Facial Changes in Fatty Liver Disease: Causes, Diagnosis & Prevention

Introduction

Have you noticed any dullness, tiredness or puffiness in your face when you look in the mirror, even when you were feeling normal all day? These symptoms are often ignored as being due to a sedentary lifestyle, such as lack of sleep, exercise and stress, however, they can sometimes be a sign of certain medical conditions. In this article, we will discuss how fatty liver can affect your face, what its causes and symptoms are, and when to seek medical help. 

What Is Liver Facies?

The liver is the chief organ that processes toxins and waste materials in the body, it also behaves as a storage house. In a healthy liver, there is little to no fat accumulation. However, when there is increased caloric intake or alcohol use, the liver turns this into fat and stores it. When excess fat is stored in the liver, it is termed fatty liver¹. As fatty liver advances, it can lead to severe inflammation and hardening of liver tissue called cirrhosis. In patients with advanced liver diseases, including fatty liver, skin changes are often visible, even though they are non-specific. These changes can be seen on the hands, palms, neck or face².   

Liver facies is a term that is used to describe the facial features that are seen associated with the late stages of liver diseases like cirrhosis. It can include dullness, tiredness, yellowing of the skin, pigmentation on the face, and a puffy appearance of the face^3,4. 

Causes of Facial Changes in Fatty Liver Patients

Causes of fatty liver symptoms on face include impaired liver function due to any of the below-listed reasons³:

• Poor liver detox function: When liver function is reduced, a bile pigment called bilirubin is deposited in whiter portion of the eyes (sclera) and skin. 
• Hormonal Imbalances: The liver is the primary organ that is involved in the metabolism of a hormone named oestrogen. When liver function is impaired, it cannot metabolise oestrogen effectively. As a result, oestrogen levels tend to remain high, which in turn can cause dilation of small blood vessels on the skin causing a “flushing” like effect. 
• High cholesterol levels: Bile is involved in the elimination of excess cholesterol in the body. An impaired bile flow can lead to abnormal levels of fat (dyslipidaemia). These abnormal fats can be deposited, which shows up as yellowish deposits, known as xanthelasmas. 
• Insulin resistance: Insulin resistance plays a key role in the progression of fat accumulation in the liver (steatosis) to more serious forms, including inflammation of the liver (steatohepatitis), scarring (cirrhosis) and even cancer related to the liver (hepatocellular carcinoma)⁸. Skin pigmentations are seen associated with insulin resistance⁹. Dark patches of velvety skin in body creases like the neck and armpits (acanthosis nigricans) can be manifested as a sign of insulin resistance¹⁰.  
• Fluid retention: In advanced cirrhosis cases, fluid retention can occur, which might result in oedema in the body as well including the face^4,11. 

Facial Symptoms of Fatty Liver Disease

Fatty liver usually asymptomatic at the early stages. However, in later stages of the disease, symptoms can be manifested. Fatty liver symptoms on face in advanced disease can include jaundice, pigmentations, spider angiomas and xanthomas. 

• Fatigue:  Fatigue can be seen in patients with liver disease¹². A dry, rough texture of the skin along with a dull or darkening complexion can be seen¹³. 
• Jaundice:  Yellowing of the white portion of the eyes (sclera) and skin is termed jaundice. Jaundice is manifested as a result of the accumulation of the yellow pigment called bilirubin and its metabolites³.
• Pigmentations:  A greyish-brown pigmentation of the skin in areas which are regularly exposed to sunlight. These features are more noticeable around the mouth and eyes. This might produce a darkened appearance around the eyes. These pigmentary changes are more linked with the cirrhosis stage of the liver disease³.
• Spider Angiomas:  They are small, spider-like blood vessels seen on the skin. They are considered a characteristic feature in the late stage of fatty liver disease, which is cirrhosis. It appears as a central blood vessel surrounded by small radiating vessels, giving a spider-like appearance. Spider angiomas are commonly seen on the face, neck, shoulders and upper arms³.
• Xanthoma:  Xanthoma is a soft and yellow, flat or raised, painless area of fat deposits that can occur anywhere on the body. The most common type of facial xanthoma is a soft, flat or slightly raised yellowish area, typically seen on the upper eyelids, near the nasal bridge. These findings are a result of dyslipidaemia, in which abnormal fats are leaked through the small vessels and gets deposited under the skin³.
• Facial Puffiness:  In advanced stages of liver diseases, fluid regulation in the body becomes irregular, which results in the accumulation of fluid. The fluid retention, along with improper functioning of kidneys, leads to oedema⁴. A generalised swelling can result due to long-term liver diseases in the body, which might include facial puffiness also¹¹.

