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I prefer to mod the Fallout 3 engine per Gopher's excellent Youtube series.
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Most people seem to like it, but it does limit your available mods. I also prefer playing through Project Brazil to start my New Vegas game. NMC's and Poco Bueno texture packs, Project Nevada, Nevada Skies, Weapon Mods Expanded, Bounties I & II, Beyond Boulderdome, A World of Pain, Mission Mohave, Willow Follower (best of all official and fan-made companions), and The Inheritance are all must-have New Vegas mods for me, in addition to your preferred HUD and stability fixes.
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