This course will discuss the anatomy of the septum, origin of septal perforations, and discuss the methods to repair a septal perforation. An emphasis is placed up the authors preferred technique - that of a endonasal septal rotation flap with acellular dermal graft support. It is assumed that the viewer has a fair amount of understanding of nasal issues including anatomy and surgical techniques. Multiple videos of the technique including live endoscopic images, still photos, 2-dimensional "how I do it," and narrated slide sets. It is the author's hope that this course will be of significant benefit to a practicing nasal surgeon, and allow them to adopt this technique and apply it to their patients.