The author describes his experience with 400 intranasal laser surgical procedures done with the carbon dioxide laser and the surgical microscope. Procedures include excision and vaporization of polyps, turbinates, tumors, telangiectasia, synechia, nasal stenosis, intranasal cysts, papillomata, and septal spurs. The author describes a suction speculum and drape of his own design which provide smoke free access to the internal nose, and protection of the alar rim and the face from laser energy. Relief of obstruction is comparable to that obtained from the more traditional means of intranasal surgery. Intraoperative and early and delayed post operative bleeding is less with laser surgery than with any other means. Avoidance of technical problems is emphasized in this manuscript, since intranasal laser surgery is in some respects difficult to perform. Included are practical suggestions about patient positioning, use of protective devices, and patient selection.