Attention towards nanoparticles from the pharmaceutical and biomedical fields has significantly increased due to their attractive surface modification, high drug-loading, and improved pharmacokinetics. Fullerenes, an allotrope of carbon, stand out for their molecularly precise structure, potent radical-scavenging activity, photoactivatable reactive-oxygen species generation, and ability to definitively confine metal atoms and clusters. Accordingly, fullerene systems have been applied in various biological contexts, including increased and controlled drug delivery, antioxidative, anti-inflammatory, and photodynamic therapy, and magnetic resonance imaging. Ultimately, the pleiotropic activity of fullerenes, coupled with its precise structure and functionalization, can realize precise and tailorable medicines. Different from some excellent reviews focusing on the structure and chemistry of fullerene derivatives and their biomedical applications, this review highlights the interaction of fullerene materials with biological systems, with insights into their structural influence on their interactions with the cellular environment.