Diagnosis of Fatty Liver Disease

Diagnosis of fatty liver disease includes taking a proper medical history, physical evaluation and performing some tests^14,15. 

• Medical History: Your doctor will take a detailed medical history, understanding any underlying conditions or lifestyle factors that may have led to fatty liver. Most associated conditions are obesity, type 2 diabetes and high cholesterol levels in the body. Lifestyle factors that can lead to fatty liver can be a sedentary lifestyle and the intake of food or beverages having high sugar content. Alcohol consumption is also assessed to know whether the fatty liver is alcohol-associated¹⁴.
• Physical Assessment: Your doctor will check your body mass index (BMI) first. The examination can also include checking for signs on face, signs of insulin resistance or cirrhosis. 
• Blood Tests 
  • Liver Function Tests: Your doctor will order a liver function test (LFT) to check for increased levels of liver enzymes, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST). LFT also include albumin levels, total protein, bilirubin, an enzyme named lactate dehydrogenase (LDH) and prothrombin time (PT), which measures how long it takes for the blood to clot^16,17. You can book a Liver Function Test (LFT) if your doctor recommends it.  
  • Complete blood count (CBC): Helps in finding any signs  of anaemia or low platelets, which is a sign of underlying portal hypertension, leading to complications & rapid deterioration of patients associated with the cirrhosis stage of the disease¹⁷. 
  • Tests for viral infections: To find whether the liver disease is caused by any viral infections such as hepatitis B and hepatitis C¹⁷.
  • Tests for autoimmune liver conditions: In autoimmune disease, the patient’s immune system attacks the liver cells, resulting in damage. The tests involve anti-nuclear antibody (ANA), anti-smooth muscle antibody (SMA) and anti-mitochondrial antibody tests (AMA)¹⁷.

• Ultrasound (US): The US B model helps in finding how much fat is accumulated in the liver¹⁸. 
• Imaging Tests: Computed tomography (CT) and magnetic resonance imaging (MRI) are the imaging tests used to check for fat deposits or other changes in the liver. 
• Elastography: It is a newer type of imaging test which mainly focuses on the presence of any liver fibrosis. There are three commonly used elastography methods, and FibroScan is one among these^14,15. 
• Liver Biopsy: It can assess the severity or diagnostic uncertainty of the fatty liver disease. Your doctor may recommend biopsy only in few cases. 

Treatment Options

Treatment options for fatty liver rely more on lifestyle changes, weight management, dietary adjustments and managing underlying conditions. 

1. Lifestyle Changes

In patients who are overweight, moderate exercise may be beneficial in managing fatty liver disease(150 minutes of moderate/ 75-100 minutes of vigorous physical activity every week along with strength/ resistance training)¹⁹. Being physically active will also contribute to counteracting the sarcopenia associated with liver disease even in the  – target 5-10% of weight loss at least is also helpful in the management²⁰. In people with fatty liver disease, alcohol consumption is also advised to be abstinent²¹. 

2. Weight Management

Weight loss can be achieved by healthy diets, physical activities, some medicines and bariatric surgery¹⁹. At least 5-10%of body weight loss can help in the reduction of fat in the liver²⁰. Your doctor will advise you to reduce the weight gradually(0.7-1.0 kg/week).  along with a caloric restriction based on the physical activity & lifestyle can further aid in lowering inflammation of liver^19,20.

3. Dietary Adjustments

 Your doctor will advise you to consume a balanced diet and avoid some types of foods. Fatty foods should be avoided; instead, unsaturated fats, particularly omega-3 fatty acids containing foods, are recommended. Foods which are less prone to increase blood glucose (low glycaemic index), including vegetables, are preferred compared to high glycaemic index foods such as white rice and potatoes. These can be consumed in moderation as long as a caloric deficit can be maintained. Sugar like fructose containing foods are advised to be avoided, which include sweetened beverages, tea and juices. Table sugar needs to be avoided²¹. Since processed foods are high in calories, saturated fats, carbohydrates and salts and low in fibre, vitamins and minerals, limiting such foods is also beneficial²². 

4. Managing Underlying Conditions

 In people with fatty liver disease, along with marked obesity, increased blood pressure, blood sugar and disturbed fat profiles are commonly present. These features are more prone to badly affect heart health as well. Proper screening and appropriate management of these underlying conditions help reduce disease and death related complications associated with the heart as well as improve fatty liver disease¹⁹.

5. Medicines

Earlier, medicines directly targeting liver damage were limited. However, certain medicines have been approved later specifically for this condition, which include saroglitazar, resmiterom and some GLP-1 medicines. Management with Saroglitazar has shown improvements in liver enzymes, serum glucose and fats, while further evidence is needed to determine the effectiveness and safety of resmetirom in liver disease^23,24.  

