Previous septoplasty and trauma are common causes of nose deformity and septal perforation. Septal perforation commonly causes nasal deviation or dorsal support loss. We report a case of an 34-years old man presented nasal obstruction of his deviated nose after severe trauma. Nasoendoscopy showed there was large septal perforation. The single stage external rhinoplasty and septal perforation repair was performed. The deviated nose was rectified utilizing osteotomy procedures. combination of conchal auricular cartilage and dermal fat was used for a dorsal and septal extension graft. Nasal septal perforation was repaired using nasoseptal mucosal advancement flap. In addition, an injected pearl fat graft was utilized to augment the volume of the nose. The patient had improved breathing, symmetrical nose, and no residual perforation after surgery. We evaluated pre and post-surgery improvement using Standardized Cosmesis and Health Nasal Outcomes Survey. Combining septal perforation repair with rhinoplasty is possible and can yield satisfactory functional results, despite the technical difficulties involved. Keywords: nasal septal perforation, rhinoplasty, single stage