Cosmetic doctors are certain that former Vice President Joe Biden’s full head of hair, smooth forehead, and Cheshire Cat grin are the result of plastic surgery and other procedures.

Around the time of the 2008 campaign, alterations in Biden’s appearance became noticeable. His hairline changed, wrinkles disappeared, his smile was brighter. “Without any question Joe Biden had hair transplants,” Dr. Barry Cohen, a plastic surgeon with offices in the Washington suburbs, told the Washington Examiner.

Bide '87 vs. Biden '19 (AP Photo)

“In fact, he had bad plugs years ago,” Cohen said. “Subsequently, he filled in his frontal hairline to camouflage the bad ‘Barbie dollesque’ plugs. I suspect he has regular Botox and probably filler. If he had a face lift, he needs another.”

2016 Democratic presidential nominee Hillary Clinton faced scrutiny for cosmetic surgery during the 2016 campaign, but thus far, there are no signs that Biden, 76, will get the same treatment as he launches his 2020 presidential bid.

Dr. Tina Alster, director of the Washington Institute of Dermatologic Laser Surgery, told the Examiner the difference in attitudes towards cosmetic procedures was gender-based. “Women are held to a higher standard,” Alster said, adding women are more likely than men to be seen as vain for undergoing cosmetic procedures.

The Drudge Report website documented changes in Clinton’s appearance during the 2016 campaign with headlines such as “Fresh-Faced Hillary Glows at Lincoln Center.”

Edward Klein, a former Newsweek and New York Times magazine editor, wrote — without citing any evidence — in his 2015 book on Clinton, “ Unlikeable,” that a cosmetic surgeon set up a discreet “mini operating room in her home with the latest medical equipment.”

Biden flashes his pearly whites in 2007. (AP Photo/Manuel Balce Ceneta)

Biden’s gleaming grin is such a distinctive feature that Trident Gum created JoeBidensTeeth.com in January 2009 as part of a promotion where the company gave away free gum. But since he became vice president, several dentists have speculated that Biden’s smile contains porcelain veneers, crowns, or bridges.

Dr. Lawrence M. Koplin, a plastic surgeon in Beverly Hills, Calif., told the Washington Examiner that, while Biden’s procedures are not perfect, they look very good. He noted that Biden had “a crushing experience with the loss of his son" — Beau Biden died in 2015 after battling brain cancer at age 46 — “and oftentimes we see rapid aging following these events. It is not a stretch to imagine his desire to reach back to ‘freshen’ his appearance and rewind to a time when things were better and happier.”

Cohen said that he didn’t expect Biden to face scrutiny for his procedures because they are now common. “No one cares anymore,” he said.

Alster said she has worked on many famous political faces and does not expect Biden’s cosmetic touch-ups to be much of a conversation in the 2020 campaign.“People may mention it, but he will probably just laugh it off,” Alster said.

A younger Joe Biden circa 1987 serving in the Senate and sporting darker, if thinner, locks. (AP Photo/Lana Harris)

Men are not immune from cosmetic criticism, though. President Trump’s famous blond, swooped hairstyle and distinct orange-tinted skin have prompted a steady stream of speculation and internet memes. President Ronald Reagan dyed his hair.

Dr. Jeffrey Spiegel, chief of the Division of Facial Plastic and Reconstructive Surgery at Boston University Medical Center, said in 2013 that John Kerry, the 2004 Democratic nominee, had been "a little over-injected" with Botox and "looks Frankenstein-ian."

The key to effective cosmetic surgery is subtlety, Alster said. “If they look like they’ve had cosmetic work, it works against them."