Nasal fold resection in pugs: when it is advisable, how it is performed and what owners need to know
Why and how nasal fold resection helps in pugs
As a veterinarian, I am frequently approached by pug owners with the same concern: "My dog squints, rubs his eyes often, and constantly has brown streaks from his tears – could this be due to the nasal fold?" In many cases, the answer is yes. Nasal fold resection in pugs is a targeted, minor plastic surgery procedure in which the protruding, hairy roll of skin (the so-called "nose roll") is removed or reduced so that the hair no longer rubs against the cornea.
This constant rubbing – known medically as trichiasis – can irritate the cornea, leading to pigment deposits, chronic inflammation, and even painful ulcers. This phenomenon is part of the so-called brachycephalic eye syndrome, which is very common in pugs. International animal welfare and professional organizations describe in detail how the proximity of prominent eyes to skin folds is precisely what causes the cornea to be repeatedly irritated. ufaw.org.uk+1
Afterward:
The classification is important: Pugs have several anatomical factors that make their eyes vulnerable – large palpebral fissures, incomplete eyelid closure ( lagophthalmos ), medial entropion ( medial entropion ), trichiasis originating from the caruncle, and, of course, nasal hairs. This overall constellation is summarized as "brachycephalic ocular syndrome" (BOS). Clinics and universities abroad point out that pugs are particularly prone to developing pigmentary keratitis, corneal ulcers, and persistent tear duct problems. Today's Veterinary Practice+1
Not every corneal irritation has the same cause – that's precisely why I differentiate very carefully during consultations: Does the irritation originate primarily from the nasal fold (hair/moist skin touching the cornea), or are other components dominant, such as medial entropion and caruncle trichiasis? This differentiation is crucial, as it determines the treatment. The Royal Veterinary College (UK), for example, states that a medial canthoplasty procedure (shortening the palpebral fissure and correcting the medial lid margin) may be necessary for many brachycephalic patients; in some cases, ridge reduction on the bridge of the nose is also performed if the fold touches the cornea. rvc.ac.uk+1
For which dogs is nasal fold resection suitable in Pugs?
nasal fold resection in pugs when the fold clearly touches the cornea or when irritation/infection repeatedly occurs within the fold itself. Indications include: chronic tearing (especially nasal tearing), dark pigment streaks on the cornea towards the nose, recurring blinking/squinting, pawing, recurring superficial corneal ulcers, or foul-smelling, moist inflammation in the fold. Expert sources explain that such skin folds create warm, moist niches where bacteria and yeast proliferate, and that contact between fold hairs and the cornea can lead to keratitis, ulcers, and pigmentation. PDSA+1
At the same time, it's important to know that in some pugs, a simple nasal fold resection isn't sufficient because the underlying condition is more extensive. Modern ophthalmological reviews show that shortening the palpebral fissure through medial canthoplasty often provides more lasting corneal protection; the nasal fold is then less frequently removed and only treated separately if it's very prominent. tieraugen.com
Preliminary examination: eyes, breathing, anesthesia risk
Before every nasal fold resection on a pug, I systematically examine:
- Ocular surface (fluorescein staining on ulcers, tear production/Schirmer test, slit lamp examination, pigment distribution).
- Eyelid position, palpebral fissure length, medial entropion component, sources of trichiasis (caruncle, nasal fold).
- General findings including respiration: Many pugs have BOAS (brachycephalic obstructive airway syndrome). This significantly affects anesthesia.
For BOAS assessment, the information from Cambridge and the Kennel Club is helpful: It describes, among other things, the Respiratory Function Grading (RFG), which is used to evaluate pugs' respiratory function. vet.cam.ac.uk+1
Regarding anesthesia: Brachycephalic patients have an increased risk of peri- and post-anesthetic complications. International articles and guidelines recommend conservative, reversible premedication, consistent preoxygenation, prompt and safe intubation, and particularly vigilant monitoring during the recovery phase; many complications only occur after extubation .
The procedure of the operation – what exactly is done?
