Puffy Face From Alcohol: Why It Happens and How Long Until It Goes Down

It's Sunday morning and the face in the bathroom mirror looks a size bigger than it did on Friday. Your eyes are swollen and there's a pink flush across your cheeks that wasn't there before. You had a few drinks last night, and now you want to know two things. Why does this happen, and how long does it take to go away if you drink less?

Nobody has run a study that measures faces the morning after drinking, so the answer is pieced together from what is known about each part of the night. Here is what each part does, and what to expect when you cut back.

Alcohol moves water around your body

Alcohol holds back a hormone called vasopressin, which normally tells your kidneys to hold on to water. With less of it, you pee more and lose more fluid than you take in. That is why you wake up thirsty. The US National Institute on Alcohol Abuse and Alcoholism (NIAAA) lists the mild dehydration that follows as one of the causes of hangover symptoms.

It seems odd that losing water would leave your face swollen. The likely answer is that your body is busy rebalancing its fluids while everything else that happened that night adds to the swelling. Alcohol also increases inflammation in the body, NIAAA says, and that may be part of why you feel unwell the next day.

The salty food you didn't plan to eat

Drinking makes you eat more. A review of 22 trials found that people who had an alcoholic drink went on to eat more food than people who had a non-alcoholic one, and they did not cut back on food to make up for the calories in the drink. Late-night snacks tend to be salty: crisps, chips, pizza, a kebab on the way home.

Salt matters here. The NHS lists eating too much salty food as one of the common causes of fluid building up in the body. A salty meal on top of a night of fluid shifts is a likely part of the swollen face you wake up with.

Short sleep shows up around your eyes

Alcohol helps you fall asleep, but NIAAA notes that sleep after drinking is broken up and you tend to wake earlier. Your face shows it. In a Swedish study, people were photographed after normal sleep and again after a long stretch without it. Strangers rated the sleep-deprived photos as having more swollen eyes, darker circles, more hanging eyelids and paler skin.

A night of drinking is rarely as extreme as that study, but the direction is the same. Less sleep means puffier eyes, and a short night after drinking stacks on top of everything else.

Why your face goes red

Your body turns alcohol into a compound called acetaldehyde before breaking it down further. Acetaldehyde widens blood vessels in the skin, which shows up as redness. Around 36% of people of East Asian descent have a strong flushing response to alcohol, mostly because of a gene variant that slows the clearing of acetaldehyde.

Alcohol is also a well-known trigger for rosacea, a skin condition that causes flushing across the nose and cheeks. The NHS advises people with rosacea to avoid alcohol if it makes their symptoms worse. In a study that followed more than 82,000 American women for 14 years, the more they drank, the higher their risk of developing rosacea. Women in the heaviest drinking group had about a 50% higher risk than women who never drank.

How long until it goes down

Here is a rough timeline. It varies a lot from person to person.

• After one night: most of the swelling comes from fluid, salt and lost sleep. NIAAA says hangover symptoms can last 24 hours or longer, and the puffy face usually fades along with them.
• After weeks or months of regular drinking: it can take longer. In a survey of more than 3,000 women, heavy drinkers (eight or more drinks a week) rated themselves as having more under-eye puffiness and more visible blood vessels than lighter drinkers. Once you stop adding new nights of broken sleep and fluid loss, the puffiness has nothing feeding it. Many people say they see a difference within a few weeks, but that comes from personal accounts. No study has timed it.
• Redness: this is slower and less predictable. Rosacea cannot be cured, according to the NHS, though treatment helps control it. Cutting out a trigger like alcohol can mean fewer flare-ups. Tiny broken blood vessels on the skin usually do not go away on their own.

Taking a photo once a week in the same light is a better way to judge progress than checking the mirror every morning. Day-to-day changes are hard to see.

If you drink heavily every day, stopping suddenly can be dangerous. Talk to a doctor first.

What helps it go down sooner

• Protect your sleep. Sleep loss shows up around the eyes first, so a full night is the place to start.
• Go easy on salty food late in the evening, especially on nights you drink.
• Drink water alongside alcohol. It replaces some of the fluid alcohol makes you lose. Be aware that the evidence that extra water improves how skin looks is weak.
• Have fewer drinking nights. Each night off is a night without the fluid loss and the broken sleep.
• If you have rosacea, the NHS also suggests daily sunscreen of at least SPF 30 and avoiding heat and hot drinks where you can.

For what else changes over a month off, see what happens when you stop drinking for 30 days. If your belly feels as swollen as your face, alcohol bloating and the beer belly covers that side of it. For the longer-term picture, read your skin after you stop drinking.

When to see a doctor

A puffy morning face after drinking is common and usually harmless. A few signs are worth getting checked. See a GP if your face stays red, burns or stings, or you notice small blood vessels that don't fade, since these can be rosacea and treatment helps. Get medical advice promptly if your skin or the whites of your eyes turn yellow, or your tummy or legs swell up. The NHS lists these as signs of alcohol-related liver disease.

If you want a clearer picture of how much you drink before you change anything, the drinking self-check takes a couple of minutes.