The marriage ended over lip injections. One sunny Tuesday last July, Dane’s then-wife of eight years came home from work with a plumped-up pout. The woman — we’ll call her Courtney — said her office had held a contest for a free procedure, and she won. “She looked really silly,” says Dane, a 45-year-old systems administrator in Pennsylvania. “I couldn’t believe it.”
It wasn’t the first time the subject had come up. “I’ve always requested, ‘Just don’t do anything permanent to your face,’” he says. “‘Whatever you want to do, it’s up to you, but I married you for your face, so let’s just keep it the way it is.’”
Lip filler, for the record, typically dissolves within three to 12 months. But Dane and Courtney’s marriage was already on the rocks. They had separated (and reunited) twice that year; they were constantly bickering and playing the blame game. In the grand scheme of things, the injections were nothing. To Dane, though, the new lips were yet another instance of being ignored. (When he previously suggested they watch Suits together, she binged the entire series alone and never mentioned it.) “She kept saying, ‘They’re just swollen, they’ll go down, I’m never going to do it again.’ She said she got Botox a few months ago and I never noticed, like she was rubbing it in my face,” Dane says. “I was like, whatever.”
“He doesn’t like anything that’s not natural. He thinks red lipstick is scary.”
Courtney’s interest in getting work done surprised him — she’d spoken disparagingly of his sister-in-law’s lip injections, breast augmentation, and tummy tuck a year prior — and he struggled to make sense of what he was learning about her. “She started her own business during our first separation, and I was like, ‘Good job. I’m really proud of you,’” he says. “But this was almost like a girl power thing. She was signed into Spotify on the iPad, and I saw she was listening to all these podcasts by women and Brené Brown — that whole space of being an independent woman stuff, being proud of yourself. There’s nothing wrong with that, but it felt like, ‘I’m going to do whatever I want and nobody can tell me otherwise. I’m going to show him.’”
He felt helpless. And ultimately, he felt let down. “I was just really disappointed that she didn’t have the self-esteem to age gracefully,” he says. A week later, he moved out. This summer, they finally divorced.
“I’ve wanted this my entire life”
In 2024, 1.5 million Americans got lip filler, according 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, rejuvenated, and happier as a result. However, some of their loved ones are contending with a different set of emotions, turning cosmetic intervention into a stand-in for any number of relationship issues.
“If it’s happening around the Botox and the plastic surgery, where one partner is naming a preference and the other one is ignoring it, it’s most likely that that same dynamic is happening in other aspects of their life,” says Dr. Chelsea Sarai, PsyD, clinical psychologist and founder of the Brentwood Therapy Collective in Los Angeles. “What gets really missed here is when we set a hard and fast boundary or a preference with our partners, are we explaining where it’s coming from?”
If the wife really wants to get some work done, whether to address an insecurity or enjoy some self-care, is she talking her husband through it? And is he really listening — or explaining his own hang-ups properly? This issue shows up in all kinds of relationships, Sarai notes, but it can be especially prevalent in straight couples, where norms around beauty or self-image differ greatly between genders. Oftentimes, there are unspoken associations with cosmetic intervention that are getting in the way, which Sarai tries to untangle by lowering the stakes: “Like, ‘Do you feel that way when she curls her hair? Or wears high heels?’” she says. “Or other ways we change our appearance that are a little bit less polarizing, just to try to understand 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 they go, ‘I do not want my wife looking like that person at table three,’” says Dr. Clifford Clark III, M.D., a board-certified plastic surgeon in Florida. “I try to explain, ‘You’re really only seeing bad results. You can’t detect good results.’”
Prior to the initial consult, Clark estimates that half of would-be patients’ significant others are hesitant or outright opposed. But that dissent usually dissipates once they learn more about what’s actually involved. “Honestly, if we’re getting pushback from a spouse, we try to slow it all down and potentially not even operate,” he says, because it’s critical to have a supportive person at home to aid in the recovery process.
“At first I was like, ‘What’s wrong with your eyes? Are you having a stroke?’ I didn’t even know what Botox was.”
