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8 Reasons Why Your Face Looks Puffy

Learn eight reasons for your facial puffiness and what you can do about it.
8 Reasons Why Your Face Looks Puffy
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In this article, you will learn eight reasons why you may be experiencing facial puffiness, including:

Waking up to a puffy face can be alarming. And there are numerous reasons why this may happen. Facial swelling can range from something minor, such as a poor dietary choice from the night before or lack of sleep, to a hormone problem and even life-threatening medical conditions. Since this wide range of possibilities can make it that much more concerning when it does happen, here's what may be behind your facial puffiness and what you can do about it.

#1 Allergic reaction

Let's just get this out of the way first thing. If you have facial swelling that either impacts your ability to breathe or includes swelling of the tongue or mouth, you need to seek medical care immediately. Angioedema is the official medical term for swelling just below the skin's surface, and it can show up when you have come into contact with an allergen, such as a bee sting, pollen, or a food or medication allergy. More often than not, allergic reactions are not life-threatening, but they do require some form of treatment to speed up recovery time, such as topical corticosteroids. And, if you have seasonal allergies, taking over-the-counter antihistamines can help reduce any puffiness and other allergic symptoms that show up during your worst seasons.

If your breathing is not impacted and your tongue is not swollen, you can probably try to treat any swelling from home with over-the-counter antihistamines like diphenhydramine or cetirizine. But, if you have a known life-threatening allergy, such as to peanuts or bee stings, you may need to use an EpiPen based on your provider's instructions and seek medical help.

#2 A side effect of certain medications

Facial swelling can be a known side effect of certain medications, including oral steroids like prednisone. Steroids are known for causing a "moon face," which is also a symptom of Cushing's syndrome (to be discussed next). Usually, the higher the dose, the more likely facial swelling is to occur. If you have a puffy face from steroids, you can talk to your doctor about tapering to a lower dose or exploring other alternatives.

#3 Cushing's Syndrome

Cushing occurs when the body is exposed to too much cortisol (the stress hormone) over time. Taking steroids over a long period of time or having a body that produces excess cortisol can lead to this disease. There are telltale signs of Cushing, including:

  • A "moon face"
  • A fatty hump between the shoulders
  • Pink or purple stretch marks
  • Weight gain in the midsection, along with fatty tissue deposits
  • Thin, fragile skin that is slow to heal
  • Bruising easily

Cushing is far more common in women than men, and thus there are a few symptoms that are specific to women, such as an increase in body hair and changes in the menstrual period.

#4 A sinus infection

The sinuses are air-filled pockets in the skull that help humidify and filter the air we breathe. They also produce a thin mucous that helps keep the nasal passages free from bacterial and viral infections. When we get sick, the sinuses can get filled with fluid that is blocked from flowing down through the nose, allowing for bacteria to grow.

If you have facial swelling, you will most likely know that it is caused by sinus pressure or sinusitis (an infection) because of the painful headache that can accompany it. Typically, the swelling is more notable around the eyes and nose, as that is where the sinuses are located.

People with asthma or allergic rhinitis (allergies that affect your nose) are more likely to develop a sinus infection. And it can become a recurrent problem, especially if you never fully resolve a prior infection or don't take measures to manage your allergy symptoms.

#5 Dental infections

With modern dental care, tooth abscesses are less and less common. But, an abscessed or infected tooth can surely still occur when a tooth is either chipped, cracked, or left with an untreated cavity. A tooth abscess can cause gum swelling and may even extend to the jawline, depending on the severity of the infection.

Like a sinus infection, you will likely know this is the problem behind any facial swelling, as it can be extremely painful when the tooth's nerve gets infected by bacteria. Additionally, the swelling is usually only one-sided, so it will not take over your whole face but will rather be local to the area under duress.

#6 A thyroid problem

The thyroid drives the body's metabolism. It sends hormones to each cell to tell it how fast it works. When there is not enough hormone (such as in the case of hypothyroidism, where the thyroid is underactive), one of the many side effects that can occur is an excess of fluid in the subcutaneous tissue. What this means is the skin can look thicker and puffier. Incidentally, fluid retention can also contribute to weight gain (about 5-10 pounds of additional weight can be attributed to hypothyroidism).

People with poorly controlled hypothyroidism sometimes have a "moon face" appearance. Hypothyroidism is far more common in women than men, and while it can show up at any point in life, it is more common after age 50. Checking your thyroid levels with a simple blood test is the easiest way to rule out a thyroid problem like hypothyroidism. And if you do have an underactive thyroid, treating it usually starts with replacing low thyroid hormone levels with thyroid hormone replacement medication.

#7 An eye infection

If you have an eye infection, you will likely have some swelling. Generally, this swelling is one-sided unless both eyes are affected. Figuring out an eye infection is usually pretty straightforward as it is often met with uncomfortable symptoms like burning, redness, irritation, excess tearing and drainage, and feeling like sand is in the eye. Sometimes, eye infections can be contagious, such as with pink eye, so it is important to get medical care to get the proper treatment and prevent spreading the infection to others.

#8 Skin problems

The face is prone to many potential skin issues, including rosacea, sunburn, and acne. If you have any of these problems, you will likely know it based on the telltale signs of either blemishes, redness, heat, or discomfort.

If you have a problem like rosacea, it is important to consult your dermatologist, as it can lead to skin thickening when left untreated. Likewise, acne can come and go based on age, stress levels, and hormonal fluctuations, but if it becomes chronic, it also warrants a trip to the doctor.

Following a good skin care regimen, supported by healthy eating, hydration, and good sleep practices can make a big difference in your overall health, which is certainly reflected in your skin. 

A note from Paloma

If you notice any significant changes with your face or overall body, you should note your routine over the last days leading up to your symptom. If you feel that your facial puffiness might be more serious, consult with your healthcare provider to rule out any serious conditions.


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Julia Walker, RN, BSN

Clinical Nurse

Julia Walker, RN, BSN, is a clinical nurse specializing in helping patients with thyroid disorders. She holds a Bachelor of Science in Nursing from Regis University in Denver and a Bachelor of Arts in the History of Medicine from the University of Colorado-Boulder. She believes managing chronic illnesses requires a balance of medical interventions and lifestyle adjustments. Her background includes caring for patients in women’s health, critical care, pediatrics, allergy, and immunology.

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