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Nasal septal surgery and rhinoplasty are controversial in children. Traditionally, an attitude of restraint has been employed by most surgeons till an empirical age of 16 to 18 years. This is to avoid the possible adverse effects that the growth spurts may have on the nose and midface region. Some authors, however, have claimed a paucity of evidence that such untoward effects of surgery are frequent. Research has shown that surgical intervention limited to certain areas of the bony and cartilaginous nasal framework is less likely to affect natural growth patterns. There is a growing consensus toward early intervention, especially in a select group of patients, where deferring the surgery may turn out to be the poorer option in the short and the long term, and suggestions have been made that conservative guidelines may be employed to minimize the unwarranted results. This article presents our experience with septorhinoplasty in children over the last two decades in an academic setting. We have retrospectively studied the pediatric patients who underwent septorhinoplasty at the Academic Medical Centre, Amsterdam, Netherlands. There were 106 children aged between 3 and 19 years who underwent nasal surgery between February 1994 and August of 2007. Sixty-six of these were boys and 40 were girls. Their follow-up ranged from 12 to 157 months with a mean follow-up period of 53 months. Eighteen patients underwent revision surgery. The clinical circumstances, indications for surgery, extent of surgical interference, and outcome in 106 patients are discussed. Importantly, the patients in this series have been followed for variable periods after puberty and adolescence, allowing for assessment beyond the nasal and midfacial growth spurts. Based on our experience, we have outlined the clinical guidelines that we follow for surgery in this age group of patients.