It's related to the Botox stuff. It does look to me like he used it or other similar treatments. In photos of Kerry in October and November he looks haggard and worn down. Suddenly in January he looks totally revitalized and years younger. Something happened. Don't disregard the Botox angle as somehow trivial. There's a larger theme there that Rove can exploit here - phonyness and detachment. If Bush has one advantage over Kerry it's that Bush does seem more genuine - perhaps because he appears far too simple-minded to be otherwise - but nonetheless that's a potential vulnerability for Kerry.
And how could Kerry claim that he "never heard of" Botox when his wife used it and spoke of it repeatedly. The "never heard of" rejoinder seems like A kerry mainstay, similar to the debate where he said he had "never thought about" amending the constitution to allow a foreign born president. What he really meant was he "hadn't yet fully considered the political ramifications" of assuming a position on one side of the issue - not enough poll data of key demographics. I mean he did seem to have given ample consideration to far less urgent matters like Patriots football, boxers or briefs, and Apples v. IBM computers.
I see a bad moon rising.