As a medic in team fortress 2, I usually pocket and ubercharge the players with cosmetics. It's an important team resource, and the odds of someone with a "default" skin making good use of it are fairly low. Much like plumage for a bird it's a reliable signal of "virility" - if you're invested enough in the game to own a $200 hat and a coordinated outfit then you've probably played it long enough for me to trust you sight-unseen.
http://i49.photobucket.com/albums/f278/katietiedrich/comic26...
If you're a pro player with the default skin, you're gonna have a bad fucking time, because you're last priority for heals, you're not getting an ubercharge, etc. That is gameplay-affecting even if the cosmetic itself is not.