The second sentence is an unusual construction. It could work, I think, but you'd have to think carefully about how it skews the emphasis. Do you mean 'fat and ugly' to be a single sense-unit, almost synonymous? I'd guess not. Probably you want 'pocked and ugly' to go more closely together, or all three to have equal value. In which case you need either an unmarked construction: His fat, ugly and pocked face (I'm English so I wouldn't add a serial comma after ugly, but you could if you wanted to); or a construction that links ugly and pocked, like: His fat face, pocked and ugly (nicked from FennelGiraffe, because I liked that suggestion).