GLP-1 receptor agonists can also be involved in the treatment by improving liver enzymes and preventing fat accumulation in the liver. A decreased body weight along with optimised blood sugar levels can also be contributed to the mechanism of improving fatty liver

disease²⁵. Also, insulin-sensitising drugs such as metformin might be beneficial in people having diabetics along with fatty liver disease. Please consult your doctor for appropriate recommendations.  

How to Prevent Fatty Liver Disease?

Maintaining healthy lifestyle choices can be helpful for overall health of the liver and preventing the progression of fatty liver disease. It can include the following: 

1. Regular Exercise

Being physically active regularly can help avoid fatty liver disease. Aiming minimum of 150 minutes of physical activity per week is beneficial. strengthening activities can be picked up with a slow start and slow progress. However, if there are any health problems or injuries, discussing this with your doctor is advised²⁰.

2. Healthy Diet

 Limiting foods containing fat and sugars is advised, as this may lead to obesity and thereby to fatty liver disease. Vegetables and whole grains are suggested compared to white bread, rice or potatoes, as these can increase the sugar level in the blood. Similarly, sweetened drinks, tea or juices should also be avoided. Fatty and processed foods should be avoided²¹.

3. Healthy Weight

Maintaining a healthy weight can help in preventing fatty liver disease. However, a gradual weight loss is recommended²⁰.

4. Avoid Alcohol

All consumption  of alcohol might lead to alcoholic  liver disease, so minimising usage can help in prevention²¹.

5. Manage Blood Sugar Levels

In people with high blood sugar levels or diabetes, chances of getting metabolic-associated fatty liver disease are higher. So, managing blood sugar levels can help in overall liver health and preventing the disease¹².

Also Read: Best Exercises for Fatty Liver You Should Try

When to consult a doctor?

Doctor consultation is recommended in the following cases: 

• Persistent Symptoms: When symptoms such as tiredness, pain in the upper right belly region, nausea, yellowing of skin and sclera, or poor appetite¹³ are present, consulting a doctor is important. 
• High-risk Conditions: High blood pressure, high cholesterol, high blood glucose (diabetes), obesity or chronic excessive alcohol use are seen to be associated with fatty liver disease. People with these conditions are advised to consult for a proper diagnosis¹⁹.
• Altered Test Reports: Altered test reports indicative of liver diseases in routine testing also suggest a consultation. 
• Emergencies: Urgent medical attention is advised in some of the serious signs of liver disease, which include¹²:
  • Dark coloured urine 
  • Swelling of abdomen or legs  
  • Vomiting of blood 
  • Passing black stools 
  • Itchy skin 
  • Confusion 

Conclusion

Liver Facies includes the facial symptoms that are seen in the late stage of liver disease, which can include fatigue, facial puffiness, jaundice, pigmentations, spider angioma and xanthomas. The causes for these changes are contributed to poor liver detox function, some hormonal imbalances, insulin resistance and abnormal fat levels in the body. A healthy lifestyle including regular exercise, maintaining a healthy diet and weight and avoiding alcohol can help in preventing as well as managing this condition.  

Frequently Asked Questions (FAQs)

References

1. Australia H. Fatty liver. June 23, 2025. Accessed July 21, 2026. Available from: https://www.healthdirect.gov.au/fatty-liver 

2. Dogra S, Jindal R. Cutaneous manifestations of common liver diseases. J Clin Exp Hepatol. 2011;1(3):177-184. doi:10.1016/S0973-6883(11)60235-1 Available from:  https://pubmed.ncbi.nlm.nih.gov/25755383/

3. Bhandari A, Mahajan R. Skin Changes in Cirrhosis. J Clin Exp Hepatol. 2022;12(4):1215-1224. doi:10.1016/j.jceh.2021.12.013 Available from: https://pubmed.ncbi.nlm.nih.gov/35814509/

4. Maekawa H, Toda G. [Edema in liver disease]. Nihon Rinsho Jpn J Clin Med. 2005;63(1):80-84. Available from: https://pubmed.ncbi.nlm.nih.gov/15675322/

5. Symptoms & Causes of NAFLD & NASH – NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed July 31, 2026. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes 

6. Steatotic Liver Disease. Accessed July 31, 2026. Available from: https://medlineplus.gov/steatoticliverdisease.html 

7. Teng ML, Ng CH, Huang DQ, et al. Global incidence and prevalence of nonalcoholic fatty liver disease. Clin Mol Hepatol. 2023;29(Suppl):S32-S42. doi:10.3350/cmh.2022.0365  Available from: https://pubmed.ncbi.nlm.nih.gov/36517002/

