She's had a lot of work done in the last few years. Makes sense as she's pushing 50 and contrary to what she and her fans tell themselves, relies on looks to supplement vocal skill that isn't there. Nothing to be ashamed of- Julie London was the same way. Except she could sing.
What I'm interested in is how much the nose job affected her voice - The nose is part of the "mask" when singing and a reason many prominent opera and standard singers have prominent noses. (They don't choose to have them, but are helped out significantly by it.)