# You often see alcoholics & drug addicts with this odd sunken facial "look". What causes it? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [May 6, 2016, 9:28pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104 "2016-05-06T21:28:06Z")\ **Posts on this page:** 18\ **Page:** 1
**Author:** ![astro](https://avatars.discourse-cdn.com/v4/letter/a/9dc877/32.png) [@astro](https://boards.straightdope.com/u/astro)\ **Post date:** [May 6, 2016, 9:28pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/1 "2016-05-06T21:28:06Z")
This kind of sunken cheeked “look” as seen in the attacker referenced in this [newspaper article]([delmarvanow.com](http://delmarvanow.com): [Man in Fruitland machete attack is unconscious](http://www.delmarvanow.com/story/news/local/maryland/2016/05/06/man-fruitland-machete-attack-critical-condition/84024618/)). What causes this? You often see this facial look in addicts, alcoholics and people on the margins. Is there something dental going on? [Direct link to just photo here if you did not want to view article.](http://i1061.photobucket.com/albums/t464/monkapotamus/dtpic_zpsht2nir6m.jpg) ---
**Author:** ![GusNSpot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gusnspot/32/436_2.png) [@GusNSpot](https://boards.straightdope.com/u/GusNSpot)\ **Post date:** [May 6, 2016, 9:45pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/2 "2016-05-06T21:45:46Z")
Many times it is loss of teeth. ---
**Author:** ![Rigamarole](https://avatars.discourse-cdn.com/v4/letter/r/77aa72/32.png) [@Rigamarole](https://boards.straightdope.com/u/Rigamarole)\ **Post date:** [May 7, 2016, 12:28am UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/3 "2016-05-07T00:28:49Z")
I think you just have a case of confirmation bias. There are so many more addicts out there than you realize, but if they don’t "look like it’, you never know. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [May 7, 2016, 12:39am UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/4 "2016-05-07T00:39:14Z")
Addicts like this exist solely to get their next fix. Taking care of oneself, like eating or brushing teeth or going to the doctor stops almost completely. Its malnourishment as a side effect of their addiction. ---
**Author:** ![Lightlystarched](https://avatars.discourse-cdn.com/v4/letter/l/eb8c5e/32.png) [@Lightlystarched](https://boards.straightdope.com/u/Lightlystarched)\ **Post date:** [May 7, 2016, 3:24am UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/5 "2016-05-07T03:24:48Z")
No teeth. No dentures. Always reminds me of those dried apple face dolls. ---
**Author:** ![guizot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/guizot/32/3636_2.png) [@guizot](https://boards.straightdope.com/u/guizot)\ **Post date:** [May 7, 2016, 6:36am UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/6 "2016-05-07T06:36:34Z")
I think it’s just weight loss. Teeth loss is mostly just a tweaker issue, but all addicts–and alcoholics, too–eventually end up eating very little. ---
**Author:** ![Mudshark](https://avatars.discourse-cdn.com/v4/letter/m/f04885/32.png) [@Mudshark](https://boards.straightdope.com/u/Mudshark)\ **Post date:** [May 7, 2016, 6:40am UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/7 "2016-05-07T06:40:00Z")
Loss of teeth, poor nutrition, loss of weight. ---
**Author:** ![Girl\_From\_Mars](https://avatars.discourse-cdn.com/v4/letter/g/3da27b/32.png) [@Girl\_From\_Mars](https://boards.straightdope.com/u/Girl_From_Mars)\ **Post date:** [May 7, 2016, 8:01am UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/8 "2016-05-07T08:01:56Z")
Not always alcoholism. We lost a friend recently to it and he was always very puffy, particularly around the face and abdomen. ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [May 7, 2016, 11:00am UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/9 "2016-05-07T11:00:54Z")
Cheeks might be sunken, but he’s got a nice head of hair. ---
**Author:** ![Me\_Billy](https://avatars.discourse-cdn.com/v4/letter/m/e480ec/32.png) [@Me\_Billy](https://boards.straightdope.com/u/Me_Billy)\ **Post date:** [May 7, 2016, 2:38pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/10 "2016-05-07T14:38:17Z")
Loss of teeth… Some drugs eat away the teeth and also the upper skin in the mouth… See “Nasal septum perforation” and “Gingivae”… [Cocaine and oral health | British Dental Journal](http://www.nature.com/bdj/journal/v204/n7/full/sj.bdj.2008.244.html) Then alcoholics may vomit quite a bit. Vomiting and not washing off the stomach acid from the teeth can cause extensive damage to the teeth… See “Drinking can lead to gum disease”… [Dr. Mercer's Blog: How alcohol affects teeth and the oral cavity](http://markmercerdds.blogspot.com/2012/03/how-alcohol-affects-teeth-and-oral.html) Other drugs and teeth… [Effect of Substance Abuse on Oral Health -](http://alcoholrehab.com/drug-addiction/substance-abuse-and-oral-health/) ---
**Author:** ![Lasciel](https://avatars.discourse-cdn.com/v4/letter/l/e79b87/32.png) [@Lasciel](https://boards.straightdope.com/u/Lasciel)\ **Post date:** [May 7, 2016, 5:09pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/11 "2016-05-07T17:09:00Z")
I’m going to agree with the lack of teeth and weight loss, but note that severe dehydration will also hollow your face out fairly significantly. ---
