The Facegen Exchange is a small program available on the Nexus (search for it).
It's quite easy to use.
All you have to do is first install "FaceGen", which is a software for modelling faces (and is avialable in a free version).
You can then use it to make a nice face or even create on using pictures.
After that, save it and use FaceGenExchange to export it to a New Vegas savegame of your choice, which will then use the new face.
I tested it with different faces, but the results vary. My guess is that NV uses less detail than Facegen so the success depends on how good the face gets changed to the lower quality.