A technique utilizing the midfacial degloving approach in the repair of nasal septal perforations in 24 patients is reported. The midface degloving approach was limited to patients with septal perforations greater than 3 cm and failed prior attempts at surgical closure. Bilateral posteriorly based unipedicled flaps were utilized in the septal closure. Complete closure was accomplished in 75% (18/24) of cases, with a follow-up of one to three years. Complications included reperforation in 25% (6/24) of cases and partial vestibular stenosis in 20% (5/24) of cases. A modification of our technique, relining the nasal floor with postauricular full-thickness skin grafts, has alleviated vestibular stenosis.