Nasal fold resection in pugs is a soft tissue surgical procedure that requires precise planning. After marking the area of skin to be removed, the fold is resected in an elliptical or wedge shape. The goal is not "more is better," but rather a measured reduction: enough to eliminate contact with the cornea, but so little that natural facial expressions are preserved and nasal production/tear drainage is not disrupted. Depending on the findings, I combine the procedure with:
- Medial canthoplasty (shortening of the palpebral fissure, correction of the medial eyelid margin) is performed when excessive palpebral fissure length and medial entropion are noticeable. rvc.ac.uk+1
- Correction of other BOAS components (separate surgery appointment) if it benefits the overall situation – such as Nares correction or soft palate surgery. Modern publications describe various techniques that improve the airway; the necessary procedure is determined on an individual basis. Clinician's Brief
In the surgical field, I ensure atraumatic preparation and a low-tension, multi-layered skin suture. Bleeding is usually minimal and easily controlled. The procedure typically lasts 30–60 minutes; the actual anesthesia time is longer due to the particularly careful induction and awakening. After the operation, the patient remains under close monitoring until respiration and protective reflexes are stable; extubation is deliberately delayed. This strategy is recommended in recognized anesthesia resources. Today's Veterinary Practice+1
Risks, side effects and complications
Like any surgery, nasal fold resection in pugs risks. These generally include impaired wound healing, bruising, infection, suture dehiscence, or cosmetically visible asymmetries. Specifically, despite successful fold reduction, residual corneal irritation may persist due to other underlying causes (medial entropion, caruncular trichiasis). In such cases, a supplementary medial canthoplasty the more effective option. British experts also point out that if the nasal fold touches the cornea, its reduction or removal may be part of the treatment plan. thekennelclub.org.uk
The greatest risk often lies not in the incision technique, but in the anesthesia of BOAS patients. Brachycephalic dogs have a higher rate of anesthetic complications compared to non-brachycephalic dogs, especially during the recovery phase; therefore, planning, preoxygenation, temperature management, attentive postoperative monitoring, and clear emergency protocols are crucial. Today's Veterinary Practice
Aftercare, healing and chances of success
After a nasal fold resection in a pug, patients wear a neck collar for 10–14 days. I prescribe anti-inflammatory eye drops and—if indicated—a topical antibiotic, along with a short course of oral pain medication. I usually remove the sutures after 10–12 days. Owners should check the eyes daily for redness, discharge, and increased squinting, and keep the wound dry and clean. A typical healing process involves initial mild swelling and hematoma, followed by a rapid improvement in the sensation of friction—the dog squints less, rubs itself less frequently, and the tear streaks diminish. Case reports from ophthalmology show that reducing mechanical irritation promotes the healing of existing corneal problems and improves the dog's quality of life. Bright Side Vets
The long-term prognosis is good if the indication is correct and all relevant causes are addressed. In studies on brachycephalic eye syndrome in dogs – with a high proportion of Pugs – corneal ulceration was one of the most frequent findings; therefore, it is important to protect the surface early and consistently. kleintierklinik.uni-leipzig.de
Frequently asked questions about nasal fold resection in pugs
1) As an owner, how can I tell if my dog could benefit from a nasal fold resection in a pug?
Typical everyday signs include: your pug blinks frequently, squints, rubs its face on the sofa or with its paw, avoids bright light, has increased tearing towards the side of its nose, and repeatedly develops brownish to black pigment streaks on the cornea towards the bridge of the nose. This pigmentation is not "dirt," but rather an indication of long-term irritation. Often, the nasal fold is so prominent that its hairs constantly touch the cornea – this is best seen in profile or from a slightly elevated angle.
As a veterinarian, I also pay attention to moist, reddened skin in the fold area; bacteria and yeasts colonize this area particularly easily, which exacerbates the irritation. Important: Not every watery eye automatically necessitates nasal fold resection in pugs . Tear duct problems, excessively large palpebral fissures, medial entropion, or trichiasis originating from the caruncle can be contributing factors, either alone or in combination – therefore, a complete eye examination (including a fluorescein test and Schirmer test) is always essential. British and international veterinary sources describe the role of the nasal fold in corneal irritation and the predisposition of brachycephalic breeds to skin fold dermatitis; both can occur together.
If the fold touches the cornea or becomes repeatedly inflamed despite care, nasal fold resection is very likely a sensible option for pugs Vetlexicon+2PDSA+2
2) Is anesthesia particularly risky for my pug with BOAS – and how can the risk be minimized?
Brachycephalic dogs represent a unique category in anesthesia. The constrictions in their upper airway (narrow nostrils, elongated soft palate, and potentially laryngeal collapse) make them susceptible to stress, oxygen deprivation, and recovery difficulties. Professional teamwork and structured protocols reduce these risks: conservative, well-controlled premedication; consistent preoxygenation; prompt, safe intubation with prepared emergency plans; close monitoring of circulation, respiration, and temperature; delayed, controlled extubation only when protective reflexes are reliably established; a calm environment; and, if necessary, microdoses of sedatives in the recovery room to avoid stress spikes.
International, peer-reviewed reviews and guidelines highlight that most complications occur during the recovery phase – this is precisely when the extra hour of monitoring is worthwhile. General AAHA recommendations on anesthesia and monitoring also help to structure planning and execution. For owners, this means: Don't hesitate to ask about your practice's anesthesia protocol – a plan tailored to BOAS is standard practice for Pugs .
3) Medial canthoplasty or nasal fold resection in pugs – which is better?
This isn't an "either-or" situation, but rather a question of the underlying cause. Nasal fold resection in pugs eliminates the mechanical friction of the fold on the cornea. Medial canthoplasty shortens the palpebral fissure and corrects the medially inward rolling of the eyelid margin; this reduces several sources of irritation simultaneously (lagophthalmos, medial entropion, caruncle trichiasis). In many pug cases, canthoplasty is the central component; the fold then needs to be shortened either not at all or only moderately.
