How to Spot an Alcoholic Face
Did you know that almost one-third of adults in the UK drink alcohol at levels that can harm their health?
The changes that heavy drinking makes to someone’s face happen gradually, so they can often go unnoticed until they are quite advanced. Each individual sign can also have other explanations, and so you may not be sure they are because of alcohol. But when several of the changes appear together in a heavy drinker, it can be a clear sign that they need to look at their relationship with alcohol.
What Causes an Alcoholic Face?
Can you tell an alcoholic by their face? Alcohol face is the concern, but it does not always start that way. Alcoholic face occurs in a person’s appearance due to chronic alcohol abuse or alcoholism. So, how does it become expressed in our physical appearance? It is often seen as a red flush on the cheeks, nose, and under the eyes.
One cause of an alcoholic face is the buildup of acetaldehyde in the body. Acetaldehyde is a toxic metabolite produced when the body breaks down alcohol. It is often metabolised in the liver, but a buildup causes the blood vessels to dilate, leading to a red flush on the skin. Other side effects of acetaldehyde include;
- Alcohol-related Liver Disease
- Alcohol-related Pancreatitis.
In addition, acetaldehyde may cause weight gain, neurotoxicity, and cancer.
Also, the flushed face that can occur after drinking is due to how alcohol affects the body’s blood vessels. When alcohol is consumed, it causes the blood vessels in the body to expand, including those in the face. This increased blood flow to the face can cause a flushed or reddish appearance. Alcohol consumption also causes dehydration making the skin appear dull and lifeless.
Over time, chronic alcohol abuse can worsen the physical changes associated with an alcoholic face. This can include the development of broken blood vessels on the face and a puffy or swollen appearance. Chronic alcohol abuse can also lead to liver damage, further exacerbating the physical changes associated with an alcoholic look.
Why alcohol changes the way someone looks
Alcohol is a toxin that the body works hard to process and clear, and that effort has visible consequences. As alcohol is metabolised, it can cause inflammation, disrupt how your liver processes nutrients, and dehydrate your body at a cellular level. Drinking also damages the small blood vessels close to the skin’s surface and interferes with your sleep, which shows in the face in its own way.
Most of these changes are caused by chronic heavy drinking or binge drinking, rather than occasional use. They also tend to become more pronounced the longer and the more you drink.
Facial redness and broken capillaries
One of the most recognisable signs of long-term heavy drinking is persistent redness across the cheeks, nose, and sometimes the forehead. Alcohol causes blood vessels near the skin to dilate, and if you drink a lot all the time, the small capillaries close to the surface can break permanently. Once that happens, the redness doesn’t go away between drinking sessions and becomes a fixed feature of your face.
This is sometimes mistaken for rosacea, a skin condition that alcohol can worsen. It’s also possible to experience both alcohol-related redness and rosacea at the same time. However, pinpointing the exact cause or location of the redness is often less important than addressing the underlying drinking habits.
Puffiness and bloating
Alcohol causes the body to retain fluid and sets off an inflammatory response in tissues throughout the body, including your face. The result is a puffiness or bloating that is particularly visible around the eyes, cheeks, and jaw. Unlike a hangover, which gets better after a night or so of rest, this inflammation stays fairly constant and becomes more obvious the more you keep drinking.
In people with alcohol-related liver damage, this fluid retention can become more severe. The liver plays a central role in regulating fluid balance in your body, but when it is under chronic strain, the liver can’t do its job as effectively.
Rhinophyma
In severe and long-standing cases of alcohol use, particularly in men, the nose can develop rhinophyma. This is a condition where the sebaceous glands enlarge, and the skin thickens, creating a bumpy, bulbous appearance. Rhinophyma is associated with rosacea, and alcohol is one of the main things that drives it. A case-control study found a significant correlation between alcohol intake and rhinophyma severity, with risk increasing alongside consumption. Rhinophyma usually takes years to develop and is generally a sign of very prolonged heavy drinking and alcohol addiction.
Jaundice in the eyes
As well as general eye exaucstion due to alcoholism, jaundice can also occour and is a sign of a serious issue that should be addressed immediately. Jaundice is when the whites of your eyes start to turn yellow, and it is one of the more serious signs that alcohol has caused significant liver damage. The liver normally clears a waste product called bilirubin from the blood. When liver function isn’t working as well as it should, bilirubin builds up and deposits in the skin and the sclera, the normally white outer layer of the eyeball.
Jaundice at any level of drinking should be treated as very urgent. It is a sign that the liver is struggling seriously, and it warrants immediate medical attention.
Premature ageing
Chronic heavy drinking ages the skin faster than it would normally age. Alcohol directly dehydrates by suppressing the hormone that signals the kidneys to retain water, so the body loses more fluid than it takes in. If you drink heavily and regularly, it causes sustained dehydration, which depletes your skin of moisture and elasticity.
Alcohol also generates unstable molecules called free radicals as a byproduct of how your body processes it. These attack collagen and elastin, the proteins that keep your skin firm and elastic. This is a direct chemical effect on the skin’s structure, separate from dehydration, and it accumulates with every drinking session.
