WHEN Henry Kissinger circled the globe as the face of American power, the column inches written about him could also have circled the globe.

In all the comment and criticism, I recall no headlines about his grooming.

Dr Kissinger wore spectacles every day. Nobody commented. Nobody cared. He wasn't the bonniest of men. Again, so what? He was the embodiment of American might – a man who could bring in his wake peace or war.

Hillary Clinton has his job now. She too has been touring the world, embodying the power of the United States. But when she pulled back her hair and wore spectacles it made headline news.

Don't ask me which country she was in or why she was there. Like most people all I registered was her shocking lack of makeup – lipstick only and no contact lens. What was the woman thinking?

If she doesn't watch her step she'll be going the way of Mary Beard. The Cambridge professor fronts the television show that is revealing to us the histories of the common people who lived in ancient Rome. She has the effrontery to be more interested in her subject than in her appearance. The media is having the vapours. These women – and any who threaten to follow a similar path – must be whipped back into line. Public opinion must be rallied against them. They could be construed as a threat to the economy.

You think I'm joking? Think again. We are celebrating, if that's the right word, the 10th anniversary of Botox. The toxin (that is the right word) recently received the go-ahead in England from Nice (the National Institute for Health and Clinical Excellence) for use in treating severe cases of migraine. It has several other medical uses, but the productt had become famous as a means of erasing wrinkles by paralysing facial muscles.

Botox is the world's most popular cosmetic treatment. In the US alone it is worth $1billion annually. There has been a 621% increase in its use since 2000, and not just among women. Simon Cowell famously compared it to using toothpaste. It's true that in most of our cities and towns it is almost as easily acquired but Botox needs careful handling. Botulinum toxin is a potent neurotoxin. Its very =long-term effects are still unknown.

What we have is a living laboratory with increasing numbers of teenagers opting to have injections as well as young women in their twenties. Who knows what we will discover in 30, 40, 50 years?

We have become so obsessed with looks that two-thirds of British adults feel they need cosmetic surgery. They say expense is the biggest deterrent. It's like a communal crisis of confidence. And it is lunacy. Whom are we measuring ourselves against? And why is our appearance the measure?

It's a poor choice we're making. We can develop our brains, work on our personalities and improve our fitness. But all the artifice in the world doesn't stop our looks from deteriorating. They're the one aspect of our being guaranteed to need more maintenance every year.

But appearance is big business. If Hillary Clinton maintains a relaxed approach towards her own, I wouldn't be surprised to hear her criticised for failing to support American industry. Make-up turns over close to $200bn worldwide a year with America the biggest spending nation.

Don't imagine we are any different. The UK beauty industry is worth £15bn a year and employs almost one million people. Facial skin creams alone will be worth £1bn by the end of this year with anti-ageing and anti-wrinkle creams topping the bill. One industry insider was quoted saying: "The ageing population is a rich vein to be mined."

That's baby boomers such as Mary Beard. I wonder how long it will be before she is offered a make-over? She is already being identified by her peers as the icon of how not to look. Rather like Bridget Bardot.

The French screen goddess has the skin type that crushes like tissue paper. She's 70 and she looks it. In an article marking the 10th birthday of Botox a doctor who administers it to the stars described her as "ugly".

As it happens I saw her up close about 10 years ago when she was already ageing. She was both wrinkled and stunning. The doctor compared and contrasted her with Sophia Loren who is the same age. He says Loren has "maintained" her looks – code for surgery or procedures.

I couldn't possibly tell but I do know women of 70 who have been blessed by nature with high cheekbones and skin that pulls back with age – as opposed to folding forward. I have a photograph of my mother taken on her 100th birthday. She has scarcely a line – a trait I failed to inherit. She would never wear make-up much less have a face full of fillers.

Today research shows that six in every 10 girls between the ages of 16 and 24 would have surgery to make them feel better about their looks. Have they learned nothing from the recent scandal about breast implants? Don't they know the industry remains shockingy light on regulation?

A report from the National Confidential Inquiry into Patient Outcome and Death described the UK cosmetic surgery sector as "a problematic cottage industry pattern of laissez faire provision". Of 619 clinics, 71 shut during their survey and a further 371 didn't respond. Yet cosmetic surgery in the UK was worth £2.3 billion in 2010 and is expected to reach £3.15billion by 2015. It says everything about how desperately insecure people feel about their looks. Need overrules their caution.

Most women and increasing numbers of men understand why people opt for treatments. It is a rare person who cares not a jot about their appearance. And if there is an easily available product or injection that will turn back the clock – or improve what nature provided – it is tempting.

Having grasped perfection for a moment, it's then even harder to settle for less, as age once again asserts itself. More procedures are necessary, then more. Yet the chasing of one's youth is the ultimate example of the law of diminishing returns.We see it in the celebrities who forged this path for us. They seemed to defy age – for a time. Now some look permanently startled and others wonky.

So happy birthday to Botox – 10 years old and growing ever more popular. It's a toxic thought.