8. Nogueira JP, Cusi K. Role of Insulin Resistance in the Development of Nonalcoholic Fatty Liver Disease in People With Type 2 Diabetes: From Bench to Patient Care. doi:10.2337/dsi23-0013 Available from: https://pubmed.ncbi.nlm.nih.gov/38385099/

9. Nagata C, Konish K, Tamura T, et al. Skin pigmentation is inversely associated with insulin resistance in healthy Japanese women. Diabetes Metab. 2016;42(5):368-371. doi:10.1016/j.diabet.2016.04.001  Available from: https://pubmed.ncbi.nlm.nih.gov/27161346/

10. CDC. Diabetes and Your Skin. Diabetes. May 21, 2024. Accessed July 31, 2026. Available from: https://www.cdc.gov/diabetes/signs-symptoms/diabetes-and-your-skin.html 

11. Kattula SRST, Avula A, Baradhi KM. Anasarca. In: StatPearls. StatPearls Publishing; 2026. Accessed July 22, 2026. Available from: http://www.ncbi.nlm.nih.gov/books/NBK519013/ 

12. Fatty Liver Disease. Liver Foundation. Accessed July 31, 2026. Available from: https://liver.org.au/your-liver/liver-diseases/fatty-liver-disease/ 

13. Liu T, Xi T, Dong X, Xu D. Research progress on pathogenesis of skin pigmentation in chronic liver disease. Biomol Biomed. 2024;25(6):1218-1232. doi:10.17305/bb.2024.11085  Available from: https://pubmed.ncbi.nlm.nih.gov/39689154/

14. Diagnosis of NAFLD & NASH – NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed July 21, 2026. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/diagnosis 

15. Nonalcoholic fatty liver disease: MedlinePlus Medical Encyclopedia. Accessed July 21, 2026. Available from: https://medlineplus.gov/ency/article/007657.htm 

16. Liver Function Tests: MedlinePlus Medical Test. Accessed July 31, 2026. Available from: https://medlineplus.gov/lab-tests/liver-function-tests/ 

17. Diagnosis of Cirrhosis – NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed July 31, 2026. Available from: https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis/diagnosis 

18. Ferraioli G, Soares Monteiro LB. Ultrasound-based techniques for the diagnosis of liver steatosis. World J Gastroenterol. 2019;25(40):6053-6062. doi:10.3748/wjg.v25.i40.6053  Available from: https://pubmed.ncbi.nlm.nih.gov/31686762/

19. Adams LA, Angulo P. Treatment of non‐alcoholic fatty liver disease. Postgrad Med J. 2006;82(967):315-322. doi:10.1136/pgmj.2005.042200 Available from: https://pubmed.ncbi.nlm.nih.gov/16679470/

20. Treatment for NAFLD & NASH – NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed July 22, 2026. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/treatment 

21. Eating, Diet, & Nutrition for NAFLD & NASH – NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed July 22, 2026. Available from: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/eating-diet-nutrition 

22. Henney AE, Gillespie CS, Alam U, Hydes TJ, Cuthbertson DJ. Ultra-Processed Food Intake Is Associated with Non-Alcoholic Fatty Liver Disease in Adults: A Systematic Review and Meta-Analysis. Nutrients. 2023;15(10):2266. doi:10.3390/nu15102266 Available from: https://pubmed.ncbi.nlm.nih.gov/37242149/

23. Effects of saroglitazar in the treatment of non-alcoholic fatty liver disease or non-alcoholic steatohepatitis: A systematic review and meta-analysis – ScienceDirect. Accessed August 17, 2026. Available from: https://www.sciencedirect.com/science/article/abs/pii/S2210740123000992 

24. Shakeel L, Shaukat A, Akilimali A. Resmetirom: A Breakthrough in the Treatment of Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD). Health Sci Rep. 2025;8(6):e70920. doi:10.1002/hsr2.70920 Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12174658/

25. Nevola R, Epifani R, Imbriani S, et al. GLP-1 Receptor Agonists in Non-Alcoholic Fatty Liver Disease: Current Evidence and Future Perspectives. Int J Mol Sci. 2023;24(2):1703. doi:10.3390/ijms24021703  Available from: https://pubmed.ncbi.nlm.nih.gov/36675217/

26. Shuaibi S, AlSejari N, Farhud S, Nguyen J, McIntyre C. Cutaneous Implications of Liver Cirrhosis: A Case of Acrodermatitis Enteropathica. Cureus. 17(4):e82734. doi:10.7759/cureus.82734  Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12094836/

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