Alcohol also depletes your body of vitamins your skin needs to maintain itself properly, particularly B vitamins and vitamin C. If you have been drinking heavily for years, your skin can look older than it should, with deeper lines, less firmness, a dull or grey complexion, and just a general loss of definition.
Pallor and dark circles
Alcohol interferes with the absorption of iron and B vitamins, both of which the body needs to produce healthy red blood cells. Anaemia from heavy drinking can cause your skin to look constantly pale or washed out. You can also develop dark circles under your eyes because of alcohol’s disruption to sleep, and these can look darker when the rest of your face is pale.
Even when a heavy drinker sleeps for many hours, their sleep quality is usually poor, and their face can reflect this. Alcohol suppresses REM sleep in particular, which is the stage where your body does most of its repair and restoration. With repeated disrupted nights, this can leave you looking chronically exhausted.
What these signs mean and what they don't
Seeing some of these signs in someone you care about is only part of the picture. Any one of them can have causes that have nothing to do with alcohol. Redness can come from rosacea alone, puffiness from allergy or thyroid problems, pallor from unrelated anaemia, and dark circles from simple lack of sleep.
The physical signs of heavy drinking are meaningful when they are seen alongside other symptoms of alcohol addiction. These include drinking becoming difficult to control, alcohol causing obvious problems in your life, being unable to quit or even drink less, and ignoring the health effects or concerns of your loved ones.
It is also worth knowing that these signs accumulate slowly enough that people close to someone often adjust to them without realising it. The face changes by little by little, and each change just feels like the new normal. That gradual and undramatic adjustment is one reason alcohol abuse can go unaddressed for years.
What to do if you notice these facial signs
If someone close to you is showing these signs, the most useful thing is usually to just have a conversation. Make sure you approach this chat with curiosity rather than accusation, because this will usually help it go better.
Ask how they are, whether they have noticed anything different, and whether their drinking has been getting harder to manage. Many people with serious alcohol problems are aware at some level that something is wrong, but find it difficult to acknowledge or do anything about it. The physical changes are often part of what finally prompts them to take it seriously. If the person is not ready to talk, that is not unusual, and it does not mean the door is closed.
If you want extra advice on how to have this chat, or if you have noticed these facial signs in yourself, Providence Projects can help. We provide residential alcohol rehab, with medical alcohol detox and expert support that continues after rehab treatment. If you are concerned about someone’s drinking, or your own, get in touch for a confidential conversation.
Reach out to our expert support team 24 hours a day
Looking for rehab?
If you are looking for rehab to take your, or a loved ones, life back from addiction, look no further than Providence Projects. Reach out to us today to find out how we can help you or a loved one achieve long-term recovery.
(Click here to see works cited)
- Gao, Bin, and Ramon Bataller. “Alcoholic Liver Disease: Pathogenesis and New Therapeutic Targets.” Gastroenterology, vol. 141, no. 5, 2011, pp. 1572–1585, https://doi.org/10.1053/j.gastro.2011.09.002.
- Second, Julie, et al. “Rhinophyma Is Associated with Alcohol Intake.” Journal of the American Academy of Dermatology, vol. 81, no. 1, 2019, pp. 249–250, https://doi.org/10.1016/j.jaad.2018.12.046.
- Szabo, Gyongyi. “Alcohol’s Contribution to Compromised Immunity.” Alcohol Health and Research World, vol. 21, no. 1, 1997, pp. 30–41, https://pmc.ncbi.nlm.nih.gov/articles/PMC6826800/.
- Drinkaware. “Almost a Third of Drinkers in the UK Are Drinking at Increasing or High Risk Levels.” Drinkaware, https://www.drinkaware.co.uk/news/almost-a-third-of-drinkers-in-the-uk-are-drinking-at-increasing-or-high-risk-levels.
- NHS. “Alcohol Misuse.” NHS, 4 October 2022, https://www.nhs.uk/conditions/alcohol-misuse/.
- Cui, J., et al. “Acetaldehyde Induces Neurotoxicity In Vitro via Oxidative Stress- and Ca2+ Imbalance-Mediated Endoplasmic Reticulum Stress.” Oxidative Medicine and Cellular Longevity, 2019, https://pubmed.ncbi.nlm.nih.gov/30728884/.
- Lieber, C.S. “Metabolic Effects of Acetaldehyde.” Biochemical Society Transactions, vol. 16, no. 3, June 1988, pp. 241–247, doi:10.1042/bst0160241, https://pubmed.ncbi.nlm.nih.gov/3181606/.
- Seitz, Helmut K., and Peter Becker. “Alcohol Metabolism and Cancer Risk.” Alcohol Research & Health, vol. 30, no. 1, 2007, pp. 38–47, https://pubmed.ncbi.nlm.nih.gov/17718399/.
- Szabo, Gyongyi. “Alcohol’s Contribution to Compromised Immunity.” Alcohol Health and Research World, vol. 21, no. 1, 1997, pp. 30–41, https://pmc.ncbi.nlm.nih.gov/articles/PMC6826800/.