The use of permanent fillers such as liquid silicone and polymethyl methacrylate (PMMA) for facial augmentation has resulted in a growing number of severe and delayed complications, including granulomas, chronic inflammation, and tissue distortion. These adverse effects are frequently associated with non-medical application and off-label use. Surgical management is often the only viable approach in advanced cases, requiring precise anatomical knowledge and careful dissection techniques to preserve vital structures and achieve aesthetic restoration. This chapter emphasizes the surgical strategies for facial removal of alloplastic materials, detailing preoperative planning, intraoperative decision-making, and reconstructive options. It also highlights the importance of early recognition and intervention to minimize long-term deformities. Given the ongoing clandestine use of illicit fillers, plastic surgeons must be equipped with advanced surgical skills to manage complex, high-risk cases effectively.