Dr. Sabrina Shah-Desai, a London-based surgeon who specializes in reconstructive procedures, noted that Bella, now 23, has ‘changed significantly’ in the years since the yearbook portrait was taken – and she explained that this could well be the result of several different surgeries. Dr. Shah-Desai added that the model also looks as though she has undergone ‘rhinoplasty and lip fillers’ as well as ‘facial sculpting’ – which means that she could have had ‘dermal fillers’ to enhance her cheek bones and jawline. The medical expert also pointed out that Bella’s face appears much thinner now than it did when she was in high school, explaining that this could be the result of Buccal (cheek) fat removal – or simply as a result of general weight loss.