I'd probably be dead or a ghoul. Hopefully the latter.
I've never exactly been handsome to begin with, and being ugly wouldn't be all that big a deal for me I don't think. When you get past looking ugly Ghouls are immortal, immune to radiation, and in some cases develop some rather interesting powers going by some of the perks from "Fallout Tactics" and the like. If you keep your head together there isn't much of a down side.
What's more since the ugly apperance seems to be largely cosmetic it occurs to me that it can, and will eventually be corrected. "The Replicated Man" storyline for example had a guy who had already developed a body changing technology that you could use to alter your apperance. While highly lethal at that level (from what he said) I'm not sure how that would affect ghouls, and I imagine it would get better with time, and eventually would (and ghouls seem pretty much immune to disease, and heal fast anyway so I don't think it could kill them) affect them.
I lack time and much skill with mods, but I had a vision of creating a mod with an area of ghouls that not only looked human, but were physically perfect, had all the ghoul abillities, and viewed themselves as gods and the true next generation of humanity destinied to rule the world, with a dogma about the divinity of radiation a bit differant from "The Church Of The Mushroom Cloud" or the guy in Megaton, instead explaining it as a manifestation of god's will (he guided humanity to creating it and starting the war) and transformation with overcoming the ugliness being the final test to providing their right to rule the world. Sort of like "The Rapture" with A-bombs.
I was thinking about doing a radio station with church music and everything.
Maybe if I have time when New Vegas comes out if there are decent mod tools.