Who Cares About the Issues: Is That Botox? By MARC SANTORA Published: October 26, 2006, New York Times WHEN John Spencer, the Republican candidate for the United States Senate in New York, was reported to have made disparaging remarks about the appearance of his Democratic opponent, Hillary Clinton, the reaction was overheated, intense and conciliatory. Charles Dharapak/Associated Press Mary Ellen Matthews/Associated Press -- NBC Janet Reno, right, with Will Ferrell on Saturday Night Live. Library of Congress SKIN DEEP William Taft, 320 pounds. And that was just from Mr. Spencer, who rushed to clarify his remarks and the circumstances in which they were said. From all the denials, it appeared that Mr. Spencer recognized that criticizing a candidate for her looks was beyond the pale, even in a campaign in which a challenger is lagging in the polls by more than 30 percentage points and is in desperate need of some attention. But looks have always mattered in politics, and in an age of 24-hour television news, it has become even more relevant. What was especially intriguing about Mr. Spencers off-the-cuff remarks, as reported in The Daily News, was his speculation that Mrs. Clinton had evolved from an ugly duckling to the presentable 59-year-old woman she is today with the help of millions of dollars of work. And if she had: Would it matter? With Americans spending $12 billion a year getting injected, stapled and snipped, cosmetic surgery long ago went mainstream. Yet there is one arena in which an accusation of having work done still stings, and that is in politics. In the 2004 presidential election, when it was suggested that John Kerry had undergone Botox injections to wipe away facial lines, the Democratic candidate did his best to furrow his brow and declare such talk nonsense. (No matter, his critics said, since he was guilty of something much worse: looking French.) Arnold Schwarzenegger, the governor of California whose changes have been chronicled on Web sites like Awful Plastic Surgery, denied rumors during his 2003 campaign that he had had a face-lift, making light of the talk by suggesting that people had him confused with Cher. Senator Clinton, too, could not let the accusation stand, calling Mr. Spencers remarks scurrilous and making it clear she had had no work done. Politicians clearly care about their looks. As Phil Gramm, the pugnacious former senator from Texas who ran for president in 1996, used to ask, Can an ugly man be elected president? (Mr. Gramm failed to win the Republican nomination.) But they seem to care even more that their looks are not perceived as artificial or that their interest in looking good might be held up as a potentially fatal example of vanity. Of course, politicians have long sought ways to convey youthful, healthy vitality. Gerald Fords advisers asked for a neutral backdrop for his debates, to downplay his thinning gray hair. Richard Gephardt, the Missouri Democrat who served three decades in Congress, penciled his eyebrows to give them shape and definition. And every politician who has sat before the television lights has been slathered in makeup (remember Richard Nixon?). It is the rare public person who will allow his or her looks to be ridiculed, as Janet Reno, the former attorney general, did when she joined the cast of Saturday Night Live for a Will Ferrell sketch called Janet Renos Dance Party. Still, there is a fine line between primping and preening. The question is, in a plastic age, does surgery still cross that line? Dr. Cap Lesesne, a board-certified plastic surgeon, has been performing cosmetic surgery for two decades, but he said that it was not until about 10 years ago that he began to see politicians at his Upper East Side practice. In the past five years, he has treated at least 18 federal, state and local officials, he said. And, he said, he knows of six United States senators who have had plastic surgery. Politicians want to come away looking younger, better, healthier, he said, but with something that does not say they have had plastic surgery. Careful not to reveal details that would compromise his patients identities, he described one case that provided an illustration of the lengths public figures will go to hide work. This person knew they were going to run for election in four years, he said. So the politician would come in every six months leading up the election, gradually improving in appearance each time, but never so much as to arouse suspicion. Being in the public spotlight almost daily and worried about getting caught in the surgery act, they have to go to extreme lengths, Dr. Lesesne said. Surgeons, he said, can become co-conspirators in the deception by, for instance, going through the mouth to hide incisions. This squeamishness over plastic surgery by politicians does not seem to extend to voters abroad. Silvio Berlusconi, the former billionaire prime minister of Italy, had a turbulent time in office, but admitting to a face-lift and hair transplants was not one of the things that Italys voters held against him. Dr. Z. Paul Lorenc, also a board-certified plastic surgeon in Manhattan, thinks American politicians would be better off if they just admitted to what is often obvious to all. I think it is silly, he said. And whats wrong with getting features youthified, he asked. Politicians, in many ways, have it worse than celebrities, he said. There are so many pictures of them out there. And unlike Hollywood royalty, they can not count on decent lighting. Obsession with looks by politicians and voters is hardly a new phenomenon. It may be an accident of history, but William Howard Taft, at 320 pounds, was the last obese president, and Dwight D. Eisenhower, the last bald president, had to win World War II before he was elected. Even as far back as 1860, looks were raised in a letter to an aspiring presidential candidate. With a beard, You would look a great deal better, for your face is so thin, wrote Grace Bedell, 11. All the ladies like whiskers and they would tease their husbands to vote for you and then you would be president." The reply came back promptly four days later: As to the whiskers, having never worn any, do you not think people would call it a piece of silly affectation if I were to begin it now? Your very sincere well-wisher, A. Lincoln.