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Dr. Andrew Rynne

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What causes puffy face?

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Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3614 Questions

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Posted on Tue, 12 Aug 2014 in Kidney Conditions
Question: for months now I've been noticing my face get puffier and puffier. I've been drinking plenty of water, eating healthy, and exercising so I'm not too sure whats making my face either gain wait or retain water. I actually think that I've been healthier then I was before this all started yet my face is still puffy. Back when this started happening I went through a bad breakup and I've been extremely stressed and down for about 8 months, so I'm not sure its its hormones or cortisol. I have also had about 15 kidney stones since i was 15 years old and constantly have them in my kidneys which makes me have blood in my urine. I also thought this could be something that triggered problems in my kidney making me retain water in my face. My kidney doctor wants to do an endoscopy on my kidney to make sure nothings wrong and well be doing that in the next couple weeks but My arms, legs, and rest of the body and very fit with barely any body fat (under %12 percent) so im not sure if kidneys are causing this. the first picture of me is about a month before anything started happening and the other two are from recently and show how badly my face has been puffing up. I have gone to the doctor to get my blood tested and everything including thyroid was fine so that's counted out. any help would be greatly appreciated because I've been battling this for a while and cant figure it out!
doctor
Answered by Dr. Shafi Ullah Khan 2 hours later
Brief Answer:
Needs a detailed clinical correlation

Detailed Answer:
Thank you for asking
Puffy face with clear and normal thyroid, no hypercortisolism, all labs clear needs a little more digging.
Here are some possibilities.
Renal functions derangement can cause that but that would have been g en era listed puffiness including edema feet etc.bit still a possibility as you had a history of renal stones.
Next possibility is hypertension uncontrolled. Puffy face is a diagnostic entity of hypertension and unless high blood pressure gets controlled it stays that way and takes a little time to come back to normal physiology.
It might be a possibility that you have a thyroid infection like hashimoto thyroiditis as it's classic for puffiness of face and thyroid functions show normal at the start. Antibodies assay will confirm.
Get a complete liver function panel as deranged albumin levels and reversed albumin globulin ratios and nd decreased total proteins irrespective of the etiology can also cause that.
Isolated angioedema of the face secondary to some vascular in infection and good pastures syndrome may also cause that. Vascular profile assessment and ruling out any infection and clearing the lymphatic pathway wouldgive some clue.
Last but not the least ophthalmologist consult for ruling out any eyelid cause for facial puffiness needs to be ruled out too.
Nut shell needs management and a little work up. Meanwhile reduce salt intake to less than 2 gm per day . compliance with the hypertensive meds is advised. Get complete Renal functions assessment.repeat thyroid functions and add some antibody titre for hashimoto to it. Seek your doctor and let them connect the dots for you.hang in there. It might take some time till confirming the cause.
I hope it helps. Take good care of yourself and don't forget to close the discussion please.
May the odds be ever in your favour.
Regards XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Shafi Ullah Khan 28 hours later
I also feel some pressure behind the cheeks and sometimes have a bad taste in my mouth in the mornings and cough stuff up, do you think it could be something to do with sinus thats causing water retention or puffiness in my cheeks?
doctor
Answered by Dr. Shafi Ullah Khan 5 hours later
Brief Answer:
Yes sinus infections may cause that except,.......

Detailed Answer:
Thank you for getting back to me
Sinus infections can not cause the puffiness unless severe abscess which is least likely in your case. Rest bad taste post nasal dripping leading to cough is a hallmark if a sinus infection. Though pressure and painful face is presentation of sinus infections but that involves cheeks bones too and is mostly unilateral. Plus that does not stay for more than 14 days puffiness is still least likely.
Nut shell get assessed for the previous etiologies we suspected and also seek an otorhinolarynfologist for these sinus infections and let them take care of it.
I hope it helps. Take good care of yourself and don't forget to close the discussion please.
Regards XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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