Bulimia nervosa (BN) is a serious eating disorder characterized by a destructive cycle of consuming large amounts of food in a short time (bingeing), followed by compensatory behaviors intended to counteract the calories consumed. These behaviors, often referred to as purging, can include self-induced vomiting, misuse of laxatives, or excessive exercise. One of the most visible signs of BN is a condition colloquially known as “bulimia face,” which is a noticeable physical change to the facial structure. This symptom is directly linked to the purging behavior and serves as a significant physical manifestation of the disorder.
How the Face Changes
“Bulimia face” describes the puffy, rounded appearance that develops in the lower cheeks and jawline area. This swelling is typically bilateral, meaning it occurs equally on both sides of the face, obscuring the natural contour of the jaw. The appearance is sometimes non-medically referred to as “chipmunk cheeks” due to the fullness it creates in the parotid region. The swelling can sometimes acutely worsen or appear a few days after a person stops purging behavior, which can be an emotionally challenging experience in early recovery.
The Role of the Salivary Glands
The distinct facial swelling is caused by the enlargement, or hypertrophy, of the parotid glands, which are the largest of the salivary glands. These glands are located just in front of each ear and extend down toward the angle of the jaw. The repeated act of self-induced vomiting causes chronic stimulation of these glands. The body attempts to protect the mouth and esophagus from the highly acidic stomach contents by increasing saliva production. This chronic overstimulation causes the parotid glands to increase in size, a non-inflammatory condition technically called sialadenosis, which occurs in up to 50% of individuals who engage in frequent self-induced vomiting.
Other Oral and Dental Health Effects
Beyond the visible facial swelling, the repeated exposure to stomach acid during purging severely damages other oral structures. The most significant consequence is dental erosion, a condition medically termed perimylolysis. This erosion focuses particularly on the enamel on the back, or lingual, surfaces of the upper front teeth, a characteristic pattern that often alerts dentists to the purging behavior. Over time, the enamel wears away, making teeth look smooth, glassy, and sometimes shorter, which increases sensitivity to hot and cold temperatures. The lack of protective enamel can expose the underlying dentin, leading to an increased risk of cavities and potential tooth decay.
Soft Tissue Damage
Purging also contributes to xerostomia, or chronic dry mouth, because the salivary glands are focused on acute overproduction rather than steady flow. This lack of saliva further compromises oral health, as saliva naturally helps neutralize acids and wash away bacteria. Furthermore, the soft tissues of the mouth, including the gums, can suffer from inflammation known as gingivitis, and the corners of the mouth may develop irritation or cracking, sometimes called cheilosis.
Reversal and Recovery Time
The swelling associated with “bulimia face” is generally not permanent and is often reversible. The primary and most effective step for resolution is the cessation of the purging behavior that causes the chronic parotid gland stimulation. Once purging stops, the glands begin to return to their normal size. The time it takes for the swelling to subside can vary significantly, but it typically occurs within a few weeks. In some cases, the reduction may take several months, depending on the severity and duration of the purging history. While sustained recovery from the eating disorder is the only long-term solution, medical treatments like diuretics may occasionally be used to help manage fluid retention and reduce swelling in the short term.