breast implants. We're not talking about gastric bypass/sleeve. We're not talking about a tummy tuck. We're not talking about a 6 month yoga retreat in Dubai. This isn't that big of a deal.

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Also said that there is another underlying problem.

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That you can unquestionably make worse by this taking this stance. You need to consider that. Consider your role more.

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but that doesn't mean I cannot voice my concerns in a marriage that we are 50/50 on...

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Doesnt sound anything close to 50/50

Sounds like you don't want to "let" her do things she wants if you don't agree.