There are continued debates around the timing and approaches to nasal septal surgery and rhinoplasty in younger patients who present with acquired functional nasal anomalies from a variety of causes. Decision-making must balance the impact of surgery on the growing nose versus the impact of chronic nasal obstruction on facial development. Growing evidence has shown that surgery in pediatric patients (< 14 years) does not compromise nasal growth in ways that earlier reports suggested. Younger patients can be candidates for nasal reconstructive surgery that improves the airway and the associated external deformity that adds to obstructive symptoms and causes aesthetic concerns and psychological stress. Cases showing long-term results will be presented to demonstrate key steps in the evaluation and management in this age group. The panel will focus on surgical approaches that may be more appropriate and safer in younger patients compared to adults. The role of patient and family discussions and the importance of shared decision-making will be highlighted in the case presentations. The multispecialty background of the presenters that includes facial plastics, rhinology and pediatric otolaryngology is organized to present the complex decision-making comprehensively. The panel will discuss the available guidelines and how they are applicable to younger patients. Surveys of current physician practice and outcomes studies will help to identify any gaps between best evidence and current practice trends and how those should be addressed.