For this week’s blog, I will be discussing one type of animal that always puts a smile on my face every time I see one: Brachycephalic pets. These are what I lovingly refer to as “smush faces”. You know… the ones that look like they were running too fast and smashed right into a wall and now they have no muzzle. Or in the case of my cat, Rex, the couch…


Brachycephalic pets are on a rise of popularity and even though they can make wonderful pets, there are quite a few health issues new brachycephalic owners need to be aware of. This blog will explain what Brachycephalic means, a little history on them and discuss the many health issues they can have.


In order to classify animals into groups, scientist created different categories to be able to help with the classifications.  One such category is called the cephalic or cranial index of vertebrates. The cephalic index is the ratio between the width (side to side) and length (front to back) of the skull.  Brachycephalic literally means “short-headed”. This refers to the distances of the front to back length of the skull (blue arrow in the photo below) is shorter than the side to side length (green arrow in the photo below).

A great, yet slightly exaggerated example of this is Stewie from Family Guy – and also why my Persian mix has the same name.


There are both dog and cat breeds that are Brachycephalic. Here is just a sort list of some brachycephalic breeds:


  • Pug
  • Persian
  • Bulldog and French Bulldog
  • British Shorthair
  • Boxer
  • Exotic Shorthair
  • Boston Terrier
  • Selkirk Rex
  • Several Mastiff breeds
  • Himalayan
  • Shih Tzu
  • Scottish Fold
  • Cavalier King Charles Spaniel
  • Pekingese

There are also brachycephalic rabbit breeds and they too can have health issues.

Most dog breeds were developed for a particular job to be done. When I started working on this blog, I knew there was a lot of smaller breeds on this list and it made me wonder why the brachycephalic genes were bred into these dogs. During my research, I came across an interesting article that said basically it is human biology that has created the brachycephalic pets. The small, rounded heads of brachycephalic pets resemble human infants and that brings out our nurturing instincts.


So, a word of caution: Don’t let your “maternal” instinct take over when looking at a pet. Make sure you can properly handle and (both physically and financially) care for a pet when you see these adorable faces!


If you have ever walked into a pet store and seen a row of puppies, you might be more inclined to go towards the little “smushfaces” because they are not as active as the other breeds on display. Their calm demeanor doesn’t necessarily mean they are going to be easier to care for…in fact it is probably the opposite. The reason these pups are not as active as their counterparts are a number of health issues that correlate to brachycephaly.


When society decided to breed dogs with shorter muzzles, they were not able to shorten all aspects of the dog’s head and body.  What was effectively shortened was parts of their bone structure but much of the skin and softer tissues remained proportionately the same as a normal muzzle size dog has. These sometime drastic changes compromise their ability to sustain exercise and activities for any length of time. Breathing issues and temperature control are what leads brachycephalic pets to lower energy levels. Bear with me for a little because there are several health topics I will need to discuss: skin fold infections, Brachycephalic Ocular Syndrome, temperature control/ heat stroke,  dental issues, breathing issues, obesity issues, higher anesthesia risk and birthing problems.



Like I mentioned earlier, the amount of skin on brachycephalic pets remain about the same as it did when they had longer snout. This extra skin has no where else to go on shorter muzzles so it creates wrinkles. Every time they eat, drink, eyes tear up, get a bath, stand in the rain/snow, etc.. water gets down inside these folds and gets stuck there. If this moisture isn’t wiped out, it creates yeast and bacterial infections. These infections need to be treated with topical and occasionally oral medications.


Brachycephalic pets have rather shallow eye sockets and their eyeballs protrude outside of the skull. The skull distortion has caused a wide range of eye problems that can be grouped together as Brachycephalic Ocular Syndrome. The following are some of the more common eye issues:

  • Eye(s) popping out – It can take very little trauma for a brachcephalic pet to accidentally have an eye come out. I have a friend who had a Pekingese and another dog and when they went running to the door to greet someone and the dogs bumped together and the Peke’s eye came out. These eyes maybe saved if the dog is treated immediately and vision may be preserved.
  • Eye infections
  • Entropion – Entropion is where one or both of the eye lids curls inward and the eyelashes scratch at the eyeball(s).
  • Dry eye – The structure of the head has deformed their tear ducts and can cause them to not produce enough tears to proper hydrate their eyeballs.
  • Eye ulcers – Typically ulcers develop on the cornea. Usually this results from an eye infection but severe dry eye can cause them as well.


