Possible Causes of Persistent Facial Puffiness 1. Post-infectious / allergic Cold/flu or throat infection can cause sinus congestion → puffiness under eyes, worsens on sitting due to venous congestion. Allergic rhinitis or sinusitis can mimic this. 2. Kidney involvement (very important in teenagers) Post-streptococcal glomerulonephritis (after throat infection). Classically causes facial puffiness, periorbital edema, especially in the morning. Needs urine test (proteinuria/hematuria) and renal function tests. 3. Nutritional / lifestyle High salt intake, irregular sleep, dehydration. 4. Less likely but to be kept in mind Thyroid disorders (hypothyroidism → periorbital puffiness, generalized edema). Nephrotic syndrome. --- Red Flags to Rule Out Immediately Puffiness with swelling of legs, decreased urine, frothy urine, or cola-colored urine → suggests kidney disease. Persistent puffiness despite rest. Shortness of breath, generalized swelling. --- What Should Be Done 1. Clinical examination (BP, edema, throat check). 2. Investigations Urine routine & microscopy (protein, RBC). Serum creatinine, urea. ASO titer (if recent throat infection). Thyroid profile (if persistent). 3. ENT evaluation if sinus/allergic cause suspected. --- Advice for the Patient Since puffiness is persistent for 4 weeks, he should not ignore it. Needs at least a urine test + kidney function test to rule out kidney involvement after throat infection. Avoid excess salt, ensure good hydration, proper sleep. Continue to avoid tobacco/supari completely. --- 👉 In short: This is not just from supari/tambaku. The most concerning possibility is post-infectious kidney problem (post-streptococcal glomerulonephritis or nephrotic syndrome), so a doctor visit and urine test are strongly advised.

Lack of hydration ? Lack of protein ? Add natural source of protein,  sprouts,  lots of Daal, paneer, cheez etc. Need lot of patience. Adv Thyroid profile,  hb Urine complete n microscopic.

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Can be due to lack of water intake...

Maybe due to hypoproteinaemia or otherwise More detailed history is desirable

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Give detailed history, does the ability to open mouth has reduced? Do you feel difficulty swallowing food? Do you have mouth ulcers?

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Can help you, kindly consult and provide detailed history for proper diagnosis and further management