This argument has been posted in Bioware Forum as well regarding Dragon age series. It just doesn't seem to be appropriate for a fantasy genre to include cosmetic surgery. You should just try and get it right the first time.
1. Give us barbers in major hold cities that:
A. Can change hair style / facial hair style
B. Edit war paint / dirt
C. No adding / removing of scars (Should have thought of that before hand, these are permanant features - and because scars can't
stack, you can't really effectively add more of them to a character without altering scars that were already there.)
2. Give us tattoo artists in major hold cities that:
A. Are culturally specific - A Nord may prefer the "knotted" artwork of his people upon his arm, while a Dunmer may appreciate something a little more dark-hearted.
B. Can not be removed - Maybe our tattoos can start to fade after an entire in-game year, requiring further touching up..?
C. Can be stacked - To create "sleeve" tattoos, or to tattoo over our previous allegiances
I might get flamed for this, but Fable had these aspects down. I wouldn't use hair / tattoo cards as they did, but the feature was implemented well in their games.