Does your face look tired and swollen, with fuller, rounder cheeks, hiding your jawline, baggy undereyes and just overall have a very sluggish, tired appearance? In other words, the face feels flat, lacking the otherwise normal sharpness and defined appearance.

In an interview with HT Lifestyle, Dr Akanksha Sanghvi, Dermatologist, Founder, Oprava Aesthetics explained the key reasons of skin puffiness. On first glance, it may appear to be a skin issue, but it goes far beyond that. She further noted how skin puffiness may indicate a serious underlying health condition.

The dermat explained, “Skin puffiness is a superficial sign of deeper imbalances within the body. From allergies and alcohol to organ dysfunction and stress hormones, puffy skin can be more than just a cosmetic issue. Skin puffiness commonly seen around the eyes, face, and extremities and typically results from increased capillary permeability, impaired lymphatic drainage, and fluid accumulation in the interstitial tissue. Loose connective tissue, such as that found around the eyes, is particularly susceptible. Inflammatory mediators, hormonal imbalances, and vascular changes all contribute to this fluid imbalance.”

Dr Akanksha Sanghvi also believed prolonged stress could play a role in how the skin appears.

The dermat added, “Cortisol, the body’s primary stress hormone, plays a significant role in facial appearance, particularly when chronically elevated. High cortisol levels, often due to prolonged stress can lead to a condition commonly referred to as ‘cortisol face.’ This is characterised by a round, swollen, and puffy appearance—sometimes called ‘moon face’—resulting from fluid retention and fat redistribution to the face and upper body. Cortisol also increases blood sugar, breaks down collagen, and promotes inflammation, which can further affect skin texture, cause breakouts, and contribute to premature ageing. Over time, sustained cortisol elevation can significantly alter facial contours and skin quality.”

Dr Akanksha Sanghvi shared this detailed guide, elaborating on the various other reasons, along with the treatment options.

Here's the guide she shared:

What are the reasons behind skin puffiness?

1. Sleep patterns

• Both a lack of sleep and excess sleep can make the face look puffy due to disrupted fluid balance and circulation.
• Sleep-deprived: When you don’t get enough sleep, elevated cortisol levels and impaired lymphatic drainage lead to fluid retention and inflammation, especially around the eyes.
• Over-sleeping: On the other hand, sleeping too long or lying flat for extended periods can cause fluid to pool in the facial tissues due to gravity and reduced circulation.
• In both cases, the accumulation of interstitial fluid in areas with looser skin, like the eyelids, results in a swollen or puffy appearance.

2. Dietary factors

• High sodium intake is one of the most direct dietary causes of puffiness.
• Sodium promotes water retention, especially in the loose connective tissues of the face and eyelids.
• Additionally, diets high in refined sugars and processed foods can increase systemic inflammation and insulin resistance, both of which exacerbate fluid retention.

3. Alcohol consumption

• Alcohol acts as a diuretic, leading initially to dehydration, followed by rebound fluid retention.
• It also dilates blood vessels, contributing to facial flushing and puffiness.
• Chronic alcohol consumption can impair liver function, further promoting systemic edema.

4. Sedentary lifestyle

• Physical inactivity negatively impacts blood and lymphatic circulation.
• This stagnation in fluid movement can lead to gravitational edema, especially in the lower extremities and face upon waking.

5. Allergies

• Allergic reactions are a common trigger of localised puffiness, especially around the eyes and lips.
• Exposure to allergens (e.g., pollen, dust, food, and skincare products) prompts the immune system to release histamines, which increase vascular permeability and lead to fluid accumulation in the skin.

6. Liver dysfunction

• The liver plays a central role in fluid regulation through albumin production.
• Hypoalbuminemia, commonly seen in liver diseases such as cirrhosis or hepatitis, reduces oncotic pressure, allowing fluid to leak into the interstitial spaces and cause generalised swelling, including facial puffiness.

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7. Kidney disorders

• Renal insufficiency, particularly nephrotic syndrome or glomerulonephritis, can result in significant fluid retention.
• The kidneys fail to excrete excess sodium and water, leading to periorbital and peripheral edema.

8. Medications

• Certain medications, including corticosteroids, NSAIDS, calcium channel blockers, and hormone therapies, may cause fluid retention as a side effect.
• Dermatologically, this can manifest as facial or generalised puffiness.

How to reduce puffy face?

1. Caffeine or green tea compresses

• These ingredients are natural vasoconstrictors, meaning they tighten blood vessels and reduce swelling, particularly around the eyes.
• They can also help reduce the appearance of dark circles.

2. Exercise

• Light physical activity, such as a walk, some yoga, or stretching, is recommended.
• They boost circulation and encourage fluid to move out of the facial tissues and into the lymphatic system for drainage.

3. Limit salt and alcohol

• Salty foods and alcohol cause the body to retain water. Avoiding these, especially at night, can prevent waking up with a puffy face.
• Alcohol also dilates blood vessels, adding to that swollen look.

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4. Barley water

• Barley water helps reduce facial puffiness by acting as a natural diuretic, promoting the elimination of excess fluid and sodium from the body, which are key contributors to water retention.
• Rich in potassium and magnesium, it helps balance electrolytes, supporting proper kidney function and reducing bloating. Its anti-inflammatory properties also help calm systemic inflammation that can lead to swelling in the face.
• Additionally, barley water provides gentle hydration without the drawbacks of sugary or caffeinated beverages, aiding in lymphatic drainage and detoxification for a clearer, less puffy appearance.

5. Apple cider vinegar (ACV)

• It can help reduce water retention and facial puffiness primarily through its ability to support hydration balance, improve digestion, and aid in detoxification.
• ACV helps regulate sodium levels in the body,excess sodium being a major cause of water retention and bloating.
• It also supports healthy kidney and liver function, encouraging the body to flush out toxins and excess fluids more efficiently.
• Additionally, ACV may help balance blood sugar levels and reduce inflammation, both of which contribute to a less swollen, more toned facial appearance.
• When diluted in water and consumed in moderation, it can act as a gentle, natural remedy for puffiness.

6. Ice soak

• Ice soak bowls, where you submerge your face in a bowl of ice water for a few seconds, help reduce facial puffiness by constricting blood vessels, which helps minimise swelling and inflammation.
• The cold temperature tightens the skin, reduces fluid buildup in areas like the under-eyes and cheeks, and boosts circulation, giving the face a firmer, more refreshed appearance. It helps to tighten open pores and calm redness as well.

7. Face cupping

• Face cupping is a therapeutic technique that uses small suction cups to gently lift the skin, promoting improved circulation and lymphatic drainage.
• This process helps reduce facial swelling by encouraging the flow of lymphatic fluid, which can alleviate fluid retention and puffiness, particularly around the eyes and jawline.
• The suction effect also stimulates collagen production, enhances skin tone, and can reduce the appearance of fine lines and wrinkles.
• Regular face cupping sessions can result in a more sculpted, refreshed, and less swollen appearance by helping to flush out excess fluids and toxins from the facial tissues.

8. Radiofrequency (RF) skin tightening

• It is a non-invasive treatment that uses radiofrequency energy to heat the deeper layers of the skin, stimulating collagen production and tightening the tissue.
• This process can help reduce facial puffiness by improving skin elasticity and promoting better lymphatic drainage, which aids in the removal of excess fluid and toxins that cause swelling.
• RF energy also enhances blood circulation, helping to reduce fluid retention and inflammation in the face.
• Over time, regular RF treatments can result in a more sculpted, firmer appearance while diminishing the visibility of puffiness, particularly around the eyes and jawline.

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.

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