Endoscopic septoplasty is described as a minimally invasive approach to the isolated deviation or spur. However, the literature has focused little attention on its usefulness in difficult revision nasal surgeries in which persisting, obstructing septal deviation exists despite prior septoplasty. In these cases, typical surgical dissection planes are obliterated. The ability to directly address a persisting deviation, which involves elevating the mucosal flap directly over the offending deviation by using endoscopic techniques, greatly facilitates treatment. In this report we describe the importance of endoscopic septoplasty in the armamentarium of the rhinologic surgeon when faced with difficult problems of the nasal septum.