So lets begin.
Graphics: This is skyrim, do the math, it's always gorgeous and atmospheric.
Environment: There is really nothing new to this, and a lot of the stuff used is merely recycled from every other part of the game (shocker i know). In fact, I would go so far as to say that there is NOTHING new when it comes to textures or objects aside from a very small number of things. Yeah it's not much of a surprise, but when you go to the Soul Caern, things DO get different and interesting(ish).
Gameplay: Well, don't expect any huge differences here, everything works just as it does in any other part of the game. The new characters are certainly interesting, and the vampire companion is a lot of fun to interact with. The worst aspect is that the game refuses to let you marry her, which seems so stupidly natural once you either get turned into a vampire yourself, or get her cured at the very end. THIS IS STUPID AND I THINK BETHESDA SHOULD HAVE KNOWN BETTER!
Moving on, the magical item of the game is a fancy bow, though there is little impressive about it unless you use special arrows. One type lets you screw over the undead something fiere with a pulse of light, and the other effectively turns off the sun. If you're a vampire or a psychotic evil bastard, this second option is fun.
Strangely enough, this game involves even MORE elder scrolls, and lets our hero read MORE of them... as if this seemed like a good idea the first time. Miraculously enough you don't go blind either. Plot armor or plot hole? your choice.
There are some new dragons, and two new shouts, nothing really interesting aside from how the ice dragon pair function, however if you play with an old character, they are hardly a challenge.
The difference between which faction you take really doesn't result in anything different, the villian dies and you still have the woman is still your teammate. If you want to rain down horrors on the little people, or never do it.. it's up to you enjoy.
In the end, the game has almost.. ALMOST no bearing on the overall arc of the game, if you're already a game finisher (like me), you get some different dialogue, but aside from that, either the vampire faction grows in strength, or gets effectively wiped out. Does this matter to you? you decide. In the end you can still get to be a vampire and kick over small towns for giggles.
Also, most importantly of all, if you were a werewolf, you ARE NO LONGER A WEREWOLF ANYMORE if you become a vampire. IF this happens you can NEVER BECOME A WEREWOLF AGAIN!!
Overall:
Pros: one very cool companion
Cool way to spread terror and mayhem by turning the sun red.
Nifty new weapons and armor that doesn't involve ebony or daedra hearts
VERY cool new places to make your home or base.
Cons:
This is expensive, 20 bucks/euros for something that has limited effect on the game
you can't marry the hottie you have to form a very personal relationship with
Some sloppy programming and planning involving making a human use the power of vampires and perminant blocks in becoming vampires or werewolfs.
Should you buy?: I would say not now. this is not worth the 20 bucks, wait for it to come down in cost.