EDIT: ISSUE RESOLVED
I'm wondering the steps involved, every one of them, to work out whatever issues I'm having getting the game to run.

My current situation is as follows, after a re-download of the game via steam I'll hit PLAY and the game tells me it's detecting my video settings.. then crashes out (no launcher). Hitting play again pulls the launcher up, settings are on 'lowest' and windowed etc, hitting the launchers start game button makes the game start for a split second then crashes out to desktop. This is with no ini settings existing at all, so those are loaded in fresh (or supposed to). Before the game stopped working I was doing fine and had about 40+ hours played with it with absolutely no crashes of any kind and 'sadly?' no in-game weirdness (sometimes it's funny to see the weird beth game madness).

What can I do to start narrowing down my problem here, my sound is configured as per the internet and I've.. iunno I'm just really frustrated that this game ran beautifully for me with zero fo these fixes before then suddenly after the 1.2 patch it doesn't even run at all even after cleaning my sytem of it and trying to 'restart' from scratch. I think something has happened in a place where the game's settings aren't removed or deleted (maybe registry?). No idea. I have to run a 'different' version of the game to play it for the past week, which runs great by the way, it's just the steam version that seems borked for my specific system recently. I've tried that renaming/deleting the blob file from steam thing, which does get steam to re-update or whatever.

Should I try re-installing Steam itself? At this point I think the issue is something else, but re-installing steam isn't difficult or time consuming.

I want to play the game I purchased with my money, is that possible? Help me out. Thanks.

Have you installed the latest drivers for your graphics card? Posting your computer specs would also be helpful to everyone. Also, did you install anything new around the time these issues started happening?

Maybe it was a patch downloaded and installed by steam. I recommend you go back to v1.1. Download http://dl.dropbox.com/u/8834359/TESV-1.1.7z and extract TESV.EXE and INSTALLSCRIPT.VDF to your skyrim folder overwriting the old file. Then copy the other two files to your data folder overwriting the files there.
Then unplug your internet cable (or disable it in Network Connections.) Then run skyrimlauncher.exe, steam will also launch, click start in offline mode. The launcher will run, set your settings then close the launcher, then close steam and re-enable your internet connection. Now run TESV.EXE to launch v1.1 of the game (Create a shortcut to it on the desktop). And remember if you ever run steam while your internet connection is active steam will update Skyrim and you will have to do this again.

Every patch past 1.1 has broken the game for me, I think this is worth a try and has a good chance of working.

Note: I've solved my issue, it seems Steam was re-downloading 'all' of my files in the Skyrim folder and not just the 'stock' game files. What that means is some left over files modified by mods that I'd even uninstalled were being grabbed somehow and re-downloaded every time I attempted to 'install' the game from steam etc. I went through and deleted the files I assumed had been modified at some point by a mod, or by myself (some text files, uGrid setup files in case of ugrid save game corruption.. as gamebryo games are want to do) and steam re-downloaded the files it still needed out of those etc. Seem to be running fine now, waiting for Bethesda to do that promised 4gb LAA update later in the week seeing as I bought my PC in the last decade thus use more than 2gb or ram...

Of course.

The most notable PC part I run on is an Nvidia gpu, I don't think this issue involves my configuration though.

Yea, the 1.2 patch though I'm not convinced the patch is doing 'this'. Most users don't seem to be talked about the issue I have, my problem feels unique.

Think I stated this but I've been playing the game since it's not working, just not the steam version etc. I have no issues actually playing the game in 'some' form, I would just prefer to play the version that's 'proper' and the one linked with my achievements and on my steam profile etc. I don't want to jump through hoops to play a game offline, literally downloading the game from 'the internet' takes less than an hour so doing your steps is a waste of time for me.