I think (and maybe this has been touched on earlier, and if so I apologise) this is probably the end of the Killstream with Ralph using his webcam. And while it might be too early to say, it well and truly looks like the Gunt has fucked up his face, and I wouldn't be surprised if there's some permanent damage there. And given Ethan's narcissism, I don't think he's the sort to wear his scars loudly and proudly. Maybe once or twice. But the Ayy-Lawgs would be quick to remind everyone how retarded the entire premise of going to Portugal was.
But also, because of that narcissism, I wouldn't be shocked if we have a longer term plastic surgery arc. Where Ralph, back in the States gaslights himself into getting increasingly ghastly surgeries in order to own Null, the Farms and his other antagonists. In turn, becoming a somehow even fatter, more bloated version of the Bogandoffs as he spirals to get bigger and bigger surgeries.