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"To be well married you have to have a penchant for the intricacies of intimacy and larval change," writes Hanif Kureishi in his latest novel, The Body. You have to have a penchant for the intricacies because finding someone to grow old with means exactly that: You both get old unless, of course, the visible effects of age have been erased by a plastic surgeon. More than 8.3 million cosmetic procedures were performed last year, according to the American Society for Aesthetic Plastic Surgery — a 293% increase from 1998. And the numbers keep rising. To paraphrase the Six Million Dollar Man: We have the technology. We can rebuild them. Better then they were before.
     Will troubled husbands and wives increasingly eschew couple's therapy in favor of facelifts, liposuction, breast augmentation, and rhinoplasty? Will they simply remodel themselves to keep their marriage — and their sex lives — fresh or to prevent their spouse's eye from wandering into another's bedroom? Nerve spoke with four plastic surgeons from around the country about nuptial nips and tucks. — Paul Katz

Dr. Jeanette Martello Pasadena, California Specialty: Liposuction Private Practice: 5 years Dr. Robert Jackson Carmel, Indiana Specialty: Facial rejuvenation In practice: 38 years Dr. Pamela Loftus Boca Raton, Florida Specialty: Labia Reduction In practice: 19 years Dr. Richard Ellenbogen Beverly Hills, California Specialty: Breast Augmentation/Reduction Private Practice: 29 years

How much of a role does a spouse play in the decision to undergo a cosmetic procedure?

Martello: A woman came in today and said, "My husband wants me to have big breasts again. My breasts have deflated, and he like them when they're big." It was so obvious she was just doing it for him. It's clear this guy expects perfection, and there is just no such thing. The No. 1 thing women do just for men is breast surgery.

Jackson: In my practice, I hear this comment a lot: "I like her just the way she is. She doesn't need to do this for me, but if she wants to do it for herself, then its okay." Then, through the interview process, you see that a lot of influence is coming from the spouse.

Loftus: It's usually a decision both make together. Partly for the financial outlay, but also because they're partners. But if my patient is feeling pressured and being told they need to have it done, they're not a good candidate.

Ellenbogen: Men think of their image in relationship to how women will perceive them. Men frequently have plastic surgery to look better to a woman. They'll be very open about that's why they're having it done. But still I lay a little head trip on them to make sure they are doing it for themselves and not being forced into it by some wife who said, "Boy, you're looking fat!"

Can cosmetic procedures revitalize a marriage?

Loftus: With a labiaplasty, my patients have told me that many of them lacked confidence about the appearance of the external genital area. After the procedure, they felt happier and pleased with their appearance, so they could relax and enjoy sex more.

Jackson: Plastic surgery can cause a lot of problems. I've had patients get surgery and then the spouse becomes extremely jealous. A patient had a significant amount of weight loss through liposuction and her husband became very paranoid and untrusting. He wanted to know where she was if she went to the grocery store. It ended in divorce. Before the surgery, he felt she wasn't attractive enough for him to have to worry about infidelity.

Martello: I can think of one woman who got a total body contour. She's been with the same man for fifteen years. She wanted a bigger butt because she's Latin, so I took fat out of all these other places and injected it into her butt. After the bigger breasts, tummy tuck and bigger breasts he's more proud of her. He brings her lunch at work. Before he would never do that.

Ellenbogen: As far as women go, they know getting their face, nose or breasts done is going to improve the way they think and feel about themselves. If indeed it does that then certainly they'll be sweeter and nicer. There is a Spanish phrase that translates to 'When a woman is happy, the world is happy'. In the United States we've allowed the woman to determine the mood of the relationship. If she feels sexy and wonderful then the relationship is better.

Among married couples, will the "cosmetic tune-up" become a trend?

Loftus: Yes. I think more people will go in for cosmetic procedures in the future. People are starting to live longer but don't look as young as they feel. Men are more and more comfortable having plastic surgery and in ten years it'll almost be an expected part of one's life. It'll be commonplace — like going on vacation or buying a car.

Martello: People will start taking care of themselves early on. There isn't a lot surgery one can do at age eighty. There is only so much hair dye can do. It gets to the point where it's time for the knife — wake up and smell the coffee!

Jackson: A number of professionals from the psychiatric world have spoken about how a person perceives themselves on the outside translates to how they view themselves on the inside. Part of it is that as we approach our senior years we don't want to contemplate ever losing the one we love. By keeping them looking young, we the keep the illusion that they aren't ever going to die.

Ellenbogen: When you hit a certain age, and one of your friends dies or becomes sick, you become mortal. And you realize, "I don't care how many years I have left; I want to look the best I can for the rest of those years." Like all things, plastic surgery will get popular and then come to a reality. Plastic surgery is being overdone, and I know the skill level of some of the people who are doing these operations. If it continues to expand, there's going to be a bunch of weird-looking people out there.

Can plastic surgery save a marriage?

Loftus: No. If the foundation of a marriage is poor, nothing will help save it.

Martello: I operate on more than just body parts. If I think someone is doing it for the wrong reason, I won't touch them. Surgery is a tool to feel better about who you are. It should be done for yourself, not for the relationship.

Jackson: I doubt that plastic surgery will make the divorce rate go up or down. Cosmetic surgery is surgery of the soul. It is a combination of both mind and body transformation but only if a marriage has a strong foundation to begin with. Otherwise any positive changes will just be temporary.

Ellenbogen: Ha! Here's why marriage depends on the couple and not science. A husband and wife walk into my office for a breast consultation. The woman says 'I want my breasts made little.' The man says, 'I want her breasts made bigger.' They leave the office and argue in the hall. Ten minutes later she returns alone and says, 'I want my breasts made smaller.' I ask, 'What about your husband? He wanted them larger.' Her reply: 'The breasts will be here in a year. He won't.'

ABOUT THE AUTHOR:
	Paul S. Katz is a writer living in New York City. His work has appeared in the pages of Entertainment Weekly, FHM, Men's Fitness,TV Guide and Daily Variety.

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