Objective: Formation of a foreign body granuloma is one of the serious complications of silicone injection, which can be difficult to treat. In this paper, the authors report their successful experience with dermabrasion as an innovative treatment in a patient who presented with diffuse silicone granuloma. Case report: The patient was a 51-year-old woman, with areas of induration and hyperpigmentation on both her legs with intermittent fevers and generalized malaise. The patient had a history of numerous bilateral hip injections of liquid silicone five years ago for cosmetic purposes. A skin biopsy showed a foreign-body granuloma consistent with a paraffinoma with "Swiss cheese" appearance. After unsuccessful medical therapy and liposuction, an extensive bilateral dermabrasion was performed on both legs. Postoperatively, her wounds exuded a collection of thick, yellow viscous fluid under the transparent semi-occlusive dressings, which showed a markedly elevated level of silicone after analysis. She experienced no complication related to dermabrasion. Conclusion: The findings of this case demonstrate that dermabrasion may be an effective treatment option for diffuse silicone granuloma, particularly when the material resides superficially in the dermis.