Recent articles even describe simplified techniques that reduce the need for a separate nasal fold resection. Conversely, there are pugs with very prominent nasal folds where nasal fold resection alone effectively resolves the problem. Therefore, during consultations and examinations, I first check which structures are actually touching the cornea. British specialist information websites for owners point out that if the fold is touching the cornea, its reduction/removal can be part of the treatment; university clinics explain the role of canthoplasty. Ultimately, what matters is the tailored combination, not the name of the technique. thekennelclub.org.uk+2rvc.ac.uk+2
4) What complications can occur and how frequent are they?
during nasal fold resection in pugs are generally rare and usually mild: hematoma, temporary swelling, wound infection, irritation from licking (which is why an Elizabethan collar is mandatory). In isolated cases, the scar may be cosmetically noticeable; with precise suturing techniques, the risk is low. The more important aspect is the anesthesia: Brachycephalic patients are demonstrably more frequently affected by anesthesia-related events – especially dyspnea during recovery. This is precisely where modern anesthesia concepts come into play: delayed extubation, oxygen administration, prepared re-intubation equipment, temperature and CO₂ monitoring, and close postoperative monitoring with quiet positioning.
Specialist articles summarize that structured monitoring is particularly effective in mitigating complications. If irritation persists despite correct wrinkle reduction, there is often an additional underlying cause (medial entropion, caruncular trichiasis) that should then be addressed surgically. British owner resources also emphasize that in rare cases of therapy-resistant ulcers, more radical steps (up to and including enucleation) may be necessary – however, this is the exception, not the rule. ( Today's Veterinary Practice +2 British Veterinary Nursing Association +2)
5) What does post-operative care look like and what can I contribute myself?
After nasal fold resection on a pug, I plan a clear and simple aftercare regimen: a neck collar until suture removal (usually day 10–12), short-term pain management, possibly a local antibiotic, and an anti-inflammatory eye drop routine for 1–2 weeks. The wound should remain dry; gentle cooling during the first 24–48 hours reduces swelling. I schedule follow-up appointments early (days 3–5) and again for suture removal. Owners should watch for redness, increased discharge, excessive rubbing, or an unpleasant odor – please report any of these immediately. I also recommend maintaining your general wrinkle care routine.
Clean regularly but gently and dry thoroughly to prevent the formation of warm, moist environments that can harbor germs. British veterinary guides explain that bacteria and yeast can easily proliferate in skin folds; good hygiene reduces the risk of relapse. For pugs with BOAS, it's also beneficial to work on weight management in the long term and avoid heat; any relief from breathing reduces stress during anesthesia and daily life. And: If you're unsure whether the cornea is truly free of contact, schedule an eye exam as soon as possible – the earlier irritative changes are detected, the easier they are to treat. PDSA
Detailed summary
Nasal fold resection in pugs is a targeted, minor procedure with a significant impact: it eliminates a common source of mechanical corneal irritation. Nasal fold resection is indicated in pugs when the hairy fold touches the cornea or when the fold repeatedly becomes inflamed. In my practice, before performing a nasal fold resection in a pug , I always check for the presence of medial entropion or trichiasis originating from the caruncle.
In addition to nasal wrinkle resection, medial canthoplasty is often in pugs to shorten the palpebral fissure and stabilize the eye's protective film. It's important for owners to understand that nasal wrinkle resection in pugs is neither a cosmetic luxury nor a fashion statement, but rather a practical way to protect the eyes. Nasal wrinkle resection in pugs reduces pain, decreases the rate of ulcers, and preserves vision.
Preparation and anesthesia are key to the success of nasal fold resection in pugs . Brachycephalic patients benefit from precise planning, as nasal fold resection in pugs is performed under anesthesia, which must be managed with particular care due to BOAS (Brachycephalic Asperger Syndrome).
Preoxygenation, safe intubation, and delayed extubation significantly improve the of nasal fold resection in pugs . During surgery, I carefully remove the excess fold in pugs Nasal fold resection in pugs requires meticulous suturing techniques and a calm, minimally invasive dissection. Crucially, the resection should only remove as much tissue as is functionally necessary.
care after nasal fold resection in pugs nasal fold resection in pugs typically heals within two weeks. If further irritation occurs, I will assess whether a medial canthoplasty is necessary in addition to the nasal fold resection blinks less, rubs less, and appears generally more alert and less bothered after nasal fold resection
In some cases, nasal fold resection in pugs be combined with other procedures, such as corrections to the nostrils or soft palate; this does not change the fact that nasal fold resection is a local procedure in pugs, but it does increase the overall benefit. I regularly emphasize that nasal fold resection in pugs is not "cosmetic," but rather pain prevention. Having performed in a timely manner in pugs Nasal fold resection in pugs is a small but very worthwhile operation – and it belongs in experienced veterinary hands.