She famously works out for at least three hours a day to fit into skin-tight costumes and the tiniest of designer clothes.
But judging by this picture, it seems that Madonna's relentless exercise regime may be taking its toll on her face.
Another explanation is that the singer is a victim of her own success - because of her svelte figure, it's hard to remember the mother of two is 48 years old.
Leaving the Locanda Locatelli restaurant in central London this week wearing minimal make-up and an austere black outfit topped by a silvery trilby hat, her razor-sharp cheekbones stood out.
Patrick Whitfield, a plastic surgeon from The Harley Medical Group, said Madonna's thin face could be attributed to her strict macrobiotic diet - and the march of time.
He added: "Ageing of the face is a funny thing. You can be fine for a long time and then suddenly the face starts to crumble.
"I think Madonna looks good in the sense that she doesn't have a wrinkly neck yet. But you can see a hollowing of the cheeks.
"You lose that fatty tissue as it is absorbed during the ageing process. The soft tissue slips off the face and you get a degree of hollowing."
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