What about my spouse?
It is best if the spouse knows in advance, because they WILL know eventually! Remember, it is difficult to achieve balance as a spouse.
Think of these conversations.
Me: "How about cosmetic surgery, dear?"Now consider that conversation versus this one.
Spouse: "Excellent idea, I have been meaning to suggest it. I can't wait." (trying to be supportive)
Thought: He doesn't like me as I am.
Me: "How about plastic surgery, dear?"
Spouse: "Oh no! I love you the way you are." (Trying to be supportive)
Thought: He won't let me be all I can be.