Me...I always spend a lot of time at character creation screen because I'm creating a character that I'll have to "watch" the entire game. I know there's a showracemenu command on PC and OWB Auto-Doc that can change your appearance any time you want, but let's forget about these two and focus on primary creation screen.
When I'm creating the Courier, I'm not neccessarily creating a beatiful character, I try to accomodate their appearance with their backstory, if that's possible.
For example; my first playthrough was a Mexican troublemaker, not really evil, but a person you rely can't rely on, that cares only about himself. So I shaped him in a way that he reflected his personality: his eyes were cold, not worth of trusting and his lips were always "smiling", but not in a nice way.
My sheriff was a bald man with gunslinger moustache, a guy you can meet in the middle of the street and forget him in the next second...that was my purpose.
My evil ex-Brotherood scribe had a Buzz saw hairstyle and Honest Abe beard and very pale skin, reflecting his tiredness.
And so on...I had many different chars, but I won't post their appearance now.
Contrary to what some people may say, I think that character creation offers a lot of visually different opportunities, no matter if original presets look quite ugly, you just have to invest some time in it an experiment with it a little.
P.S.
The only mod I use when creating char, is high-res eyes, I never use custom hairstyle, because they are mostly uncompatible with headgear.