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It's the Son'a treatment.

His head looks larger and rounder. Maybe he was on HGH as VP?

I think he lost weight and an old guy got 10 years older. I'm all for conspiracy theories but the Fake Joe Biden stuff I see on /pol/ is retarded.

They prolly gave him the old nip and tuck to make him look like less of a ghoul. Although now he has more of a Skeletor vibe with his skin...

Or you know alzheimers and dementia