The marriage ended with lip injections. On a sunny Tuesday last July, Dane’s then-wife of eight years came home from work with a swollen pout. The woman — we’ll call her Courtney — said her office had run a contest for a free procedure and won. “She looked really stupid,” says Dane, a 45-year-old systems administrator in Pennsylvania. “I couldn’t believe it.”
It wasn’t the first time the issue had come up. “I always asked, ‘just don’t do anything permanent to your face,'” she says. “Whatever you want to do is up to you, but I married you for your face, so let’s keep it as it is.”
Lip filler, for the record, usually dissolves within three to 12 months. But Dane and Courtney’s marriage was already on the rocks. They had broken up (and reunited) twice that year. they were constantly fighting and playing the blame game. In the grand scheme of things, the injections were nothing. For Dane, however, the new lips were yet another case of ignorance. (When he previously suggested that they see Suits Together, she shot the whole series by herself and never mentioned it.) “She kept saying, ‘they’re just swollen, they’re going to go down, I’m never going to do it again.’ He said he had botox a few months ago and I never noticed, that he was rubbing it on my face,” says Dane. “I was whatever.”
“He doesn’t like anything that isn’t natural. He thinks red lipstick is scary.”
Courtney’s interest in getting the job done surprised him – she had spoken disparagingly about his sister-in-law’s lip injections, breast augmentation and tummy tuck a year before – and he struggled to understand what she was learning about her. “She started her own business when we first broke up, and I said, ‘Good job. I’m really proud of you,” he says. “But that was almost like a power girl. She was connected to Spotify on the iPad and I saw that she was listening to all these podcasts by women and Brené Brown – all this space about being an independent woman, being proud of yourself. There’s nothing wrong with that, but I felt like “I’m going to do what I want and nobody can tell me otherwise.”
He felt helpless. And finally, he felt disappointed. “I was really disappointed that he didn’t have the self-esteem to age gracefully,” she says. A week later, he moved. This summer they finally broke up.
“I’ve wanted it all my life”
In 2024, 1.5 million Americans got lip fillersaccording to the American Society of Plastic Surgeons. Ten million fought wrinkles with Botox, Dysport and similar injections, and nearly 1.6 million went under the knife. Many of them, of course, feel beautiful, refreshed and happier as a result. However, some loved ones deal with a different set of emotions, turning aesthetic intervention into a stand-in for any number of relationship issues.
“If it’s happening around Botox and plastic surgery, where one partner names a preference and the other ignores it, it’s very likely that the same dynamic is happening in other aspects of their lives,” she says. Dr. Chelsea Sarai, PsyDclinical psychologist and founder of Brentwood Therapy Collective in Los Angeles. “What’s really lost here is when we set a hard and fast limit or a preference with our partners, do we explain where it’s coming from?”
“At first I thought, ‘What’s wrong with your eyes?’ Are you having a stroke?” I didn’t even know what Botox was.”
If the wife really wants to do some work, whether to deal with an insecurity or to enjoy some self-care, does she talk her husband through it? And it’s him really to listen — or explain his own vacation correctly? This issue occurs in all kinds of relationships, Sarai notes, but it can be especially prevalent in straight couples, where the rules around beauty or self-image are very different between the sexes. Often, there are unspoken associations with cosmetic intervention that get in the way, which Sarai tries to untangle in sessions by lowering the stakes: “Like, ‘Does it feel like this when she curls her hair?’ Or does she wear high heels?’ he says. “Or other ways that we change our appearance that are a little less polarizing, just to try to figure out where that fine line is.”
When getting work done becomes a wedge in a relationship, it’s usually a matter of patient-partner education. “Sometimes husbands only see awful results when they’re out to dinner and say, ‘I don’t want my wife to look like that person at table three,'” she says. Dr. Clifford Clark III, MD, a board certified plastic surgeon in Florida. “I try to explain, “You’re really only seeing bad results. You can’t spot good results.”
