A 60-year-old man presented with multiple miliary osteomas of the face. This rare type of osteoma cutis is characterized by milia-like extra-skeletal bone formation in the cutis and/or subcutis of the face. Histologically, bony trabeculae with peripheral osteoblasts can be found next to lipocytes and haematopoietic cells. Primary osteoma seems to be derived from residual aberrant embryonic mesenchymal tissue. Surgical therapy is the most efficient treatment. We review clinical features, aetiology and therapy.