Brachycephalic (Flat-Faced) Dogs: 7 Health Problems (Vet Answer)

How to Care for Your Adorable Flat-Faced Dog: A Comprehensive Guide to Brachycephalic Health

Introduction
If you‘re the proud owner of a French Bulldog, Pug, Shih Tzu, or any other smushed-face pup, you know how irresistible they are with their big eyes, snuffly snouts, and larger-than-life personalities. Brachycephalic (meaning "short head") dogs have soared in popularity in recent years. Unfortunately, the physical features that make them so cute—their flattened faces and short muzzles—can also lead to a number of health issues.

As veterinarians, we love all dogs, but we have a special spot for these squishy-faced sweethearts. We want to make sure you have the information you need to be the best advocate for your brachy buddy. In this article, we‘ll take an in-depth look at the unique health considerations for flat-faced dogs and share our top tips for keeping your furry friend in tip-top shape.

What Makes a Dog Brachycephalic?
Brachycephaly is a physical condition where the skull bones are shortened in length, giving the face and nose a "pushed in" appearance. In recent years, breeders have increasingly selected for this trait in certain breeds because many people find it adorable. Popular flat-faced breeds include:

English and French Bulldogs
Pugs
Boston Terriers
Pekingese
Shih Tzus
Boxers
Cavalier King Charles Spaniels

While not all individuals in these breeds have extreme brachycephaly, most have some degree of it. The flattening of the facial bones often causes a narrowing of the airways from the nose all the way to the lungs. Nearly all flat-faced dogs suffer from some degree of Brachycephalic Obstructive Airway Syndrome (BOAS).

Additionally, having bulging eyes and excessive skin folds comes with its own set of health issues. Brachys are also prone to spinal abnormalities, allergies, and other conditions.

Let‘s take a closer look at the most common health problems seen in flat-faced dogs:

Brachycephalic Obstructive Airway Syndrome (BOAS)
BOAS is a progressive disorder caused by anatomical abnormalities that restrict a dog‘s ability to breathe. Signs include:

Noisy breathing, snorting, and snoring
Difficulty breathing, especially with exercise or in heat
Coughing, gagging, or retching
Inability to sleep soundly due to breathing issues
Collapsing or fainting from lack of oxygen

Several upper airway abnormalities contribute to BOAS:

Stenotic nares: Abnormally narrow or small nostrils
Elongated soft palate: The soft tissue at the back of the roof of the mouth is too long and blocks the trachea
Hypoplastic trachea: The windpipe is narrower than normal
Everted laryngeal saccules: Small sacs inside the voicebox turn outward into the airway due to chronic negative pressure from increased breathing effort

In severe cases, the larynx (voicebox) can collapse, making it difficult for the dog to breathe at all. Untreated BOAS can lead to right-sided congestive heart failure as the heart works harder to pump oxygen through the body.

Treatment depends on severity but often involves surgically widening the nostrils or shortening the soft palate. Maintaining a healthy weight, using a harness instead of a collar, and avoiding humid or hot conditions is crucial. Brachycephalic dogs are at a high risk of heat stroke.

Skin Fold Dermatitis
Those adorable wrinkles can be a haven for moisture, yeast, and bacteria if not kept clean and dry. When skin touches skin, it can quickly become inflamed and infected, especially in the facial folds, lip folds, and in the "tail pocket."
Signs include:

Redness
Musty odor
Discharge
Itching or rubbing face
Hair loss

Regularly cleaning and drying between the skin folds is crucial. Topical antibiotics or anti-fungals may be necessary to treat infections. In severe cases, surgery can be performed to remove excess skin folds.

Spinal Malformations
Breeds like French Bulldogs, Pugs, and Boston Terriers are prone to having abnormally formed vertebrae called hemivertebrae. These wedge-shaped bones cause the spine to be curved or twisted (hence the "screw tail" seen in many brachy breeds). Sometimes they cause no symptoms, but in other cases, they put pressure on the spinal cord and cause pain, weakness, or even paralysis.

Additionally, the unique head shape can sometimes lead to a condition called Chiari-like malformation, where the skull is too small for the brain, putting pressure on the brainstem and spinal cord. Affected dogs may have neck pain, weakness, or trouble walking. Some dogs require surgery to relieve pressure on the spine and reduce symptoms.

