So ugly it reminds you of piss. Could also refer to how they smell with the small of piss
Bob: Oh dude Stephanie is kinda hot
Jorge: Nah dude she's piss-ugly
Bob: You gay?
The ugly/disgusting physical appearance one develops after a long car ride or trip. Edematous face, chapped lips, pimples, greasy or dry skin.
Her: Did you see Maley yesterday?
Him: Yeah didn’t she just get back from Mexico?
Her: She looked hella car ugly.