The Duchess of Alba plastic surgery shock has to go in the history books. The before and after pics of her are so over the top that it's just hard to even comprehend it. It's a puzzle on what the Duchess of Alba was even thinking before she underwent all of this plastic surgery. Either she lost her mind, or just doesn't care anymore. Either way, she didn't hold back at all. The before and after photos show that the Duchess of Alba had a facelift, Botox, lip injections, and facial fillers.