Mass Effect was one of the more articulate games I've played with a wide variety of tweaks to the "create your own character" games and it is honestly hard to create a decent looking character after trying to modify the original basis of Commander Shepard, the one that Bioware gives you as a model to go off of. Even then, the random option is your friend since press it enough and you get a decent choice. However, I always stuck with the generic, box art Commander Shepard.
And that can be said with any game that doesn't have generic "Face A, Face B" character mods. It is extremely difficult to get a good looking chatacter when there is a slide for everything from jawline to shoulder width. All I do is take an original design from the games premades (ie Saints Row 1 & 2 and most WWE games) and alter those templtaes slightly from making skin lighter and change hair and such.
Fallout 3 though didn't give me too much trouble even though the screen for that was dark and light was coming in from one angle, making it harder to create your future self. However, mine wasn't all too bad. Looked pretty decent.