There are differences in the way brachycephaly affects the facial bones. Many of the breeds, like Pugs and Pekingese, have shortening in both jaws. While other breeds like Boxers and Bulldogs, have a shortened upper jaw and a normal length lower jaw. Teeth, just like skin and tissue, does not change even though the jaw is shortened. Brachycephaly pets still have the normal size and amount of teeth as compared to a pet with an average head size. Adult dogs have 42 teeth, adult cats have 30 and adult rabbits have 28 teeth. That is a lot of teeth for a miniaturized mouth! Brachycephalic pets have a higher risk of overcrowding and malpositioned (incorrectly positioned) teeth. Teeth that have come in at inappropriate angles and/or not in the correct location can cause pain and damage to their gums and soft palate. They are more inclined to have retained baby teeth as well. Dental hygiene is an absolute must for brachycephalic pets!!


Brachycephaly interferes with breathing in three ways creating what is referred to as Brachycephalic Obstructive Airway Syndrome. The earliest indication of Brachycephalic Obstructive Airway Syndrome (BOAS) is noisy breathing or snoring. There was a large study done in 2015 that looked at all dogs that had come in for routine veterinary appointments. In this study, it showed 91% of just Pugs were diagnosed with BOAS. Due to BOAS, many of these pets may be subject to bouts of fainting or loss of consciousness due to a lack of oxygen. This can be exacerbated by exercise or when it is hot out. The following three paragraphs will go into more details regarding the three ways BOAS impacts breathing. They are: a reduction in opening of the nostrils, soft palate blocking the airway and the size of the airway.

Stenotic nares refers to the narrowing of their nostrils. Most brachycephalic pets have some degree of stenosis. The severity of their narrowed nasal passages can be described as mild, moderate or severe. Not only do pets with moderate and/or severe stenotic nares have trouble breathing, they can have difficulty eating as well.  Surgery can be performed on some moderate to severe stenotic nares. The photos below show a severe stenotic nares, mid-surgery (one nostril is corrected, the other side is not), and after the surgery was complete.


The soft palate in mammals is responsible for closing off the nasal passage when swallowing and works in different ways when coughing and sneezing is involved. Again, this is another body part that has stayed the same length as brachycephalic’s normal faced cousins. Because of their smaller heads, the soft palate has nowhere else to go but to hang down their throat. This can decrease the amount of air going to their lungs even more.  An elongated soft palate can be related to recurring reverse sneezes associated with many brachycephalic pets.

Past the soft palate, the trachea and tissue around the vocal chords can be compressed causing a partial blockage known as everted laryngeal saccules.

The deformed skull of brachycephalic pets has forced changes in their sinus cavity giving them a propensity for sinusitis.



As you may know, dogs don’t sweat like us humans do. When a dog’s body temperature rises, they will begin to pant to cool down their bodies. Their heart rate increases and the lungs work harder to bring in more oxygen. Panting works by bring air into their lungs through their nose and exhaling out their mouth. As the air passes over their tongue, the moisture / saliva in their mouth will evaporate and begin the cooling process. Since brachycephalic pets can have smaller nostril openings, airway obstructions and shorter muzzles, it makes lowering their body temperature much more difficult. Without the muzzle nature intended, they can’t lose heat in a quick and effective manner. This can make brachycephalic pets very uncomfortable and develop heat stroke much quicker than other breeds. As a brachycephalic pet owner, you will need to be aware of this and act accordingly or your pet may suffer grave consequences.


I’m sure you hear it all the time about how extra weight on a person or animal’s body is detrimental to a healthy life and it is no different for brachycephalic pets. Although, having additional pounds on a brachycephalic pet can intensify many of the above issues, especially the breathing and skin issues. Keeping your “smushface” a healthy weight can keep them healthy and happier longer!


Brachycephalic pet’s compromised respiratory system makes it very difficult for them to get enough oxygen while they are fully awake. But under anesthesia, they have a much higher risk of experiencing adverse effects. Their heart and respiratory rates are notoriously unpredictable. If your “smushface” is overweight, this will only heighten the problems that can occur during and after anesthesia.


Due to brachycephaly’s disproportionately large heads and small bodies and breathing issues, labor and delivery is extremely difficult. A majority of brachycephalic pets are unable to deliver their young on their own. When they cannot, they are required to have a caesarean section. Which puts both the mother and babies at risk with the anesthesia.

There are surgical treatments available to correct some of the brachycephalic health issues. They are not always the best option for every dog so you should have a conversation with one of our trusted veterinarians. Don’t hesitate – surgeries tend to be more successful in younger pets.


As a result of the many health issues associated with brachycephalic pets, insurance can be very expensive for them and some health conditions may be excluded. Much like having a college fund for your child, if you have a brachycephalic pet, you should have a health fund for future veterinary treatments.

One more word of advice for “smushface” owners: Many of these health conditions can be rather serious, especially respiratory distress and heat stroke, do NOT wait to see a veterinarian. Besides from being fatal in some cases, the longer you wait to treat an issue the more expensive it becomes.

I know the huge list of health problems might seem like I’m criticizing brachycephalic pets but just like the other “smushy” owners out there, there is nothing else like sharing your life with one of those little funny face clowns.


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