Cosmetic filler injections are known to cause a number of acute and chronic effects, including local inflammation, nodule formation and granulomatous reaction. The timeline of these events is highly variable, occurring from hours to decades following injection. In few cases, systemic effects have been observed. We report a case of granulomatous disease secondary to illicit silicone injection causing recalcitrant hypercalcemia. Additionally, we review the pathophysiology of inflammation in cosmetic filler injections, the prevailing understanding of hypercalcemia in granulomatous disease and summarize the most effective treatment modalities for this rare condition.