Septal perforations only require treatment when symptoms develop. Two surgical procedures are described for the repair of septal perforations. For defects up to 2 cm, a posterior inverting septal flap composed of mucoperiosteum taken from the bony septum has been successful in seven of eight patients. In two patients with large defects, a two-staged nasolabial skin flap was rotated into the defect and was successful in each case.