There is a large body of literature dedicated to patient selection in plastic surgery. Much of this, however, is dedicated to the recognition of patients with body dysmorphia, those psychologically unfit for surgery, and those who have medical conditions that make the risk of complications unacceptably high. There is, however, little in the way of recognition and management of patients with chronic pain issues. With opioid misuse and dependence on the rise, the likelihood of plastic surgeons encountering patients who have obvious or occult opioid dependence issues has increased. In this case report and review of literature, we aim to present an evidence-based approach to the diagnosis and management of plastic surgery patients with a known opioid dependence.