Health & Care
Tibetan Spaniels are flat-faced dogs.
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Health Issues for Brachycephalic or Flat-Faced Dogs

Flat-faced dogs — aka brachycephalic dogs — are so cute and adorable with their smushed-in faces. But those flat faces can mean health concerns.

Dr. Ernie Ward  |  Sep 27th 2017


I’m a fan of Frenchies; a Bulldog, Boston Terrier and Boxer buff; I’m partial to Pugs and Pekes; and I admit serious sentiments for Shih Tzu. In addition to my abundant affection, these breeds have in common certain anatomical traits that make them both wonderfully cute and incredibly impaired. Brachycephalics, or “smushed-face dogs,” while extraordinary in appearance, must be cared for carefully to keep them healthy and happy. Here is some must-know health issues for flat-faced dogs.

1. Flat-Faced Dogs Have Difficulty Breathing

Boston Terriers are a flat-faced dog breed.

Boston Terriers are a flat-faced dog breed. Photography ©Wojciech Kozielczyk | Thinkstock.

If you’ve spent more than 2 minutes around a brachycephalic dog, chances are you heard snuffling, snorting or snoring. This is usually due to narrowed nostrils (stenotic nares), a large tongue (macroglossia), a flap of tissue flopping down from the roof of the mouth (elongated soft palate), tiny trachea (tracheal stenosis) and bulging pockets of tissue in the back of the throat (everted laryngeal saccules). Any one of these can cause serious respiratory trouble in most dogs; brachycephalic breeds can suffer from all five.

Many brachycephalic dogs will require surgical correction of one or more of these conditions. Bulldogs top that list, but any smushed-face dog may eventually benefit from surgery. Most dogs are fine during normal activities; it’s only when stressed, intensely active or overheated that airway issues pose a lethal threat. I strongly urge owners of brachycephalics to use comfortable harnesses instead of constricting collars to avoid compressing already compromised airways. When selecting a brachycephalic puppy, carefully observe the parents and grandparents whenever possible, and ask about any upper airway issues. Also check the size of the nostrils and breathing sounds for any narrowing or noises. Heat hazards

Dogs don’t perspire to cool down the way humans do — they pant. Breeds with breathing problems, such as brachycephalics, are more prone to overheating and heatstroke. It’s critically important to keep them cool and calm, especially during warm weather.

2. Brachycephalic Dogs Have Eye Health Isseus

Boxers are brachycephalic dogs.

Boxers are brachycephalic dogs. Photography ©GlobalP | Thinkstock.

The smushed-in face and skull also create eye anomalies. The most frequently diagnosed eye problems I encounter involve the eyelids, especially entropion — an inward-rolling eyelid that causes the eyelashes to rub against and scratch the eyeball (cornea). Surgery is usually successful, although some dogs may require additional eye tucks as they age.

Another common issue is tear staining. Dark streaks surrounding the eyes or wet, constantly draining eyes are hallmarks of tear duct problems. Surgery can’t help this problem; daily cleaning is the best advice. I don’t recommend using antibiotics in an attempt to reduce staining or tearing. They don’t work and may create complications, including antibiotic resistance.

Some brachycephalics’ eyes bulge so much their eyelids can’t adequately cover the corneas, resulting in drying, irritation, scarring and even blindness. This is called lagophthalmos and often requires both medical and surgical treatments.

The bulging eyes are also at higher risk for “popping out” or proptosis. I’ve had to surgically replace many eyes in Pekingese, Shih Tzu and Pugs during the past 25 years. Thankfully, most do well, although a few required eventual eye removal due to blindness or complications. “Dry eye” or keratoconjunctivitis sicca (KCS) is also something I diagnose in many brachycephalic dogs. You can spot a dog with dry eye by the thick, goopy discharge, cloudy corneas and angry sclera (white part of the eye). Dry eye requires daily medication to prevent eventual blindness.

3. Those Cute Noses and Facial Folds Cause Problems

A pug's cute nose can spell out problems.

A pug’s cute nose can spell out problems. Photography ©Leesle | Thinkstock.

One of the facial features we love about brachycephalics is the “pug nose.” Unfortunately, it’s a nose for trouble. In addition to narrowed nostrils, the skin folds around the nose and eyes can trap debris and moisture, causing serious skin infections.

4. Dental Health is Also a Concern

Flat-faced dogs suffer from dental issues.

Flat-faced dogs suffer from dental issues. Photography ©adogslifephoto | Thinkstock.

Cramming 42 teeth into such a tiny mouth can be a problem. I see many smushed-face dogs with crooked, overlapping teeth and lots of oral problems. Home dental care, good nutrition and twice-yearly vet checks are essential to keep your brachycephalic healthy and pain free.

Despite all the health issues for brachycephalic dogs, it’s hard to resist their charms. They’re intelligent, caring and attentive in a way few breeds can match. Maybe it’s the fact that they give so much that leaves them vulnerable and fragile. Whatever the case, we need to be more vigilant when breeding brachycephalics and provide extra-special care when we bring them into our homes. My hope is that future generations of flat-faced dogs will be healthier, sharing their unique joy with everyone who loves them.

Flat-Faced Dog Breeds:

Shih Tzus are a flat-faced dog breed.

Shih Tzus are a flat-faced dog breed. Photography ©GlobalP | Thinkstock.

  • Affenpinscher
  • Boston Terrier
  • Boxer
  • Brussels Griffon
  • Bulldog
  • Bullmastiff
  • Dogue de Bordeaux
  • English Mastiff
  • English Toy Spaniel
  • French Bulldog
  • Japanese Chin
  • Neapolitan Mastiff
  • Pekingese
  • Pug
  • Shih Tzu
  • Tibetan Spaniel

Dr. Ernie Ward is an internationally recognized veterinarian known for his innovations in general small-animal practice, long-term medication monitoring, special needs of senior dogs and cats and pet obesity. He has authored three books and has been a frequent guest on numerous TV programs.

Tell us: Do you have a flat-faced dog? Have you encountered any of these health issues?

Thumbnail: Photography ©GlobalP | Thinkstock.

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