I think they should offer a LOT more face presets. The ones they had are quite ugly, except famle caucasian number 10 (with a bit of tweaking). But it's obvious the engine (and the artists) are cable of so much more because there are some gorgeous women in the game. I met a character called Cass, who was drowning her sorrows in some NCR outpost, and she's gorgeous. I would love it if my character looked like her. You compare her to some of the presets and you wonder why they're so bad when they're making faces like that!
If you have the PC version, there were mods for Fallout 3 that changed all the presets to specific characters. I personally built mine earlier in this thread off of a preset of a Gary clone.
No doubt such mods would come to New Vegas, assuming you had the PC version like I said.
This is my current char, after converting my FO3 char to this game (matching the sliders), it still didn't look the same...so I did the best I could at the time. No doubt I will tinker with it more as time progresses to get a better result.
http://screenshot.xfire.com/s/105980758-4.jpg
http://screenshot.xfire.com/s/105980766-4.jpg