3 doctors from top hospitals in Bengaluru, Delhi, Mumbai share 5 warning signs of fatty liver written on your face

The liver, hidden deep in the abdomen, often signals trouble through visible changes on the face, according to three leading specialists.

Fatty liver disease, often called a 'silent killer', is reaching epidemic proportions in India, with a 2021 study suggesting that nearly 39 percent of adults are now affected. While the liver sits deep within the abdomen, leading hepatologists and gastroenterologists warn that the organ's struggle often manifests in plain sight.

Fatty liver disease can progress to fibrosis and chronic liver failure if untreated. (Freepik)

“The face serves as an early external indicator of internal metabolic stress,” Dr Vikram Raut, senior consultant, liver transplant and HPB surgery, Fortis Hospital Mulund, Mumbai told HT Lifestyle. Because the liver is central to hormone regulation, toxin clearance, and nutrient processing, its dysfunction can trigger visible dermatological and vascular changes.

Medical experts from across the country have identified five critical facial signs that could signal your liver is under siege. According to them, your face may be telling a story your liver can't – heeding these warnings early could be the key to preventing long-term complications like cirrhosis or liver failure.

1. Yellowing of the skin and eyes (jaundice)

The most classic sign of liver distress is a yellow tint, known as Jaundice. Dr Mallikarjun Sakpal, consultant, HPB and transplant physician, Aster CMI Hospital, Bengaluru, explained that this occurs when the liver fails to process bilirubin — a waste product from red blood cell breakdown. “When the liver struggles, bilirubin levels rise, causing a mild yellowing of the whites of the eyes or facial skin that should never be ignored,” he told HT Lifestyle.

2. Facial puffiness and under-eye swelling

If you wake up with a consistently bloated look around your cheeks and eyes, it may not just be a lack of sleep. Dr Sudeep Khanna, senior consultant, gastroenterology, Indraprastha Apollo Hospitals, pointed to fluid retention as the culprit. “When the liver is overloaded with fat, it produces less of the proteins needed to keep fluids inside blood vessels. This leads to leakage into facial tissues, causing persistent puffiness,” he explained in an interview to HT Lifestyle.

3. Adult acne and oily breakouts

Sudden breakouts, particularly around the jawline, cheeks, and forehead, can be a sign of metabolic dysfunction-associated steatotic liver disease (MASLD). According to Dr Sakpal, a fatty liver cannot remove toxins or balance hormones like androgens efficiently. This imbalance triggers overactive oil glands and stubborn pimples that resist standard topical treatments.

4. Red 'spider' veins and rosacea-like flushing

Tiny red lines branching out like a spider’s web — known as spider angiomas — are frequent markers of severe liver scarring or cirrhosis. Dr Raut explained these are caused by dilated capillaries. Dr Khanna added that 'rosacea-like flushing' often arises from poor estrogen breakdown, which increases blood flow to the facial skin and triggers visible vascular networks.

5. Dullness, itching, and patchy skin

Liver disease can rob the skin of its natural glow. Dr Sakpal shared that a fatty liver often reduces the absorption of vitamins A and E, leading to dry, flaky, and itchy skin. Furthermore, Dr Raut added that patients may experience a 'grey-brown' darkening or patchy appearance on the face due to hormonal imbalances and the accumulation of bile salts in the bloodstream.

A silent epidemic: can it be reversed?

While these signs are alarming, the medical consensus is hopeful. Dr Khanna shared that fatty liver is often asymptomatic in its early stages, usually only detectable via ultrasound. However, once facial signs appear, it is a clear signal to act. “Weight loss of just 5 to 10 percent can significantly shrink liver fat and even reverse disease progression,” Dr Khanna said.

Recommended lifestyle swaps

⦿ Diet: Switch to greens-rich meals and cut out sugary sodas.

⦿ Activity: Incorporate at least 30 minutes of daily walking.

⦿ Supplementation: Adding anti-inflammatory spices like turmeric can aid recovery.

⦿ Screening: If you have risk factors like obesity or diabetes, consult a doctor for a FibroScan or ultrasound.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.