Silicone injections may result in complications that bring patients to a dermatologist or plastic surgeon. These complications may be due to the use of nonmedical grade products, large volume injections, incorrect placement of the product, or a combination of the above. Frequently, complications result when injections are performed by unlicensed practitioners. Individuals who undergo large volume procedures may develop a variety of life-threatening problems ranging from infections to pulmonary emboli. Once they develop problems, these patients often present to licensed and board-certified physicians for treatment. Based on a review of the literature, this article provides a management algorithm for various complications. In addition, a medicolegal perspective is presented. Finally, the transgender experience as it relates to silicone injections is also reviewed.