Standard oral NAD+ booster supplements like nicotinamide riboside or niacin do not typically cause facial or bodily puffiness. However, some individuals undergoing high-dose intravenous NAD+ infusions report temporary localized water retention, mild inflammation, or flushing effects during or immediately after the clinical administration. If persistent or unusual fluid retention occurs, it is usually linked to individual sensitivities, underlying medical conditions, or electrolyte imbalances rather than the direct biochemical pathway of cellular NAD replenishment. Consulting a healthcare provider helps isolate the root cause of any unexpected physical swelling.