What causes coarse facial features with bulbous nose?

Tip contouring: Rhinoplasty (nose job) surgery enables re-shaping of the nasal tip. A bulbous nasal tip is one in which the tip cartilages may be large and splayed apart. The dome areas may have very poor definition and the nasal tip skin may be of increased thickness such that underlying structures are not well-defined.

Cartilage shape: The shape of the nasal til is created be the cartilage structure of the nose. This can be surgically corrected.