In Hollywood, when we say that someone has had “some good work done,” we’re talking about eye lifts.

And lip implants, tummy tucks, cheek pulls, lipo, chemical peels, rhinoplasties, breast augmentations, upper-arm trims, and neck reductions.

There’s “good work” and “bad work.” Good work is work that you can barely notice. It’s restrained. Youthful but not young. The neck is smooth but not tight. The bosom ample but not cartoonish. The eyes and the surrounding tissue are open and clear of sagging pockets of eyebrow fat.

The actor or actress who has had good work looks younger, and what people in the plastic-surgery business call “refreshed.”

The actor or actress who has had bad work done looks like a burn victim: skin blasted smooth; permanently startled eyes, finger-in-an-electric-socket wide; and fat lips surrounding a mouth pulled into a ghastly rictus that suggests, more than anything, some kind of amphibious sea creature walking the earth in Juicy Couture.

In bad work, the pieces don’t fit together, as in a clumsy Photoshop experiment. The worst part about bad work is, despite the line-less face and the elastic bosoms, it somehow makes the subject look older and more decrepit.

Speaker of the House Nancy Pelosi has had, in my opinion as someone who has worked in Hollywood for over 20 years, good work done. Mostly, I think (and I’m no doctor), some judicious Botox injections around the hairline and forehead. Maybe an eye tuck. Almost certainly some work around the mouth. But honestly, she looks pretty good for a powerful and unpopular multi-millionairess.

Sure, she’s got that wide-eyed, startled look that people get when the surgeon tugs too hard on that final suture, but my guess is that she comes by that look honestly. Who, in her position, wouldn’t be startled by the torrent of opposition to Obama’s health-care legislation? How could she not be shocked — and how could her face not show it? — to discover that she and her party are in free fall, from back-to-back smashing victories in 2006 and 2008, from sweeping majorities in both houses of Congress and a popular president in the White House, to this? To procedural tricks and outright bribery? To the speaker of the House begging and threatening members of her own team in a desperate, rat-in-a-coffee-can, crazy-making effort to pass the single most unpopular piece of federal legislation since . . . since ever? And in an election year?

All in all, I’d say she looks pretty good, considering. No, wait, that’s too stingy: She looks amazing.

The last speaker of the House whose physical appearance seemed to symbolize the exhausted and tapped-out energy of his party was corpulent, red-faced Tip O’Neill, who, as far as I know (and I’m no doctor), didn’t have any work done, ever.

O’Neill was a streetfighter, of course, and a political gangster back when that really mattered — back when politics was really all about ward heeling and steak frys and buying the votes you needed when you needed them. O’Neill punished his enemies and rewarded his friends, and he had the face to prove it — a pocked, veiny red face that showed a thousand late-night benders spent arm-twisting committee chairmen, jowls that drooped under the weight of big union pancake breakfasts, and a belly bursting with pork-barrel spending and special amendments and last-minute earmarks.

Tip O’Neill lumbered around D.C. like the old Democratic party itself — powerful, huge, blue-collar, a little soused. And then along came Reagan and a reenergized Republican party, and suddenly Tip O’Neill wasn’t such a great physical symbol anymore. Suddenly, he was the butt of Johnny Carson’s jokes; the punchline to a hundred Republican fundraisers; a liability, in other words.

It’s impossible to imagine what a “refreshed” Tip O’Neill might have looked like — I’m thinking a little Joe Biden crossed with Barney Frank — but it’s safe to say that cosmetics weren’t the problem. And as with speaker of the House and unpopular millionairess Nancy Pelosi, a little work wasn’t the solution.

Which is the problem. Because in Hollywood, when we say that someone has had a little work done, we’re acknowledging that work, in fact, has been done. What we’re saying, essentially, is that an actor or actress is a lot older than he or she looks — and probably deserves to look a lot worse than he or she does — and that we as insiders can identify the work and where on the body it took place; but we’re also assuming that out there in America, the ordinary folk will buy it.

In Hollywood, we imagine a vast nation of easily duped proles who really and truly believe that an actress in her late 40s has grapefruit-firm breasts and a neck as smooth as PVC pipe. When an actor comes in to read for a role with saucer eyes and teeth so white they’re actually blue, we don’t think, “Eek! A monster!” We think: “He looks pretty good for 63,” and we give him the part, because in Hollywood there’s no better choice for a role than a pro, than someone who knows the job and has played a million versions of it but still looks okay. A little weird, maybe (especially around the eyes), but okay.

Say this for gin-blossomed old Tip O’Neill — he was the real thing. He looked the part. In a true-to-life movie about American politics, he would have been the perfect star: charming, working-class, corrupt, emotional, persuasive. If you were trying to pass an enormous new federal entitlement package that required massive new spending and crippling tax hikes, he’s the guy you’d cast to do it, and he’d do it over dozens of lunchtime porterhouse steaks. A brittle and Botoxed unpopular millionairess, tone-deaf to the wider country and besotted with perks, just isn’t the right fit for the job. Speaker of the House Nancy Pelosi will be 70 years old at the end of March. And she looks great.

She shouldn’t. She should look a little more like Old School Tip — a little heavier and redder and jowlier. What she’s trying to pass, ultimately, is a signature piece of legislation from the lost Walter Mondale administration: a big-government boondoggle, a massive new entitlement — exactly the kind of thing that administration would have passed with O’Neill’s guidance.

(If you’re too young to know who Walter Mondale is, I’ll pause briefly while you consult Wikipedia. But the nutshell version is: Old Time Big Government Democrat, lost big to Reagan in 1984. Pledged in his convention address to raise taxes. And no, that last sentence does not contain a typo.)

If you could somehow “refresh” Walter Mondale, it would be hard to do better than turning him into Barack Obama. Obama’s all sleekness and lean lines; he’s dashing and looks great in a suit. As a piece of casting, there’s no better choice. But no matter how hard they try, politics still isn’t Hollywood.

Old School legislation requires some Old School politics; even good work looks like work. The American people might forgive some judicious tummy suctioning and neck darts on their favorite stars, but they’re not as crazy about that kind of thing on gigantic new federal expenditures, hence the ferocious opposition to Obamacare. And because the Democratic party is made up, like Hollywood, of people who believe that you can sell anybody anything if you get the optics right, they’re just not hearing it.

But everyone else is hearing it, loud and clear. And the sound they’re hearing from Washington, D.C., is the sound of a hundred sutures bursting; a thousand brows re-furrowing themselves; the crackle and roar of a million wrinkles re-etching their lines along the eyes, mouth, ears, and nose; the noise of jowls and bellies reinflating and bursting out — in other words, the sound of a lot of work going horribly wrong, a greasy federal boondoggle bursting into life, and the Democratic party returning to its roots.

I’m no doctor, but I think that is going to be a hard one to fix.