The external rhinoplasty approach was used in nine patients for closure of septal perforations varying from 8 to 30 mm in diameter. Nasal obstruction was the most prominent symptom. An autologous graft was always inserted between the mucoperichondrial flaps. Seven perforations were closed successfully. Symptomatic improvement was achieved in all patients. The closure of nasal septal perforations via external rhinoplasty approach has a high percentage of success due to excellent exposure of the septum.