Dean wasn't a huge fan of boxing, but since Las Vegas hosted many of the championship bouts he wrote a mystery around the sport...hence the title. As usual, Dean rarely took anything too serious so he used the title to also set up a running joke throughout the book. At the end of each even numbered chapter King got punched in the face. Whether it was on purpose or by accident he always ended up taking one to the jaw. Again...hence the title.

Faceful (face full) is not a real word. Dean made it up. He figured if there could be a word like fistful, why not faceful. Titling the book a Fistful of Face would have seemed like King was the one doing the hitting, but that wasn't the case. Therefore, he just reversed the words.

Trying to add a new word to the English vocabulary could be dangerous when your work is translated into other languages. The French translation titled this book My Head has a Fist in it, while in Greece it was called The Face that Swallowed the Fist.