Median cleft lip is a midline vertical cleft through the upper lip. This is a rare anomaly with very few cases described in the literature. Median cleft lip has been thought to be associated with hypertelorism or hypotelorism. It is caused by the failure of fusion of the medial nasal prominences. In this case report, a 4½-year-old girl with a median cleft is presented. The patient has no other anomalies of the nose or alveolus. The patient has normotelorism. A shortened bifid frenulum of the upper lip is present. A technique using an elliptical excision of the cleft with muscle approximation is described.