With recent exception, the history of septal surgery has predominantly been characterized by a slow progression toward conservatism. The earliest techniques used transmucosal reductions of deviations. As with all new surgical approaches, long-term complication rates and failures began to emerge. The resulting problems of septal perforation and nasal collapse prompted the development of the submucous resection technique by Freer and Killian, which was less radical in nature, preserving a mucoperichondrial cover. This allowed for manipulation of the cartilaginous and bony septal framework without violating the integrity of the septal mucosa. Although this was a significant advance for intranasal surgery, limitations existed and long-term results were unsatisfactory in selected cases. In severely deviated and externally deviated noses, the submucous resection was unable to address the most dorsal component of the quadrangular plate.