Endoscopic septoplasty forms a key skill set for endoscopic sinus/skull base surgery. Improving the nasal passage helps facilitate better access for surgery but also topical medical delivery post-operatively. There is increasing data to support improved outcomes following endoscopic sinus surgery with a septoplasty. This chapter provides a step-by-step approach to endoscopic septoplasty, which will also help equip you with the tricks required for nasoseptal flap elevation.