The use of permanent dermal fillers has gained popularity in facial aesthetics. However, these durable solutions have complications requiring careful understanding, diagnosis, and management. This comprehensive chapter for plastic surgeons explores the complications associated with permanent dermal fillers, focusing on silicone and polymethyl methacrylate. It provides historical context, highlighting the evolution and popularity of these fillers. This chapter delves into complications such as granuloma formation, nodule development, inflammatory reactions, tissue necrosis, hypercalcemia, migration, vascular issues, infections, and late-onset complications, emphasizing the significance of early detection. Diagnostic methods, including clinical evaluation and imaging techniques, are discussed. From conservative to surgical, management approaches focus on patient selection, technique, and post-procedure care. This chapter also addresses future directions, emphasizing technological advancements, long-term safety studies, and guideline development.