Background: This study aimed to identify clinical characteristics and classifications of nasal septal deviations associated with revision septoplasty. Methods: The cross-sectional study design included 652 patients undergoing septoplasty at a tertiary referral center. We classified patients according to Baumann’s validated septal deviation classification and assessed similarities and differences regarding septal pathologies and types of nasal septal deviations in both groups. Results: The sample comprised 600 primary surgery cases and 52 revision cases. In primary surgeries, type 1 septal deviations were most common (60.3%), followed by type 5 (10.5%) and type 3 (10.0%). In revision surgeries, type 1 deviations (36.5%) were most common, followed by type 3 (25.0%) and type 2 (17.3%). Group comparisons revealed that type 2 and type 3 septal deviations, high septal deviations, and septal perforations were significantly more frequent in revision cases. Common septal pathologies included an oblique septum (98.0%), ipsilateral septal crest (76.4%), contralateral turbinal hyperplasia (42.5%), and vomeral spur (39.9%). Conclusions: This study suggests that using validated classification systems for septal deviations, which combine various pathologies, can provide a more clinically relevant assessment and improve patient counseling and treatment.