Grouchy partners are less common than one might expect after, say, lurking around Reddit, where forums like r/AskMen are full of plastic-surgery gripes. (“In my social circle, most of the couples [in which] the wife had mommy makeovers ended in divorce,” one user wrote.) “Most women get a lot of support,” Clark says. “The line is, ‘Honey, you’re great. You’re doing this for you. You’re not doing this for me.’ And I think that’s really the trademark 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 a breast augmentation. “I said, ‘Hey, if you don’t mind me asking the obvious question, why now?’ She goes, ‘Well, I’ve wanted this my entire life. My husband would never let me do it, and now he’s passed,’” he says. “She might be the happiest patient I’ve ever had.”
“I don’t want to go through life with this as an issue”
Still, procedures sometimes become a sticking point. Every three or four months, Brianna, a 30-year-old in Pennsylvania, has 10 to 15 units of Botox injected into her forehead and crow’s feet for about $450 — which she can comfortably pay since she climbed out of debt and landed a higher-paying recruiting job. Her fiancé, however, hates it. “He doesn’t like anything that’s not natural,” says Brianna (a pseudonym). “He thinks red lipstick is scary.”
His outlook — influenced by his no-frills mom, Brianna says — has taken a toll. “We’ve struggled a lot recently. He’s never been like, ‘You’re ugly,’ but he likes 70% of me — not the 30% that likes to get dressed up,” she says. They got engaged in December 2023, but they haven’t set a wedding date yet. “I don’t want to go through life with this as an issue,” she confesses.
With her therapist’s encouragement, she asked her fiancé for more words of affirmation. He initially brushed off the request, then he promised to work on it and turned to Men Are From Mars, Women Are From Venus for help. His momentum has tapered off, though. “I told him, if you don’t want to give validation, go date someone Amish who doesn’t care about their looks!”
“It sucks you have to put botulism in your face to feel presentable”
At 26, David married a beautiful woman we’ll call Ellen — think Jennifer Aniston but curvier. Approximately $35,000 worth of Botox, nine couples counselors, and one divorce later, the 51-year-old investment advisor in Washington State sees her as pathetic — “super massively insecure,” he says.
David and Ellen briefly dated in high school, then reconnected in their twenties and planned to spend the rest of their lives as DINKs (double income, no kids). Soon, however, she wanted to be a stay-at-home mom. They could afford it; her stepdad had gotten David a $65,000-a-year sales job with lots of room to grow and an annual $100,000 expense account. 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 kids, a house reno, biannual trips to Palm Springs, and a live-in Brazilian au pair made things tight. Ellen, meanwhile, coped with shopping sprees. “If you get stressed out over money,” David recalls, “why are we f*cking spending all the money?”
Though money can seem like a black-and-white issue, Sarai says fights over finances can also often be a stand-in for something else. “Is it an actual budgetary issue? Or is it: I don’t really want to value our money in this way?” she says. When you dig deeper, you often find “this deep fear of: ‘Is my partner who I love and chose to be with going to change? Are they going to look like someone I don’t see myself with or don’t recognize or didn’t choose? That underlying fear can be really at the root of what’s causing the resistance and the lack of curiosity in those partners who are just trying to shut it down immediately.”
“If you don’t want to give validation, go date someone Amish who doesn’t care about their looks!”
In their early thirties, Ellen began making quarterly Botox appointments at about $600 a pop. “At first I was like, ‘What’s wrong with your eyes? Are you having a stroke?’ I didn’t even know what it was,” he says. He tried to be supportive. But then, when he was 38, he and his father-in-law both got laid off. It took a full year to find another job. Meanwhile, the injection bills kept coming. “I felt sorry for her,” he says. “It sucks that you have to put botulism in your face in order to feel presentable.”
Their relationship continued to disintegrate. According to David, while he was scrambling to work 15- or 16-hour days, seven days a week, Ellen began drinking heavily. When he tried experimenting with new ways to please her in the bedroom, she accused him of cheating. Clearly, they had their issues — but before they finally divorced, one idea kept nagging at him: “I was thinking, Oh my God, is it the Botox that turned her into this?”
