Queen Elizabeth has officially returned to her royal duties after a three-month vacation in Balmoral this past summer.

During her outing in London, Her Majesty stepped out in an all-blue ensemble. She was greeted by a massive group of royal fans, who she greeted with a huge smile on her face.

The monarch’s photos from the outing reveal how well-rested the mom of four looks after her long summer vacation. But it is also evident how much weight the Queen has lost. The Queen’s neck looks longer, and the skin on her neck and skin are looser.

But it is important to note that Her Majesty is already 93 years old, which means that the condition of her skin has changed over time. The Queen is also particular about the food she eats, and she has always been thin.

However, this still didn’t stop royal fans from wondering if the Queen should still be allowed to take part in her royal engagements and duties considering her elderly age. But after her visit to the Haig Housing Trust, she will open the Centenary Development.

The Queen will have a very busy week ahead, and overall her health is still fine. But earlier this month, it was revealed that her knees are giving her trouble. However, the Queen doesn’t want to undergo surgery since she would have to recover for a few weeks. And considering her busy schedule, this is just impossible for her to do.

Shamir Patel, a leading pharmacist, told Express that Her Majesty should seek professional advice on what she could do to deal with her knees.

“Of course, anybody, of any age, who has undergone surgery and then experiences problems with that area should seek medical advice and guidance. It may well be the case that there is not a serious issue here, but that a check-up is needed to ensure everything is okay with the surgery that was completed 16 years ago. With any procedure comes risks, but most come during or shortly after the surgery,” he said.

Queen Elizabeth II
Queen Elizabeth II is seen at the Chichester Theatre while visiting West Sussex on Nov. 30, 2017, in Chichester, United Kingdom. Getty Images/Stuart C. Wilson