Before the initial consultation, Clark estimates that half of significant other candidate patients are hesitant or adamantly opposed. But that disagreement usually disappears once they learn more about what’s really involved. “Honestly, if we’re being rejected by a spouse, we try to slow everything down and maybe not even function,” she says, because it’s critical to have a supportive person at home to help with the recovery process.
Rude contributors are less common than you might expect since, say, they lurk on Reddit, where forums like r/AskMen are full of plastic surgery scams. (“In my social circle, most couples [in which] the wife had mom makeovers ended up in divorce,” one user wrote.) “Most women have a lot of support,” says Clark. “The line is, ‘Honey, you’re wonderful. You do this for you. You’re not doing this for me.’ And I think that’s really the hallmark of a very healthy relationship.”
Even the most emphatic objections come with an expiration date. An 82-year-old woman once came to Clark for breast augmentation. I said, “Hey, if you don’t mind me asking the obvious question, why now?” He says, “Well, I’ve wanted this all my life. My husband would never let me do it, and now it’s passed,” she says. “She might be the happiest patient I’ve ever had.”
“I don’t want to spend my life with this as an issue”
However, procedures sometimes become a sticking point. Every three or four months, Brianna, a 30-year-old from Pennsylvania, injects 10 to 15 units of Botox into her forehead and crow’s feet for about $450 — which she can comfortably afford since she got out of debt and found a higher-paying job. But her fiance hates it. “He doesn’t like anything that isn’t natural,” says Brianna (pseudonym). “She thinks red lipstick is scary.”
His perspective — influenced by his ungrateful mom, Brianna says — has been affected. “We’ve been fighting a lot recently. He’s never said, ‘You’re ugly,’ but he likes 70% of me – not the 30% that he likes to dress up,” she says. They got engaged in December 2023, but have yet to set a wedding date. “I don’t want to go through life with that as an issue,” he confesses.
With her therapist’s encouragement, she asked her fiancé for more words of affirmation. He initially denied the request, then promised to work on it and turned around Men are from Mars, women are from Venus for help. However, his momentum has waned. “I told him, if you don’t want to give validation, go date someone Amish who doesn’t care about how they look!”
“It sucks that you have to put stuffing on your face to feel presentable”
At 26, David married a beautiful woman we’ll call Ellen — think Jennifer Aniston but curvier. About $35,000 worth of Botox, nine couples’ counselors and one divorce later, the 51-year-old investment adviser in Washington State sees her as pathetic — “massively insecure,” he says.
David and Helen dated briefly in high school, then reconnected in their twenties and planned to spend the rest of their lives as DINKs (double income, no kids). Soon, though, she wanted to be a stay-at-home mom. They could afford it. Her stepfather had gotten David a $65,000-a-year sales job with plenty of room for growth and an annual expense account of $100,000. He took clients golfing and to state dinners. But over the next dozen years—despite raises that nearly doubled his salary—the cost of IVF, two children, a home reno, a semiannual trip to Palm Springs, and a live-in Brazilian au pair made things tight. Helen, meanwhile, tackled the shopping. “If you’re worried about money,” David recalls, “why are we fighting to spend all the money?”
While money may seem like a black and white issue, Sarai says that fights about finances can also often be a stand-in for something else. “Is this a real fiscal issue? Or is it: Do I really not want to value our money this way?When you dig deeper, you often find “that deep fear: ‘Is the partner I love and chose to be with going to change?’ Will they look like someone I don’t see myself with or recognize or didn’t choose? This underlying fear can really be at the root of what causes the resistance and lack of curiosity in those partners who just try to shut it down right away.”
“If you don’t want to confirm, date an Amish guy who doesn’t care about his looks!”
In her early thirties, Ellen began booking quarterly Botox appointments at about $600 a pop. “At first I thought, ‘What’s wrong with your eyes?’ Are you having a stroke?’ botulism on your face to feel presentable”.
Their relationship continued to fall apart. According to David, while trying to work 15 or 16 hours, seven days a week, Helen started drinking heavily. When he tried to experiment with new ways to please her in the bedroom, she accused him of cheating. Sure, they had their problems—but before they finally broke up, an idea kept nagging at him: “I thought, Oh my god, is it the botox that did this to her?“
