Surgery of the internal and/or external nasal valve is a key factor in functional rhinoplasty. It can significantly improve the nasal breathing of patients with nasal dysfunction leading to obstruction, insufficiency, and/or nasal valve collapse. With proper diagnosis of the causes, various surgical maneuvers are useful to repair a damaged valve and to correct breathing problems. Any pathology of the internal or external nasal valve must be diagnosed meticulously. Historically, surgery of the internal nasal valve was mainly limited to resection of the caudal end of the upper lateral cartilages. The endonasal approach offers a number of surgical techniques to correct the various causes of nasal valve dysfunction. Surgery of unilateral or bilateral nasal valve dysfunction involves a systematic approach to the nasal valve mucosa, septum, upper and lower lateral cartilages, tip, piriform aperture, and turbinates. Cartilage grafting or repositioning to reconstruct the nasal valve can also be achieved through an open technique. While the open technique offers good access and visualization to the surgeon and should be carried out only in cases with severe deformity of the nasal tip, different endonasal approaches are stressed here since they avoid some complications. Furthermore, these methods lead to excellent results and preserve the fine mucosal and muscular motoric and sensoric functions of the anterior nose with greater predictability for the aesthetic and functional outcome, remembering that the principal key in rhinoplasty is conservation.