Character creation is a core part of the Fallout franchise, Fallout 4 included. Beyond choosing your SPECIAL stats, you can also alter the appearance of your character to look how you want. If you find some of the options lacking, that's because a few vanity options are locked behind in-game progression, one of those being facial tattoos.
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Fallout 4 is the first game in the franchise that supports facial tattoos, but in order to use them, you
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