Swollen Face: Causes and When to Get Help

Common causes of a swollen face

Allergic reactions and angioedema

An allergic reaction to food, pollen, pet dander, insect stings, cosmetics or medicines can cause swelling of the lips, eyelids and face, often with hives and itching. Angioedema is swelling in the deeper layers of the skin. It is usually not itchy and often affects the lips, eyes and tongue. It can be:

• Allergic, with hives
• Caused by ACE inhibitor blood pressure medicines (such as lisinopril), sometimes after years of use
• Hereditary, with repeated attacks of swelling and sometimes belly pain
• Idiopathic, with no cause found

When facial swelling comes with breathing difficulty, wheezing, vomiting or dizziness, it is anaphylaxis.

Dental abscess

A tooth abscess causes throbbing tooth pain and swelling of the cheek, jaw or under the chin on one side, sometimes with fever and a bad taste. It needs dental treatment and sometimes antibiotics. Swelling that spreads to the floor of the mouth or neck is dangerous.

Skin infection

Cellulitis causes a red, hot, tender, spreading swelling, often from a small break in the skin, an insect bite or a pimple. Infection around the eye (periorbital cellulitis) causes swollen, red eyelids and needs prompt treatment, especially in children.

Sinusitis

Sinus infections can cause puffiness over the cheeks or around the eyes, with facial pressure and a blocked nose.

Salivary gland swelling

The parotid glands sit in front of the ears. Parotitis from mumps, bacterial infection, or blocked ducts from salivary stones causes swelling in front of the ear or under the jaw, often worse when eating.

Injury

Bumps, bruises and fractures of the face cause rapid swelling and bruising. Dental work and facial surgery also cause temporary swelling.

Swollen face on one side

One-sided swelling usually has a local cause:

Swelling of the whole face

• Fluid retention: salt, alcohol, hormonal changes before periods and lying flat cause temporary puffiness, worst in the morning.
• Kidney disease: nephrotic syndrome causes puffiness around the eyes, especially in the morning, with swollen ankles and foamy urine.
• Steroid medicines and Cushing's syndrome: cause a rounded "moon face", with weight gain in the upper back and belly, thin skin and purple stretch marks.
• Hypothyroidism: causes puffy eyes and face with tiredness and dry skin.
• Superior vena cava syndrome: blockage of the large vein draining the head, often by a lung tumor, causes swelling of the face, neck and arms with prominent chest veins. It needs urgent assessment.
• Preeclampsia: sudden facial swelling in the second half of pregnancy with headache or vision changes.

How doctors find the cause

The first priority is checking breathing and the airway. A clinician will then ask about timing, triggers, new foods or medicines, dental problems, injuries and other symptoms, and examine the face, mouth, teeth, eyes and neck. Tests depend on the suspected cause: dental X-rays, CT of the face or sinuses, ultrasound of salivary glands, blood tests for infection, kidney function, thyroid function or complement levels (for hereditary angioedema), and urine tests for protein.

Treatment and home care

• Allergic swelling: a non-drowsy antihistamine at the label dose eases mild swelling and hives. Anaphylaxis needs epinephrine and emergency care.
• ACE inhibitor angioedema: stop the medicine under medical advice. It must not be restarted.
• Hereditary angioedema: specific medicines that replace or block the proteins involved.
• Dental abscess: drainage, root canal treatment or extraction. Antibiotics if the infection is spreading.
• Cellulitis: antibiotics.
• Salivary gland problems: fluids, sour candies to stimulate saliva, warm compresses and massage, and antibiotics for bacterial infection.
• Injury: cold packs wrapped in a cloth for 15 to 20 minutes at a time in the first 48 hours, and sleeping with your head raised.
• Morning puffiness: reduce salt and alcohol, drink enough water, sleep with your head slightly raised, and use cool compresses.

Frequently asked questions

What causes a swollen face on one side?

One-sided facial swelling is most often caused by a dental abscess, a salivary gland infection or stone, a skin infection, an insect bite or an injury. Swelling around one eye can be a stye or periorbital cellulitis. Spreading swelling with fever or difficulty opening the mouth needs urgent care.

Why is my face swollen in the morning?

Fluid shifts into the face while you lie flat overnight, especially after salty food, alcohol, crying or poor sleep, and usually settles within a few hours of getting up. Persistent morning puffiness around the eyes with swollen ankles or foamy urine can signal kidney disease and should be checked.

How do I reduce facial swelling quickly?

For minor swelling, apply a cold compress for 15 to 20 minutes, keep your head raised, reduce salt, and take an antihistamine if allergy is likely. Swelling from infection or a tooth needs medical or dental treatment. Any swelling affecting breathing or swallowing needs emergency care.

Can an allergic reaction cause face swelling?

Yes. Allergic reactions commonly cause swelling of the lips, eyes and face, often with hives and itching. If swelling affects the tongue or throat, or comes with breathing difficulty, wheezing, vomiting or dizziness, it is anaphylaxis and needs epinephrine and emergency care.