Nasal septal perforation (NSP) is a common complication of nasal surgery and can cause nasal obstruction, crust, and epistaxis. Many surgical methods have been introduced for repair of NSP, among which mucosal flap and artificial dermis have been widely used. However, mucosal graft can shrink and migrate and is difficult to fix at the perforation site. Mucosal advancement flap requires a wide extent of septal mucosa dissection, and artificial dermis can cause nasal obstruction because of its bulkiness and lower biocompatibility than autologous mucosa. To overcome these problems, we reported successful outcomes in 4 cases of small NSP by free mucosal graft with bioscaffold.