Cut and color your hair however you want; wear what you want to wear; get eyelash extensions, or don’t; eat what you want to eat: These are my general responses when having a conversation with my significant other about her body. Obviously, some of these typical couple discussions are more fraught than others, but they’re all basically related to bodily autonomy, and I’ve always thought it a given that, as a dude, I have no place telling a woman what she should or shouldn’t do with her body. Not trying to be a performative “nice guy” here — it’s just, y’know, basic stuff.
But as is often the case with mental faculties, there are spasms, if you will. One such spasm occurred just a few weeks ago when my girlfriend told me that she was considering getting Botox, as innocuously as she might mention a manicure appointment. Like a deer in headlights — if those headlights were images of expressionless faces, plastered to the point of unwrinkle-able oblivion — I froze. “But why?” I asked. “You don’t need it. You’re so…” I continued, before realizing that I was extremely close to stepping in it.
Had I continued, I would have said: “You’re beautiful the way you are! You don’t need Botox, you’re only 27! And what do you mean you’d do something like that without telling me?” Luckily for me, by this time we’d already arrived at her friend’s house, and despite ironically being greeted by friends who had recently undergone lip injections, the discussion never went any further.
Clearly, it was a landmine best avoided — not least because, I realized, when it comes to Botox (or any cosmetic surgery, really) I was leaning on zero facts, assaulted instead by a mental Rolodex of plastic-surgery-gone-wrong urban legends. The one silver lining, I would soon discover, is that I was not alone in my ignorance.
“This is incredibly common,” says Wendy Lewis, an aesthetics industry insider and former plastic surgery consultant. “While women may be pleased to hear their partners say how beautiful they are and that they don’t need it, the nuances of cosmetic enhancements can often be lost on the male species.”
Indeed, despite the fact that most of the men I spoke to admitted to pushing back on their significant other’s desire to change some physical aspect of themselves, they also confided that they really didn’t know specifically what they were pushing back against. “I don’t fully understand the long-term effects and the health issues that might potentially arise,” one 28-year-old man tells me. Another says he was worried his girlfriend would regret any sort of cosmetic enhancement, including but not limited to Botox and fillers, because “it’s permanent.” Another baseless assertion: “The more you use it, the more you need it,” a different guy explains.
So before we even get into navigating the treacherous terrain of, “Babe, do you think I’d look better with cheek fillers?” let’s find out a little bit more about what we’re talking about when we’re talking about cosmetic enhancements.
The first lesson of Plastic Surgery 101: Injecting neurotoxins — more commonly referred to as Botox — into the skin isn’t actually surgery. Botox is considered an injectable, and while it can be deadly in larger amounts (being as it is, as mentioned, a neurotoxin), the tiny regulated units (measured in CCs) given to correct wrinkles has been used safely for decades. “Botox works by blocking nerve signals in the muscles where it is injected,” states this Medical News Today report. “When those nerve signals are interrupted, the affected muscle is temporarily paralyzed or frozen. Without movement of these selected muscles in the face, certain wrinkles may be softened, reduced or even removed.”
Per Michele Garber, a plastic surgery coach, Botox is mainly used to softens fine lines around the eyes and between the brow. “It gives you more of a refreshed look,” says Garber. “It also can soften vertical lip lines that can be very annoying to women because lipstick bleeds into these lines.” It’s also not reserved for people with already-wrinkled skin. “According to the American Society of Plastic Surgeons, [Botox] procedures have increased 28 percent since 2010 amongst 20 to 29-year-olds,” reports Vogue. In other words, preventative Botox is increasingly used by young people to avoid looking old.
Now, yes, there can be severe side effects in rare cases, which include gangrene of the skin, blindness and stroke, according to Alan Matarasso, a plastic surgeon in New York. But the vast majority of these procedures — and there are a lot: In 2015, Botox, produced by pharmaceutical maker Allergan, generated global revenue of $2.45 billion — are safe.
Botox also isn’t permanent. “It lasts about four to six months,” says Dara Liotta, a plastic surgeon on the Upper East Side who charges $20 per unit which she admits is higher than the average price. “For wrinkles around the eye, you might use a total of 20 units, 10 on each side, so that’d be $400. For wrinkles, they call them the 11 lines between the eyebrows that appear when you make a mad face. That’s usually about 25 units, so it’s around $500, which is on the higher end [of pricing].”
Other non-surgical forms of cosmetic enhancement include devices (such as lasers) that stimulate the skin to renew cells and produce new collagen, and which are generally used to eliminate brown spots, treat enlarged pores and repair sun damage, per the Buckingham Center for Facial Plastic Surgery.
