The flat-faced dog phenomenon

In recent years, there has been a marked rise in the number of people buying flat-faced dog breeds. These are also described as brachycephalic breeds or dogs with shortened muzzles. According to Kennel Club figures, ownership of so-called flat-faced dogs, such as the French bulldog, pug and shih tzu, has gone up by 3104% since 2007.

The rise has been partly attributed to celebrities, such as Lady Gaga and Leonardo DiCaprio, being photographed with the breeds.

What does brachycephalic mean and why is it an issue?

The term brachycephaly has Greek origins and means “short” and “head”. In general terms, it refers to dogs whose head is almost as broad from side to side as it is from front to back. Vets use something called the cephalic index to measure this. This is the ratio between the width and length of the dog’s skull. Dogs with a cephalic index of more than 80 are considered to be brachycephalic.

In flat-faced breeds, these head shapes have been developed through years of selective breeding. In other words, as a result of human intervention. The breed’s skulls have been getting shorter over time. But other parts of the head and body, such as the soft palate (the soft tissue located at the back of the roof of the mouth), have not reduced at the same rate. This has led to an increase in short-muzzled dogs suffering serious health issues such as eye ulcers, deformities of the spine and heatstroke.

What about BOAS?

One of the most common problems suffered by dogs with flat faces is an inability to breathe normally. This is especially the case after exercise or while eating meals. This condition is called Brachycephalic Obstructive Airway Syndrome (BOAS) and is caused by a narrowing of the upper respiratory tract.

Treatment may be needed if your dog has breathing difficulties so please contact your vet as soon as possible or, out of hours, your nearest Vets Now pet emergency clinic or Vets Now 24/7 hospital.

My dog is brachycephalic, is he at risk?

If your dog is making an unusual noise or simply struggling to breathe during exercise, while eating or when he’s excited, he may have BOAS so you should seek veterinary help. There are also several signs you should be aware of. These are:

Flat-faced dog breathing noise

This can present itself in a variety of ways. For example, pharyngeal noise is when the dog’s soft palate extends into the opening of his airway (larynx). This means he needs to put in extra effort to breathe. This can sound like snoring.

Laryngeal noise, on the other hand, is a result of a narrowed airway. This is usually similar to high-pitched wheezing and is most common in affected pugs. Nasal noise is caused by an obstruction in the nose, such as abnormal growth of cartilage.

The other noise to be aware of is reverse sneezing. This is caused by the soft palate irritating the throat and tends to last between a few seconds and a minute.

Listen now: Dave Leicester of Vets Now discusses flat-faced dogs on BBC radio

Narrow nostrils

This is known as nasal stenosis and is typically caused by an unequal growth of the wall of the nose or excessive folding of the nasal septum. This condition ranges from mild to severe and forces affected dogs to breathe through their mouths, which takes more effort.

Studies show that French bulldogs with moderate to severe stenosis of the nostrils are around 20 times more likely to develop BOAS.

Image of pub for Vets Now article on brachycephalic dog breeds

Eating difficulties

Dogs with BOAS often find it difficult to eat and are also more susceptible to vomiting. This is often due to the soft palate impeding the airways and the ability of your dog to swallow. You may notice coughing and choking.

In some dogs, the increase in pressure on the airways can also draw the stomach into the chest, causing reflux.

Sleep apnoea

This is when your dog stops breathing during sleep and is potentially fatal if left untreated. It’s caused by the soft palate blocking the respiratory tract during closed-mouth breathing.

Heat intolerance

Dogs rely on panting — and ducts within their nose — to regulate their temperature. A blocked nose can hinder their ability to cool down and lead to heatstroke, which is a life-threatening condition that requires emergency treatment.


If a BOAS-affected dog struggles to breathe during exercise or while sleeping, there is a danger that not enough oxygen will get into his bloodstream. This can cause the dog’s skin, particularly around the tongue and gums, to turn a bluish shade and might lead to collapse. If this occurs, you should seek veterinary help immediately.

Huge rise in flat-faced dogs needing corrective surgery

Treatment and prognosis

There are various ways to treat flat-faced dogs who have health issues. These include reducing the size of the soft palate and performing surgery on the nose to help improve the flow of air. Weight is often a contributing factor to these problems and a weight loss regime should also form part of the treatment.

The long-term outlook and quality of life for a dog with BOAS can improve dramatically following these procedures. However, it’s likely they will remain susceptible to problems such as heatstroke.

Image of Prof John Williams, Vets Now soft tissue surgery specialist

Our specialists

Two of Vets Now’s 24/7 pet emergency hospitals — Manchester and Glasgow — are led by internationally-renowned veterinary experts who specialise in the type of surgery typically required by flat-faced dogs.

One of those is Professor John Williams,. He specialises in all aspects of soft tissue surgery, particularly emergency and damage control surgery. He has improved the lives of scores of brachycephalic dogs over the past decade.

Speak to your vet about referring your pet to our team of specialists. They are dedicated to giving your pet access to the best possible care at the time they need it most.

Thinking about getting a flat-faced dog?

The British Veterinary Association has urged people considering getting a flat-faced dog to opt instead for a dog with a healthier conformation and a longer muzzle. As is the case with our own emergency vets, they say they have seen “concerning trends in dog health and welfare” because of the rise in ownership of brachycephalic breeds.

However, if you are determined there are several things you should consider:

  • The rise in popularity of brachycephalic breeds has increased animal suffering as a result of the health issues listed above
  • Insurance premiums are typically higher for brachycephalic breeds — research from MoneySuperMarket has shown the average yearly pet insurance premium for the French bulldog is £490, compared with £304 for Labradors, £334 for golden retrievers and £289 for English springer spaniels
  • The rise in demand for brachycephalic breeds has, according to the Kennel Club, provided a “ready market for unscrupulous breeders to effectively churn out puppies for profit”
  • Many brachycephalic dogs will struggle to live fulfilling lives in terms of how much they can exercise — some are unable to swim or exercise at all in warmer hours of the day and many have a shorter life expectancy due to their health issues

If none of this deters you, please use a rehoming centre or a responsible breeder who takes the pet’s welfare seriously. Make sure you are supplied with genuine health certificates, speak to the breeder’s vet about the puppy’s parents. And never buy a flat-faced puppy whose mother had to have a caesarian section to give birth.

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