We encountered a rare case of four asymmetrical nostrils 10 years ago. The upper nostrils looked normal while the lower appeared as sinuses. The lower pair communicated with the nasal cavities but the upper pair was obliterated. There was a thick columella and an elongated continuous nasal septum separating the nasal cavities. The left nostril sill was thicker and situated higher than its counterpart. When the patient was 3 months old, the lower sinuses were trimmed and closed primarily, while the upper pair was perforated and kept patent with a silicone tube covered with a split thickness skin graft. Four years later, a revision was performed. Stages of operation were preferred as nasal growth was concerned. The result was satisfactory following 10 years of observation.