Background <p>Septal deviation leads to nasal obstruction, impaired breathing, and facial growth disturbance in children. Most surgeries performed in childhood to fix the deviated nasal septum are conservative. However, further procedures, such as extracorporeal septoplasty, may be needed in cases of a severely deviated septum. Limited publications address pediatric extracorporeal septoplasty surgeries.</p> Methods <p>We describe an endonasal modified dorsum-preserving extracorporeal septoplasty technique that offers a valuable option in severe anterior septal deviation and external nasal deformity in children. This technique brings the septum to the midline by correcting the anterior part of the septal cartilage. A straight septum in the midline also improves the external appearance of the nose. Thus, the technique was also called aesthetic septoplasty, as it led to aesthetic improvement secondarily.</p> Results <p>Fifty-four children (43 boys and 11 girls), aged 6–15, were included in the study. The mean follow-up period was 24 months (12–60 months). All patients and their parents reported both functional and aesthetic satisfaction. There were no major complications. None of the patients required revision surgery.</p> Conclusion <p>The endonasal modified dorsum-preserving extracorporeal septoplasty technique provides a safe and effective solution for correcting anterior septal deviation alongside external nasal deformity in pediatric patients. This technique merges functional restoration with aesthetic enhancement and may represent a valuable surgical option in select cases of pediatric nasal deviation.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>