Deformities of the naso-septal L-strut create functional and aesthetic problems, such as the twisted nose, the malpositioned tip, the saddle deformity, and internal valve insufficiency. The surgeon must approach these problems with three principles. First, in certain situations, the L-strut must be modified. Second, the L-strut must be structurally stable to support to the nose. Third, the position of the L-strut and its relationship to neighboring structures will determine the changes in nasal form and function. The current article focuses on two common types of deformities of the septal L-strut: deviation and collapse. Mild deviations are addressed through repositioning or camouflaging techniques. Moderate deviations are treated with cartilage-bolstering techniques. Severe deviations are resected and reconstructed with cartilage grafts. Dorsal septal reconstruction or onlay grafting treats collapse. Caudal septal reconstruction and tip-supporting grafts address nasal tip collapse. Total septal loss or collapse requires construction of a new L-strut. These techniques should maintain support to the nose while improving nasal form and function.