How about two mirrors and one sconce between them? It would give you much better light at the face level and would work with a low vaulted ceiling.

You can use any recessed light rated for a wet location I guess. You can also add fan with light and/or tubular solar light - that is what I am going to do in our master bath. We also have vaulted ceiling.

I have a 60 inch vanity in my MB with 2 sinks. I highly recommend Kiohler's Caxton sink in the 12x15 inch size. They are plenty big, yet smaller than so many of the other choices out there. It will give you a couple extra inches of countertop space. We opted for 2 mirrors with the lights above them pointing down. My bathroom also has a valulted ceiling. I have a skylight in the bathroom and its great. I had a solar tube in my previous house and I also highly recommend them too. I have a recessed light above the tub and one above the shower. They were in the ceiling when we bought the house they are an eyeball type trim so they can be angled about 30 degrees.
Just in case you want to see the Kohler sinks here is a shot of mine.

Thanks badgergirl for the suggestion on smaller sink. Your bathroom actually sounds very similar to mine! We have vaulted ceiling and skylight as well! I just wish our room was wider, it's only 6.5 feet and widening it wouldn't be practical. We also have the eyeball trim recessed lights, which I can not wait to get rid of. :) Do the down lights cause shadows or is it fine, since you have skylight?

Skny, I am not bothered by shadows from my down lights. The glass shades on my lights are a champagne or light amber color so that does affect the light. I prefer more white light but white shades would not have looked good in my bathroom. So I have gotten used to seeing my self in a "softer more golden" glow. Another thing to consider with down lights is that you do see the bulbs when you look up. I chose to put up with that because I just did not like the look of my fixture pointing up. Sorry, I don't have a picture of my vanity lights to show you and can't take one at this time.

I have no idea what your style or budget is but Tech Lighting makes some great bath bars. With those you don't see the bulbs and the light is not directed down as much as with sconce type vanity lights. Tech's lights are more contemporary and a bit more money but they are very good quality and not your usual big box store fare. I used some of their pendants in my kitchen remodel but didnt know about them when I previously did my master bath.

My daughter is having Tech's Metro bath bar (in the 25.8 inches width) installed later this week so the picture below is not her bathroom but it is a picture of the fixture she is using.
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My sister has their Solace bath bar and loves it. It can be mounted vertically or horizontally. It is about 26 inches in length/width. The picture below is from Tech's website:
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I saw the light below at a lighting store recently. The light source is LED and I absolutely loved the light it give off. I wish I had it in my bathroom. The other two lights I posted are available with halogen or fluorescent bulbs.
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Check out techlighting.com to see some of their other options.

p.s. I don't like my eyeball lights either but didn't think to change them out. I rarely ever have the need to turn them on. The room is plenty light without them on.

I just installed the one shown in the last photo in our Powder Room. I fell in love with it and wanted something modern and LED. I don't have a photo of ours yet as the mirror is not up, but it lights the small room well and the thin panel lights on all sides.