Le Fort type I osteotomy is a surgery to improve facial appearance and occlusion by moving the maxilla. There are few complications of Le Fort type I osteotomy, but the morphology of the external nose may change with the movement of the maxillary bone. In addition, nasal septal deviation may occur due to maxillary bone movement, resulting in nasal obstruction. We report a case of nasal septum surgery using the hemitransfixion approach for nasal obstruction symptoms after Le Fort type I osteotomy. The patient was a 52-year-old female who underwent Le Fort type I osteotomy approximately 10 years ago and developed nasal obstruction symptoms afterwards. The nasal septum surgery was performed with a hemitransfixion approach because she had caudal nasal deviation and postoperative nasal obstruction symptoms improved. After Le Fort type I osteotomy, L-strut deviation is more likely than physiological nasal septum deviation, and nasal septum surgery using the hemitransfixion approach is effective.