Their face shape often comes from tooth loss. “Meth mouth” is extremely recognizable with methamphetamines because it is made of very acidic ingredients that weaken enamel, and causes dry mouth. Heroin similarly causes dry mouth which is harmful to the teeth because saliva helps keep bacteria under control. Add in that both meth and heroin can cause behavior like grinding of the teeth and you end up with a recipe for dramatically poor oral health.
Without the teeth to support the cheeks they are free to sink in, causing the characteristic look you recognize.
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