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It seems hard to tell what the old ones looked like, even though they are a major part of the backstory. I never actulay see any decriptions of what they were.

Seveal theorys:
Lizardmen theory-fantasy
Funny nose aliens-the eldar and orkz are both humanoid
Ascended-were the eldar gods old ones or just warp entities created from belief, was that on lizardman old one/god in fantasy really an old one. either wa that would point torwards energy beings/anti ctan
They're us!-or are the old ones led by thier leader jhr'vez jh'nzun selling hammer of war to imperial citizens on terra

As far as I know the old ones were the ones creating or guiding the slann (or was it the opposite way around) and the slann were lizard alike.
So the only thing we know about the old ones is that they were a psychic race.

The old ones look like what ever H.P. Lovecraft says they do.

I know they mention that they were the creators of the Ork race and from what it says in the codex the orks knew them as a "legendary caste of greenskins" who bred them to be a competent group of warriors to fight on their behalf. So they probably looked like more sophisticated and less muscular orks.