Madonna has sparked facelift rumors after she was spotted leaving a medical centre with two black eyes.
The 49-year-old singer masked her eyes with oversized black sunglasses as she left the New York building but the dark purple bruising was still visible.
Cosmetic operations on the eyes or nose can leave the patient with bruises.
Although Madonna has always denied going under the knife, insisting her youthful looks are natural, it is not the first time she has been dogged by surgery rumors.
In September, she was photographed with a new scar and swelling around her ear.
Celebrity plastic surgeon Alex Karidis said at the time, "I believe she has undergone a form of facelift."
In 2004, Madonna - who is 10 years older than husband Guy Ritchie - was at the centre of another surgery riddle.
She was photographed looking wrinkle-free at the Grammy Awards with many commentators saying she'd had medical help to maintain her youthful looks.
Aposotolos Gaitanis, plastic surgeon at the Harley Cosmetic Clinic in London's Harley Street, said, "Madonna has a very well-proportioned face, with high cheekbones, a high forehead and a well-defined jaw line. I suspect she has been enhanced by cosmetic surgery."
Madonna recently said she felt she was a victim of ageism.
She said, "Not only does society suffer from racism and sexism but it also suffers from ageism. Once you reach a certain age you're not allowed to be adventurous, you're not allowed to be sexual. I mean, is there a rule? Are you supposed to die?"
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