Then there’s the ever more popular dermal fillers (usually just called “fillers”), which are designed to be injected beneath the surface of the skin to add volume and fullness. Think plumping up thinning lips; enhancing or filling in shallow areas on the face and under the eyes; chin augmentation; and cheekbone enhancements, says Liotta, who also says that 90 percent of her patients are between the ages of 20 and 45. “Fillers are sold by syringe,” she says. “There’s one CC in most syringes. The way I explain that is that there are five CCs to every teaspoon — that’s part of my speech about how one syringe of filler isn’t gonna make you puffy.”
Fillers, too, aren’t permanent. “Filler can last anywhere between six months to around two years, depending on what you need,” says Liotta. “The price for that is usually about $1,000 or $1,500 per syringe.” Which again, Liotta adds, is on the very high end of prices for this particular procedure.
If all this is news to you, I’ll say it once more, you’re not alone. As recently as 2016, in a Body and Soul article titled “Why Are Guys More Scared of Botox Than Women,” several men admitted that they not only thought Botox was a waste of money, but that they would be “disappointed” or outright “disgusted” if their spouse were to get Botox, as well as being “freaked out” because “it’s not safe” and “it makes people’s faces look ridiculous.”
Liotta tells me says that it’s not uncommon for men to have feelings of terror when their significant other mentions Botox or other, more involved surgical enhancements, like a rhinoplasty. “They think, ‘Oh my God, your face is gonna be frozen, and your nose is gonna collapse,’” she says. “They see the extremes of it. I think it’s because the social media culture and the beauty culture is more geared toward women in that respect. Women have a lot more experience seeing the gamut of plastic surgery treatment, and how subtle they can be and their friends [who] have had it. Whereas men only hear about it when it’s crazy.”
The men I interviewed confirmed Liotta’s theory, admitting they were reluctant to support their significant others in their desire for cosmetic enhancement because it creates such an “unnatural look,” along with the fear that they “would become addicted.” “It’s like redoing the bathroom in the house, and then, when that’s finished, moving onto something else, and now you want to redo that,” one man, whose significant other had floated the idea of getting Botox, explains.
Another guy tells me that his partner has yet to undergo any sort of enhancement, but understands that if she ever did, it would be something she was doing for herself. Still, he believes, somewhat contradictory, that just because a woman has the right to do something to her body, it doesn’t mean that she should. “Someone breaks into the house, you have a right to kill them, but that doesn’t mean you should,” he argues.
Another young man tells me he’s glad that his girlfriend hasn’t yet mentioned anything about cosmetic enhancements. He continues by saying that he’d prefer she never gets them, but that if she did, he’d be more inclined to support breast implants than Botox, because he’s afraid of “losing the things about her that make her, her.” “You don’t want all the cute facial expressions and weird quirks to get affected,” he tells me. “Because when you love someone, you love every inch of them.” (Their small breasts less so, perhaps.)
There is, of course, an alternative explanation for this sort of devotion, one that’s likely uncomfortable for most men to acknowledge. “Part of this has to do with simple possessiveness and fear of loss of control,” says Lewis. “There can be a worry and insecurity that arises about the woman they love looking different or being different, or that she is doing it to attract someone new or better looking than he is. Some men are clearly happier to have their mates be a little overweight or sagging a bit because it’s a form of control mechanism — in their minds, they can keep her because she won’t be desirable to other men.” This, she adds, is a form of abuse and doesn’t make for a healthy relationship. “More women today do little tweaks for themselves than for the men in their lives, which is a much healthier attitude toward the whole category.”
Matarasso tells me that although he’s noticed younger generations of men become more tolerant toward cosmetic surgery — mainly because both women and men are choosing to undergo these procedures at a younger age, making it less taboo than it was in the 1990s and early 2000s — he thinks that the conversations around cosmetic surgery can reveal certain dynamics of a couple. “It can bring a lot of things to the surface,” he says. Foremost among those things: Feelings of jealousy. “When men or women decide to come in for surgery, their partner may feel like, is he or she seeing someone else?”
So, a little faith in and support for your partner will go a long way. But that brings us back to the tricky part: There is, obviously, a fine line between being supportive of your significant other’s decision to undergo a cosmetic procedure, and rooting for it as though you’re overjoyed that, finally, she’s fixing her damn face! “I wouldn’t want my boyfriend to get overly excited or start cheering me on if I told him I wanted to get some work done,” says one woman I know. “I just would want him to support me.”
If that seems eerily close to a damned-if-you-encourage, damned-if-you-don’t scenario, that’s because it is. “It’s a double-edged sword,” says Matarasso. “Telling her, ‘Go, you need it!’ is obviously a problem. But also, ‘No, you don’t need it,’ that’s a problem. It’s sort of a no-win situation for the partner in many ways.”
