OK so the new patch fixed the exclusive fullscreen mode bug (refresh rate for my 1920x1200 resolution now shows as 59 Hz instead of 60 Hz) and the missing special effects are back in fullscreen/exclusive full screen mode so that's good.
I'm playing the game with TressFX hair on and tessellation to test stability and although it never froze, at least so far from 30 minutes of playing, I was experiencing lots of hitching (split second freezes), especially during QTEs and cutscenes. I am playing with 2xSSAA, 16xAF and everything else on or maxed but the framerate shows mostly as 60 fps so I figured my system (Core i7-920 @ 3.2 GHz, 12 GB, GTX 680 SLI v314.14 beta drivers, Windows 8 Pro 64-bit) should be able to handle it. These hitches seemed to occur when the game was auto-saving (TR icon in the bottom right corner) but I can't be 100% sure as it is difficult to play QTEs and keep your eye on everything.
One mildly annoying bug I did notice though was that despite have V-sync Triple Buffering enabled in the Graphics Options, I was seeing screen tearing in both the cutscenes and gameplay but not all the time. It is like Adaptive V-sync is now enabled in the game but I've checked the Tomb Raider (2013) profile and v-sync is definitely not forced to Adaptive. I can't stand screen tearing so I find this distracting. I've been playing the game since Tuesday with Triple Buffering enabled in the game and never saw screen tearing before (and I wouldn't expect to either) so it looks like this is a new bug introduced with this patch.
Finally, TressFX hair is still not quite right with this patch and still flickers and "spazzs out" with SLI enabled. In fact, despite the patch notes I didn't notice any differences at all with TressFX hair between the original and patched game so I assume these promised NVIDIA optimizations are not included in this build?
P.S. I lowered my CPU overclock from 3.65 GHz to 3.2 GHz to ensure that it was not the reason for the freezes I was getting with the original build of this game so that is why my specs in the signature differ from those I've listed in this post.
Core i7-4770K @ 3.5 GHz, ASUS Z87-Deluxe v1707, 16 GB, NVIDIA GTX 780, X-Fi Titanium HD, Windows 8.1 Pro 64-bit