In her last year of college, Michelle Riley had professional goals and one big personal one: Get a dog. She’d wanted one for years and started researching long before she graduated. An online test told her that, breed-wise, a pug would be a good match for her lifestyle—she didn’t want to have to run hours a day to keep the dog happy, and she loved the breed’s funny, squishy face. After she graduated, she found an older, bonded pair of pugs in need of a home and happily made them part of her family.

What the best-breed-for-you test didn’t tell her was that her new pooches Peaches and Pugsly—like many other flat-faced dogs, including French and English bulldogs and Boston terriers—would be prone to a host of health conditions, many of them directly related to the exact quality that makes them so appealing to so many people: their comical, smushed-looking faces.

Riley, now director of photography for the Humane Society of the United States, still adores pugs—she’s had four of them over the years—but she says it’s lucky that she got health insurance for the first pair. “I was so young and poor, I had just gotten out of college and I couldn’t afford thousands of dollars in vet bills,” Riley says. “So I got pet insurance right away and it was the smartest thing I ever did, because they started getting sick right away.”

Due to the breathing problems caused by their foreshortened faces, two of her pugs have needed surgery to open up their nasal passages. Another had to have his soft palate operated on, simply to function normally. Each of these surgeries cost at least a few thousand dollars.

The technical term for these breeds is “brachycephalic” (or short-headed). The structure of their bodies means that dogs of these breeds often suffer from health issues ranging from breathing problems to heatstroke; many of them can’t exercise for long without collapsing.

Diagram depicting the health issues brachycephalic dogs can face

Dr. Barry Kipperman, a veterinarian who serves as board president for the Humane Society Veterinary Medical Association, says those who are breeding dogs to maintain and even increase these exaggerated features are helping to drive these health issues.

If you look at pictures of bulldogs from a century ago, he says, you’ll see they had somewhat longer snouts. “Dogs are reliant on their nose to relieve high temperature and breathe properly. And so without the nose, their capacity to breathe properly and move air is very limited,” Kipperman says. Knowing that the flat, babylike faces are appealing to potential buyers, though, “breeders have selectively bred the nose out of these dogs to make them cuter. [...] The consequence of this selective breeding is that these dogs now are becoming less and less healthy, and less and less able to function and breathe properly.”

Pet lovers need to know what to expect when they adopt one of these breeds and to be prepared for likely medical costs. Kipperman noted that HSVMA has launched a “Cost of Cuteness” campaign, encouraging “veterinarians and animal protection groups to collaborate with breeders and breed clubs to work on improving the health of these dogs and undoing what has been done over the past couple of generations.”

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