Facial Swelling and TED

by: Dr. Amy Patel Jain

How to cope with facial swelling and thyroid eye disease- An oculofacial plastic surgeon’s take.

Thyroid eye disease can lead to significant swelling around the upper and lower eyelids, the malar area, and even the lower face. This facial swelling can be cosmetically disfiguring for lead withdrawing socially from society. Though there is no magic pill or easy fix to solve this issue, there are several preventative steps and treatments that can help.

Sleep with your head elevated: Sleeping with an extra pillow can allow gravity to work to your advantage and prevent fluid retention in the face. This means that when you wake up, you will likely be less puffy.
Sleep hygiene: It is so important to get good rest. Ample, good quality sleep helps reduce stress which is such a trigger for inflammation in our bodies.

Reduce salt intake: Salt leads to fluid retention and this can be especially noticeable in thyroid eye disease patients’ faces. Now, this does not mean give up your favorite treats, but adopt the 80/20 rule. 80 percent of the time be conscious of how much salt you are taking in, and 20 percent of the time enjoy a meal out, French fries, or potato chips.

Stay hydrated: Hydration will help combat swelling especially when eating out, drinking alcohol, or traveling.

Cool compresses: Cool compresses on the face can help reduce inflammation and swelling. You can put a cold towel in the freezer for a short period of time and place it on your face in the morning and the evening. You can also use an ice roller to help reduce facial swelling.

Eye Creams: Eye creams often contain green tea extract or another caffeine substitute that temporarily constricts the blood vessels to the eyelid area. This then can reduce some of the fluid retention in that area. It is important to recognize this treatment is temporary and often only lasts a few hours. And, yes, hemorrhoid cream can also work as it has a similar caffeine extract in it to help shrink blood vessels and prevent swelling.

Lymphatic Massage: The lymphatic system is an organ system comprised of lymph nodes, lymphatic vessels and lymphatic tissue. Its primary roles include enhancing the immune system by ridding the body of toxins and reducing build of “interstitial fluid,” a medical term that basically translates to swelling. The lymphatic system exists throughout our body including our face. We have lymph nodes in front of our ear extending towards our jaw line and towards our nose and lower eyelid. Manual lymphatic treatment, basically massaging the system with your hands or an instrument, has been studied in the sports world regarding sports related injuries, and other studies have demonstrated its benefit for mild lymphedema related to breast cancer reconstructive surgery. However, limited data for its use regarding facial edema exists. It is always best to start with a professional and learn techniques that can then be used at home.

Facial Gua Sha: Facial Gua sha is an ancient Chinese practice implemented to help reduce inflammation and swelling, improve headaches, and enhance lymphatic circulation and theoretically reduce swelling and promote collage and elastin production. A heart shaped jade stone is used to methodically massage the face. Potential negative affects of the procedure could be contaminating the skin with bacteria that can lead to increased skin break outs. Also, any significant manipulation of the face could also cause microtrauma and theoretically lead to increasing elasticity and swelling- the opposite of what you are trying to do.

Overall, the take home message here is that all of the above mentioned preventative measures and treatments are to try. What works for one person may not be the best use of time for someone else. Also, many of these treatments are preventative and of minimal cost. I always encourage my patients to focus on the foundation – stress reduction and lifestyle changes. Only then will additional treatments such as eye creams and massages be potentially maximally beneficial.