Background: Facial deformities caused by illegal injectable fillers present significant challenges in aesthetic and reconstructive surgery. These complications range from immediate reactions to persistent granulomatous responses, often resembling medical conditions. While non-surgical approaches are initially used, surgical intervention becomes essential for effective management. Objective: This chapter aims to provide a comprehensive overview of the surgical management of complications resulting from illegal facial fillers, drawing from the author’s experience in addressing these deformities. Methods: A combination of aesthetic and reconstructive surgery techniques is employed, including the use of supra-ciliary and extended lower blepharoplasty incisions. This chapter highlights the importance of evaluating each case thoroughly, with a focus on tissue removal, reconstruction, and reshaping of facial features. Results: Surgical interventions lead to significant improvements in facial aesthetics and psychological well-being. However, the presence of scarring and the need for repeat procedures are common. Long-term follow-up and additional surgeries are essential for continued improvement. Conclusion: Surgical intervention remains the most effective treatment for facial deformities caused by illegal fillers. Informed consent regarding recovery time, potential need for further interventions, and scarring is critical. Adhering to a comprehensive and patient-centered approach ensures positive and lasting outcomes.