At 48, the Madonna chic goes cheekless

But judging by this picture, it seems that Madonna's relentless exercise regime may be taking its toll on her face.

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Hollow, goodbye: A gaunt-looking Madonna leaving the Locanda Locatelli restaurant with husband Guy Ritchie

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.

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Razor-sharp: Years of intense exercise have left Madonna's cheekbones looking as if they could cut glass.

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."