**Author:** ![astro](https://avatars.discourse-cdn.com/v4/letter/a/9dc877/32.png) [@astro](https://boards.straightdope.com/u/astro)\ **Post date:** [May 7, 2016, 5:11pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/12 "2016-05-07T17:11:36Z")
> [@kayaker](#): > > Cheeks might be sunken, but he’s got a nice head of hair. Looking at mugshot collections some people, men especially, in various stages go drug and alcohol decay and living at the margins often have surprisingly lush and full heads of hair. ---
**Author:** ![Damfino](https://avatars.discourse-cdn.com/v4/letter/d/f9ae1b/32.png) [@Damfino](https://boards.straightdope.com/u/Damfino)\ **Post date:** [May 7, 2016, 7:22pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/13 "2016-05-07T19:22:48Z")
Weight loss can lead to atrophy of the buccal pad of fat which normally fills out the cheeks . ---
**Author:** ![kayaker](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kayaker/32/441_2.png) [@kayaker](https://boards.straightdope.com/u/kayaker)\ **Post date:** [May 7, 2016, 7:30pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/14 "2016-05-07T19:30:38Z")
> [@astro](#): > > Looking at mugshot collections some people, men especially, in various stages go drug and alcohol decay and living at the margins often have surprisingly lush and full heads of hair. I would consider ramping up my own alcohol and drug use if my hair would look that great. ---
**Author:** ![spamforbrains](https://avatars.discourse-cdn.com/v4/letter/s/e274bd/32.png) [@spamforbrains](https://boards.straightdope.com/u/spamforbrains)\ **Post date:** [May 8, 2016, 1:34am UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/15 "2016-05-08T01:34:51Z")
> [@](#): > > some people, men especially, in various stages go drug and alcohol decay and living at the margins often have surprisingly lush and full heads of hair. drug abuse and malnutrition reduce testosterone levels and thus the deadly effect of testosterone on the hair follicles is prevented. During normal aging, the fat pads under the cheeks are often lost causing facial hollowing. Any kind of stress such as severe drug abuse or getting divorced can accelerate this effect. ---
**Author:** ![Belowjob2.0](https://avatars.discourse-cdn.com/v4/letter/b/b9e5f3/32.png) [@Belowjob2.0](https://boards.straightdope.com/u/Belowjob2.0)\ **Post date:** [May 8, 2016, 5:37pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/16 "2016-05-08T17:37:14Z")
Alcohol and and drug abuse destroy vitamin C. Vitamin C is essential for collagen formation. Collagen is the the skin’s structural support. > **[Effect of vitamin C and its derivatives on collagen synthesis and...](https://pubmed.ncbi.nlm.nih.gov/18505499/)** > > Vitamin C (VitC) plays a critical role in the maintenance of a normal mature collagen network in humans (anti-scurvy properties) by preventing the auto-inactivation of lysyl and prolyl hyroxylase, two key enzymes in collagen biosynthesis. In this... > **[Ultimate Guide to Vitamin C](https://health.howstuffworks.com/wellness/food-nutrition/vitamin-supplements/vitamin-c.htm#pt1)** > > Vitamin C is something you hear about all the time -- learn the real scoop on this important nutrient and how it can help your body function properly! ---
**Author:** ![jz78817](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jz78817/32/1028_2.png) [@jz78817](https://boards.straightdope.com/u/jz78817)\ **Post date:** [May 8, 2016, 5:41pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/17 "2016-05-08T17:41:58Z")
> [@Girl\_From\_Mars](#): > > Not always alcoholism. We lost a friend recently to it and he was always very puffy, particularly around the face and abdomen. that sounds like advanced stages of liver failure, leading to ascites (fluid retention, especially in the abdomen.) ---
**Author:** ![guizot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/guizot/32/3636_2.png) [@guizot](https://boards.straightdope.com/u/guizot)\ **Post date:** [May 8, 2016, 7:46pm UTC](https://boards.straightdope.com/t/you-often-see-alcoholics-drug-addicts-with-this-odd-sunken-facial-look-what-causes-it/754104/18 "2016-05-08T19:46:53Z")
> [@Belowjob2.0](#): > > Alcohol and and drug abuse destroy vitamin C. Vitamin C is essential for collagen formation. Collagen is the the skin’s structural support. > > [Effect of vitamin C and its derivatives on collagen synthesis and cross-linking by normal human fibroblasts - PubMed](http://www.ncbi.nlm.nih.gov/pubmed/18505499) > > [Ultimate Guide to Vitamin C | HowStuffWorks](http://health.howstuffworks.com/wellness/food-nutrition/vitamin-supplements/vitamin-c1.htm) Well I guess that’s one reason why I think it might not so much be about teeth, because when people get clean and sober, their face starts to look better again (they lose the “sunken look”), and I don’t think it’s because they’re getting dentures or implants for lost teeth. I think it’s because their skin is recuperating, and they’re regaining lost weight.