A New York plastic surgeon has charted the slew of cosmetic tweaks Madonna has had over the years – after fans raised concerns about her health.

Photos of the star, 65, re-emerged on social media over the weekend in which she looked unrecognizable, causing some users to say her face looked ‘painful’.

Despite years of speculation, Madonna only recently admitted she has had plastic surgery, but she has not revealed what the procedures were or how often she has gone under the knife.

Board-certified surgeon Dr Barry Weintraub, who reviewed before and after images of Madonna, said he saw signs of at least 12 cosmetic facial procedures, which he estimates would have cost ‘multiple six-figure sums’.

Dr Weintraub said one of the most obvious changes was to her cheeks— which are now ‘inflated’ and ‘much fuller’, likely due to multiple dermal filler injections, which see gel-like substances injected under the skin.

He pointed out that Madonna has also lost her characteristic dimples, likely due to the fillers.

Starting at the top of her face, Dr Weintraub said she had clearly had a brow lift — which was indicated by her ‘unusually high’ forehead and higher than normal eyebrows.

‘You see a flatter straighter line, which indicates there may be an incision in front of the hairline [to pull up the skin],’ he said.

‘Her eyebrows are [also] higher than the position of her brows in 1986, meaning the distance between her eyelashes and her eyebrows is much higher than ours. You see a lot more volume in the upper third of her face.’

Brow lifts are usually done by making an incision along the top of the scalp and then also pulling the skin back in order to remove wrinkles and sagging.

He also said work had been done to her eyelids in order to give them a younger appearance and remove wrinkles.

‘When you go into your 60s, there are often puffs of fat in the lower eyelids and some excess skin in the upper eyelids,’ he said.

‘In these pictures, however, you see none of each. Her lower eyelids are totally smooth, which means skin has probably been removed. The fat pads have also been removed.

‘So what you’re seeing is this smoothness and tightness all around and that is from surgical lifting volumization.’

He added the star had also likely had botox into areas of the forehead and around the eyes because there were no wrinkles present when she moved her face.

He also pointed out that Madonna’s characteristic mole above her lip appeared much more faint, which may simply be the lighting in the photos or a side effect of the facial tweaks.

Dr Weintraub believes she has also had at least one nose job.

Pointing to a 1986 photo, he said: ‘In the original picture, the tip of the nose is blunted and the nostrils are not arched,’ he said.

‘[But now] the nose is more pointy. And if you look closely, the left nostril is also slightly higher than the right.’

He also said her much fuller facial appearance was down to repeated filler and fat injections.

‘Her cheekbones are much, much fuller,’ he said, ‘and that is secondary to either fat or filler injections’.

‘We see this all too often in our field, but unfortunately people tend to fill their faces to try to plump out wrinkles.

‘She also has… two little dimples on each side [in the original picture], which you don’t see now because they are filled with fat.’

The above video was posted by the star in October last year, but has recently resurfaced online

2008: After Madonna appeared to display facial bruising in 2008, fans began to speculate that she had undergone lower eyelid surgery

2021: Madonna’s changing appearance began to cause concern among fans who have speculated how she achieved her remarkably smooth visage

He added: ‘If you look at her ’86 picture, she had a nasal-labial fold like a normal person — that’s a crease going from the corner of the nose to the mouth,’ he said.

‘But in the newest picture, she’s totally flat, meaning that not only has she had a lot of filler but she also had a facelift.’

Previously, there have been suggestions that her larger cheeks are down to implants. But Dr Weintraub dismissed this, saying that if it was the case then the implant outline would be visible.

He also said her lips were ‘very large’, which was likely also the result of repeated fat or filler injections.

‘Those are not normal lips, and look nothing like what she had in ’86 and the filler also,’ he said.

He said filler had likely also been applied to her jawline to ‘build it out’ and minimize wrinkles — and there were signs her jaw had been re-shaped.

A neck lift had also been carried out, he suggested, to avoid skin sagging around the neck.

He suggested she may also have had laser resurfacing surgery on the skin, where a laser is used to remove the outer layer of the skin and stimulate the production of collagen.

And he said it was also possible she had had a mid-face suspension, which involves lifting and tightening the tissues in the mid-face area to help avoid sagging.

‘The whole key to excellent cosmetic surgery is to look like no one touched you,’ he said.

‘You need to look natural and you need to preserve your anatomical landmarks that we’re all born with.

‘But there are major differences between 1986 and pictures of her [Madonna] within the last year or so.’

2023: Dr Horn believes Madonna not only had a ‘facelift’ – which he said was ‘obvious because her skin’ appeared ‘tight and pulled back with no wrinkles’

The picture of Madonna from within the last year has recently re-surfaced on social media, sparking concerns among fans over the ‘painful’ appearance.

More concerns were raised over her ‘unrecognizable’ appearance at the Grammy‘s this year — with the star reportedly ‘affected’ by the comments.

She accused those making the comments of ‘ageism’ and ‘misogyny’ at the time, but later admitted to having plastic surgery after posting a photo with the caption: ‘Look how cute I am now that swelling from surgery has gone down. Lol.’

Fans began to suspect Madonna was experimenting with facial surgery back in the 1990s when there were rumors she was trying out Botox and was undergoing a nose job — allegations she never confirmed.

In 2008, she was photographed with facial bruising, which fans suggested may have been due to surgery done on her lower eyelid.

And in the 2010s, she revealed she was a fan of Dr Frederic Brandt — also known as the ‘Botox Baron’ — although made no claim she had botox.

Madonna is currently gearing up for her delayed Celebration World Tour, which was pushed back after she suffered a life-threatening bacterial infection.

It is scheduled to kick off later this week at the O2 Arena in London before seeing the star travel across Europe and the United States.

Dr Weintraub compared a photo of Madonna in London from 1986, during her heyday, to the image taken within the last year which has sparked concern.