Tension nose rhinoplasty or the correction of a tension nose deformity suggests that the nose is overgrown in all directions: the top, the front, and the bottom. Correction of a tension nose requires careful reduction of each of the parts that are oversized in a proportionate fashion. Typically, the part of the nose that is most overgrown is the central septum that pushes the nose down, forward, and up, while even shortening the upper lip to create a “gummy smile”. A three-dimensional understanding of the nose permits appropriate intervention that will yield the optimal aesthetic result.