Excellent - it truly does work out of the box!
The only reason why I haven't given it 5 stars is because the media uploader is very confusing to use - I'd recommend that the plugin author updates this to use WordPress' latest version of this.
Dropped this in place, activated it, and the only problem I had was that the directory wp-content, needed to be secured (ownership changed) to that of the web-server user (apache:apache). Once I did that... whammo it worked fine.
I was a little confused as to why, after I'd uploaded the image, it didn't automatically set it as my profile picture... but I just had to press the [Make this my Author Profile Picture] button... at the bottom.
The plugin-author should change the button color to something really glaring (green/red/blue)... rather than the pale grayish color (don't use any theme color).
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