Importance: We propose a novel technique utilizing both a headlight and an endoscope to repair large iatrogenic septal perforations using autologous fascia lata grafts and extended pedicled mucosal flaps. Objective: The use of an autologous fascia graft, a fat graft, and an extended pedicled mucosal flap enables the closure of a large and anterior perforation of the nasal septum. This approach is an effective and applicable method for nasal septal perforation repair.