Supernumerary nostril is a very uncommon congenital anomaly where an additional nostril is present besides the normal pair. Since the initial description by Lindsay in 1906, only sporadic cases have been documented. The anomaly may occur on one or both sides and can coexist with other craniofacial abnormalities. We describe an 8-day-old female neonate with an accessory nostril positioned superolateral to the left nostril, accompanied by medial coloboma of the left eyelid and absence of the alar cartilage. Management was planned using core reconstructive principles, emphasizing relocation of aberrantly positioned tissues and coverage of secondary defects with adjacent local flaps. Alar cartilage repositioning combined with a glabellar flap was performed. The postoperative course was uneventful with acceptable functional and aesthetic outcomes. Early correction is advocated to limit distortion of the developing nasal framework, secondary facial deformity, and later psychosocial impact.¹–⁵