The modified endoscopic Lothrop was initially performed for salvage surgery but over the past two to three decades, with the advancement of endoscopic endonasal surgery, it has become a commonly performed operation both for access in neoplastic and inflammatory disease as well as in anterior skull base reconstruction. Draf III procedures are important techniques for accessing the frontal sinus, the purpose of which depends on the pathology or anatomy involved. Classically, the Draf III was an operation that typically took a prolonged period of time and required multiple angled instruments, angled endoscopy, and curved powered instrumentation. The evolution of anterior skull base surgery created the need for the Draf III procedure to be just a small part of the surgery and therefore needed to be performed more efficiently and with a lower risk of complications.