From Britain, where cosmetic surgery has yet to reach the epidemic proportions of the United States - the equivalent of one operation per year for every 150 people - things look rather different. Hillary Clinton's appearance seems to me the least of her problems, which have more to do with her loyalty to her ghastly husband and her readiness to make excuses for his shortcomings - both political and personal. Indeed a willingess to submit to what is in effect a form of self-mutilation suggests an underlying malaise which is emotional rather than physical, especially in the instance of a woman who has so many reasons to feel furious about the way her husband has treated her - and so little outlet for her rage other than her own face and body.
In any case, facelifts and all the other costly procedures of cosmetic surgery create as many problems as they claim to solve. Four or five years ago, I began to notice attractive women of a certain age with curiously immobile faces, and it was a while before I realised why their range of expressions was so limited. They reminded me of the characters in L P Hartley's forgotten but chilling novel Facial Justice, about a dystopian society in which everyone has an operation to look the same. The American novelist Erica Jong, writing about her own surgery, captured this unsettling absence of individuality when she described her new face as "a moon into which no craters have been carved". She also admitted to feelings of loss: "My face looks blameless. My soul is all stitched up".
Why, then, are so many women doing it? Because we are routinely bombarded with messages that tell us we have to look young - and act young - to please a man. At one end of the scale there is The Rules, the bestselling book which advises women to retreat into a parody of 1950s femininity to get a husband; at the other, we have the new pseudo-science of evolutionary psychology informing us that men are genetically programmed to chase younger women. Men "universally prefer younger mates", announces an idiot's guide which landed on my desk this week, while "all over the world, women prefer mates older than they are".
This is comically untrue, as has been proved by the horrified reaction of most women of my acquaintance to the sight of wrinkly old Michael Douglas groping Catherine Zeta-Jones. Nor do I know any woman who has exclaimed, over pictures of Rupert Murdoch and his bride Wendi Deng: "Wow, what a hunk! Lucky Wendi! How did she do it?"
The truth is we are all attracted to youth and beauty, though neither is a determining factor on its own. Rich, successful women tend to go out with men their own age or younger, for the simple reason that they can; the power relation has shifted in their favour. In this context, cosmetic surgery is a throwback to a time when a woman's sole asset was her appearance, which had to be preserved at all costs. Hillary Clinton is hardly in this position: if she wants to be taken seriously, a divorce would be considerably more effective, and physically less traumatic, than going under the knife.
ANOTHER DAY, another massacre in an American city, this time killing seven people (not including the gunman) in a church in a suburb of Fort Worth. Photos of shocked survivors dominate the front pages, murdered teenagers smile from college yearbooks, but what else is there to say? Everyone knows the problem is guns, and the lack of political will to ban them. So let's just reflect on a couple of paradoxes about contemporary American culture, starting with the fact that the end of the Cold War and the consequent absence of external enemies has created a vacuum which is rapidly being filled by right-wing militias and lone gunmen. The second is that the American government, which is so intent on not spilling a drop of its soldiers' blood in Kosovo or East Timor, allows the carnage at home to continue unchecked. Double standards have seldom been so obvious, or so lethal.