Due to the presence of Carnegie Hall and the Russian Tea Room on adjacent sites, the tower is only 50 feet (15 m) wide on 57th Street, making it among the world's most slender skyscrapers at its completion.

Carnegie Hall Tower is designed with a red-and-orange brick facade and cast-concrete decorations, both inspired by the older structure.

In late 1980, the corporation and the New York City government signed a memorandum of understanding, which allowed the potential development of a skyscraper on the lot.

After the building opened, the upper floors were marketed to small tenants, and the tower had some of New York City's most expensive office space by the 21st century.

Other nearby buildings include Metropolitan Tower, 140 West 57th Street, and 130 West 57th Street to the east; The Briarcliffe to the northwest; the Louis H. Chalif Normal School of Dancing and One57 to the north; the Nippon Club Tower and Calvary Baptist Church to the northeast; and CitySpire and New York City Center to the south.

[6] The neighborhood was historically part of a former artistic hub around a two-block section of West 57th Street between Sixth Avenue and Broadway.

[10] By the 21st century, the artistic hub had largely been replaced with Billionaires' Row, a series of luxury skyscrapers around the southern end of Central Park.

[24] Carnegie Hall Tower has a red-and-orange brick facade and cast-concrete decorations, both inspired by the older structure.

[25] Douglas Davis wrote for Newsweek: "Unlike the postmoderns, Pelli pushed the new technology of glass, plastic and wafer-thin stone to its limit—part of what he called 'extreme modernism'".

According to the project architect, Malcolm Roberts, the use of conventional brick was intended to make the building "humanly scaled to passersby".

A decorative band runs near the top of the sixth story, complementing a broad terracotta frieze at Carnegie Hall; it is interrupted by a set of windows.

According to Pelli, "We chose a variety of brick, not only to relate the tower to Carnegie Hall, but to pop this building out on the skyline".

[15][19] The core consists of two joined tubes of cast-in-place concrete, designed by engineer Jacob Grossman of Robert Rosenwasser Associates.

[14][22] The tubes connect to each other at the tower's center, and east-west spandrel beams extend from the core, further stiffening the superstructure.

[14][22] The exterior walls double as wind-resisting elements since the windows are spaced closely and have small dimensions, similar to Carnegie Hall itself.

[2] At the time of completion, Carnegie Hall Tower was New York City's second-tallest, and the world's eighth-tallest, concrete building.

[55] The Russian Tea Room's owners refused several offers to acquire their building, so Macklowe withdrew his bid for the Rembrandt site in 1983 and developed Metropolitan Tower on the other parcel.

[57][58][59][a] The tower was tentatively planned to include 4,500 square feet (420 m2) of public space in the front, offstage areas in the rear, and an addition to Cafe Carnegie at ground level.

[63][64] The tower needed approval from the Landmarks Preservation Commission (LPC), which had previously designated Carnegie Hall as a city landmark; the Board of Estimate; the City Planning Commission; and Manhattan Community Board 5, whose community district included Carnegie Hall.

[26][68] The tower's foundations were completed that month, but the Russian Tea Room refused to sell either its building or its air rights.

[16] Part of the appeal to small firms was the tax abatements offered to tenants in exchange for Rockrose providing space at the tower's base for Carnegie Hall.

[77] The venue's expansion into the tower's base opened in April 1991 with an exhibit of memorabilia from Pyotr Ilyich Tchaikovsky.

[41] A Newmark agent said at the time that fourteen of the building's twenty tenants were expanding compared to their previous spaces.

[80] The offices, with asking rents of $33 to $60 per square foot ($360 to $650/m2),[41] attracted small tenants such as Capitol-EMI[41][81] and Kenneth Cole Productions.

By contrast, the average annual rent for "premium" Midtown office space was $85 per square foot ($910/m2) per year.

[97] Similarly, Architectural Record magazine said the ornamentation and the facade were "thoughtful references" to the design of Carnegie Hall, but the tower's height "will render such relational gestures meaningless".

[20] Progressive Architecture said Carnegie Hall Tower, as well as nearby skyscrapers being designed on side streets, "break Manhattan's pattern of high-rise on the avenues, low-rise at midblock".

[21] Kurt Andersen wrote for Time magazine, "This slender, elegant slab is like a dancer among thugs",[29][99] praising it as "the finest high-rise to go up in New York City in a generation".

[29][74] Conversely, Carter Wiseman of New York magazine regarded the tower as "much too tall" but also "perilously unsubstantial" as seen from the north or south.

[102] John McPhee of The New Yorker wrote in 2003 that the buildings "look like three chopsticks incongruously holding a cocktail blini", as they surrounded the small Russian Tea Room.