Eye Problems
Those big, bulging eyes may be beautiful, but they‘re prone to a host of problems including:

Corneal ulcers: The cornea becomes scraped or punctured more easily. Entropion, where the eyelids roll inward due to facial wrinkles and rub on the cornea, can also cause ulcers.
Proptosis: The eye can actually pop out of the socket due to shallow eye sockets and protruding eyes. This requires immediate emergency treatment.
Distichiasis: Eyelashes grow in the wrong spot and rub on the eye.
Dry eye: Lack of normal tear production leaves eyes red and irritated.
Cherry eye: The third eyelid gland prolapses and protrudes from the eye as a red mass.

Brachycephalic dogs need regular eye exams and may require treatment like lubricating drops, antibiotics, or surgery in some cases.

Allergies
Flat-faced breeds tend to suffer from allergies more than other dogs, both environmental allergies and food sensitivities. Common signs include:

Itchy skin, especially the face, paws, and ears
Recurrent ear and skin infections
Hair loss
Skin redness or dark pigmentation
Gastrointestinal problems like vomiting or diarrhea

Allergies require lifelong management but can usually be controlled with strategies like hypoallergenic diets, allergy testing, medications, or immunotherapy.

Dental Problems
Flat-faced dogs have the same number of teeth as longer-muzzled breeds, just in a much smaller space. This extreme crowding leads to dental issues like:

Misaligned bites (undershot or overshot jaw)
Crowded or rotated teeth
Food and debris getting stuck between teeth
Periodontal disease and tooth loss
Difficulty chewing and eating

Regular, professional dental care is a must for all dogs, but brachys require even more frequent cleanings and oral exams. Tooth extractions to relieve overcrowding are often necessary.

Orthopedic Problems
Due to their unique builds, brachycephalic dogs are prone to bone and joint issues like:

Hip dysplasia: The hip joint is malformed, causing arthritis and pain. Most common in French Bulldogs.
Luxating patellas: The kneecap slips out of place, leading to limping and arthritis.
Intervertebral disc disease: The cushioning discs between the vertebrae bulge or rupture, pressing on the spinal cord. Can cause pain, weakness, or paralysis.
Leg deformities like bow-leggedness

Maintaining a healthy weight is key to minimizing joint stress. Orthopedic surgeries may be required in some cases to restore normal joint function.

Digestive Issues
Brachys are more prone to digestive problems like regurgitation, vomiting, and dysphagia (difficulty swallowing). Abnormal facial structure, along with a compressed upper esophageal sphincter, means food and stomach acid can more easily come back up.

Some dogs require frequent, small meals from an elevated bowl to eat comfortably. Others may need acid-reducing medications or a specialized diet to manage symptoms. In rare cases, a procedure to tighten the esophageal sphincter can help.

Temperature Regulation Difficulties
That adorable flat face means less muzzle surface area to dissipate heat. Narrow airways from BOAS make panting less efficient. Brachys are extremely heat intolerant and can quickly develop dangerous hyperthermia or heat stroke if left in warm temperatures or allowed to over-exercise.

These dogs are usually happiest in air conditioning during the summer months. Always watch for excessive panting, drooling, glazed eyes, vomiting, staggering, or collapse – these are signs of heat stress and require immediate veterinary treatment. Limit outdoor time to mornings and evenings, and never leave a brachy in a hot car.

Reproduction Difficulties
Brachycephalic breeds almost always require cesarian sections to deliver puppies due to their large heads relative to the birth canal. They also tend to have smaller litter sizes on average. This contributes to the increased cost of flat-faced puppies from responsible breeders who provide proper prenatal care.

Conclusion
Despite the long list of health considerations, we know how much happiness and love flat-faced dogs bring to their families. By understanding the unique needs of brachycephalic breeds and partnering with a knowledgeable veterinarian, owners can help their snuffly companions live their best lives.

If you‘re considering adding a brachycephalic dog to your family, please carefully evaluate the potential costs and challenges associated with their care. Choose a responsible breeder who performs genetic health testing and breeds for physical soundness, not just appearance. Avoid supporting puppy mills or pet stores that prioritize profits over welfare.

With proper care, these special squish-faces can enjoy long, joyful lives. They‘ll certainly keep you laughing with their snorts, grunts, and endearing antics! Remember, your veterinarian is always your best resource for any questions or concerns about your dog‘s health. Together, we can keep those wrinkles smiling for years to come.