Cocaine is a potent vasoconstrictor, and long-standing use can result in an acquired palatal cleft. Similar to congenital cases, this palatal defect can cause nasal emission and hypernasal speech. The goals of palate repair include optimizing palatal function for speech and feeding while avoiding dehiscence or postoperative fistulae. The modified double-opposing Z-plasty is an effective technique for cleft palate repair. We describe the first reported case using this technique to repair a palatal defect resulting from chronic cocaine use. Recommended requirements for using this technique include absence of future or ongoing ischemic insults to the tissue (cocaine abstinence) for at least 1 year, an intact vascular pedicle demonstrated by greater palatine dimples, presence of sufficient vascularized soft tissue with preserved pharyngeal arches, small to medium defect sizes within 10 cm2, and extensive flap mobilization with tension-free closure. The advantages of this technique include preservation and reorientation of functional muscle, single-stage repair, and obviated requirement for distant donor sites.