Lymphatic Massage for Periorbital Puffiness
For healthy adults with isolated under-eye puffiness, gentle manual lymphatic drainage is a reasonable supportive measure, though the evidence supporting its efficacy specifically for cosmetic periorbital edema is limited. 1
Evidence-Based Recommendation
The only guideline-level evidence addressing lymphatic drainage for periorbital/facial edema comes from the 2024 EULAR recommendations for systemic sclerosis, which states that manual lymph drainage could be considered for improving hand function in SSc patients with puffy hands (Level of Evidence 2, Strength of Recommendation B). 1 While this addresses a different anatomical location and a pathological condition rather than cosmetic puffiness, it establishes that manual lymphatic drainage has demonstrated benefit for localized edema in controlled studies.
Physiological Basis
Facial puffiness can be objectively measured through increased water content and skin thickness, particularly in the lower eyelid region, with these changes being more pronounced in women over 40 years of age. 2
The eye and periocular tissues do have lymphatic drainage pathways, including lymphatics in the ciliary body, choroid, and potentially optic nerve meninges, which contribute to fluid clearance from ocular structures. 3, 4
Quantitative studies demonstrate that lymphatic drainage from periocular tissues increases over time (from 1.64% at 3 hours to 4.96-6.40% at 5 hours post-injection), suggesting active lymphatic clearance mechanisms exist in this region. 5
Safety Profile
A systematic review of manual lymphatic drainage across multiple conditions found no severe adverse events reported with the technique. 6
The technique is non-invasive and carries minimal risk when performed gently, making it appropriate for trial in healthy individuals without contraindications. 1, 6
Important Caveats and Limitations
The evidence for MLD specifically improving cosmetic periorbital puffiness is essentially absent from high-quality medical literature. The guideline evidence addresses pathological edema in systemic disease, not physiological or cosmetic puffiness. 1
Studies on MLD for various types of edema show heterogeneous results, with unclear overall effects on quality of life outcomes, though no harm was demonstrated. 6
Small sample sizes in existing MLD studies may lack power to detect true differences, meaning absence of evidence is not evidence of absence. 6
Practical Approach
If recommending lymphatic massage for under-eye puffiness, set appropriate expectations: it may provide modest temporary improvement but should not be presented as a definitive medical treatment, given the lack of specific evidence for this indication. 1, 6 The technique is safe to try, but patients should understand they are using an intervention with limited scientific validation for this specific cosmetic concern. 6