In plastic-reconstructive surgery in recent decades silicone fluid has been injected for cosmetic reasons and has occasionally led to granulomas with foreign body reaction (siliconoma). A 77-year-old woman is presented who developed protuberant facial granulomas 15 years after the injection of silicone fluid to improve scars. Histopathology revealed large lipid-filled cells, surrounded by histiocytic cells and foreign body giant cells. Laser microprobe mass analysis (LAMMA) showed peaks consistent with PO2 and PO3, which are usually found in regions of foreign body reactions. Treatment with isotretinoin given orally in low doses (20 mg total dose per day) resulted in a complete resolution of the granulomas. The anti-inflammatory action of isotretinoin was the reason for selecting this treatment modality.