The history of modern septal surgery starts almost two centuries ago. During its evolution to today, the emergence of submucous resection by Killian in Germany and Freer in the United States of America at the beginning of the twentieth century is an important milestone in nasal septal surgery, because we are still widely using the same principles and almost the same operation described at that time. Metzenbaum described a technique for correcting deviations of the caudal septum in 1929. Peer replaced the dislocated caudal septum with a graft obtained from the nasal septum. Galloway resected the nasal septal cartilage extensively to eliminate septal deviation and replaced it with straight cartilage between the mucoperichondrial flaps. King and Ashley resected almost the entire septal cartilage, trimmed, straightened, and placed it back in its bed. Cottle presented “the maxilla-premaxilla approach to extensive nasal septum surgery” in 1958, which is also another milestone in nasal septal surgery because this technique is still one of the workhorses of the surgeon, like submucous resection. Rees and then Gubisch published on extracorporeal septoplasty, where the entire bony and cartilaginous septum was removed, reconstructed on the table, and inserted between the mucoperichondrial flaps. Endoscopic septoplasty, subtotal reconstruction of the nasal septum, splinting the L-strut framework by grafts, the use of PDS foil, and the oblique split cut technique of the costal cartilage in revision septoplasties are great contributions to nasal septal surgery during the recent four decades.