Still, another woman tells me that it’s possible to find the right balance. “In a lot of situations where a girl wants some kind of fillers, the boyfriend thinks it’s completely unnecessary and doesn’t want to fuel her insecurities,” she says. “The most supportive thing a guy could do in this situation would be just to have a dialogue with her about why she wants work done. Is it because most girls on Instagram look a certain way, and she wants that look too? Then maybe that’s not the best reason. Is it to fix something she’s been self-conscious about for a long time, she’s done the research and can afford both the monetary cost and potential medical risks? Then the guy should probably be supportive.”
All of this assumes, of course, that your significant other asks your opinion in the first place, and there’s a decent chance they won’t. Liotta, for example, isn’t private about using injections on herself, but also doesn’t feel the need to tell her husband every time she uses them. “So for me, I did cheek filling myself a few days ago in the office and he never knew,” she says. “Not that I wouldn’t have told him — he’d never say something negative about it — it’s just, why look behind the curtain?”
Liotta goes on to explain that she has patients confide in her on a weekly basis that they don’t want their husbands to find out. “There are those people who think, ‘I’m doing this for me, and I don’t want to talk about that.’ Then there’s also people who just feel like its unnecessary information,” she says. “I don’t tell my husband every time I shave my legs.” To be clear, Liotta’s husband knows she gets Botox and fillers, but she still chooses to get injected when she knows she’s not going to immediately see him, “just because he doesn’t need to know that information,” says Liotta.
While Matarasso agrees that it’s a woman’s choice, he isn’t quite as relaxed about casual cosmetic enhancements, and believes there are very good reasons for “looking behind the curtain.” “Remember, this isn’t a haircut — even injections can have complications,” he warns. “Getting fillers has more risk than shaving your legs!”
Secret procedures aside, though, Lewis believes that if the couple is in a healthy place, they should be able to talk about it openly and honestly. “Show her that you’re taking an interest and be her sounding board,” she advises. “If it’s something small, like a filler or a laser, be open about it. Every woman likes to hear the words, ‘You’re beautiful just the way you are, but I respect your desire to do what you want to your body and I support you.’” Lewis even notes that she could always tell which couples had the best relationships. “When a husband or boyfriend said to me, ‘I want her to have the best doctor, no matter what the cost or where he is,’ I knew he truly loved and cared about her wellbeing.”
Writing for GQ, Sophie Saint Thomas advises men in this situation to be there in the doctor’s office, either in person or via text. “If your lady is getting something done that requires anesthesia, such as a nose or boob job, it might be nice to go with her, but injections are so quick that it’s not necessary,” she writes. “If you can’t join her on her beauty expedition, encourage her the day of and check in throughout in a supportive — but not annoying — manner.”
Matarasso takes it one step further and advises that men accompany their significant other even for her consultation. “I’d love it if you were in the room with her, that way there’s less misunderstanding,” he says. “It’s never the same when someone goes home and tries to explain things. For one partner to translate to the other isn’t helpful.”
But don’t be surprised if you, too, walk out of your significant other’s consultation with dreams of injecting a little Botox in your forehead, or a little filler to help remove the dark circles under your eyes. “The other day, I had it happen where the guy came in with his fiancée, who wanted to get a little bit of Botox and under-eye fillers before their wedding,” says Liotta. “We did it, and then two weeks later, he came back for under-eye filler. Because what you see isn’t a hard process — it becomes more like a maintenance thing, or like a little bit of self-care, rather than a plastic surgery.”
In other words, the good work — which, according to every professional I spoke to, is in the vast majority, despite the cultural longevity of the more notorious disasters — isn’t noticeable because it’s subtle. “You may not know a woman has had some tweaks or injections because she just looks good,” says Lewis. This, says Lewis, is “an education” for most men (myself included). So her advice: Don’t be a control freak. If your girlfriend or wife wants to explore her options, let her. “Many women, especially when a relationship is new or tenuous, don’t want the men in their lives to know about their dalliances with cosmetic procedures, and that’s their right,” says Lewis. “I’ve known so many women who go to great lengths to hide a little liposuction or neck tightening, and they can get away with it. Women are very adept at camouflage — our hair, a little well-placed makeup, the right scarves and high necklines can hide it well.”
So what have I learned for the next time my girlfriend brings up this subject?
Despite a better understanding of the processes involved, it would be disingenuous to say that I’ve completely changed my mind about the safety and/or necessity of cosmetic procedures in general. But then, for the most part, that’s neither here nor there, because there really is only one good thing to say in this circumstance: “Whatever you do is your choice, but if you go ahead with this, I want to make sure you have the best doctor, no matter what the cost or where the doctor is.”
And if all else fails, just go get Botox together — you’ll probably end up wanting it anyway.