Despite the widespread application of augmentation rhinoplasty in Asia, reports on the interaction between alloplastic implants and injectable filler are scarce. This paper reports on a patient with delayed-onset edematous foreign body granuloma that had been caused by augmentation rhinoplasty performed using a silicone implant in conjunction with a liquid silicone injection 40 years earlier. This is the longest reported duration between initial rhinoplasty and the exacerbation of foreign body granuloma. This case report also presents intraoperative findings pertaining to the interlocking structures between silicone implants and injected liquid silicone. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article.