BAL HARBOUR — In the waiting room of a bustling plastic surgery practice, a woman in fatigues waits to talk about her upcoming procedures to plump her lips and liposuction her belly before she gets sent to Iraq.
Across from her, a young mom waits for her final checkup after a tummy tuck and breast enlargement. Another woman wants Botox shots under her arms so she doesn't sweat so much.
But inside his consult room, plastic surgeon Michael Salzhauer is busy reading a rather unusual story book to Nujad Perez, a mother of two who recently had a tummy tuck.
"In the car, Mommy told me she was going to have an operation," Salzhauer reads, turning the page to reveal a little girl and her mother, who has a jagged nose and a saggy stomach. "My older brother Billy has a game called 'Operation' where the nose lights up. … Mommy, is your nose going to light up?"
He turns the page again. "No, but my nose may look a little different after the operation," said Mommy.
Salzhauer, 36, wrote and self-published the children's book, My Beautiful Mommy, for the growing number of women getting what he calls "mommy makeovers." It will be released on Amazon.com on Mother's Day.
The book has sparked criticism from around the world and raised questions about the value of beauty and the message that plastic-surgery seeking parents send to their children.
"Why are you going to look different?" the child asks in the book. "Not just different, my dear — prettier!" the mother responds.
Salzhauer, who has four children and a fifth on the way, chafes at the notion that he's trying to sell plastic surgery to kids. This book, he says, is for parents who have decided to get plastic surgery.
He tells Perez he once had a nose job that blackened his face and made his then 4-year-old daughter cry. The book, he says, helps dispel a child's fear.
Perez, 33, an assistant manager at a Walgreens in Key West, wishes she had had the book for her 5-year-old son after she got her tummy tuck two weeks ago. "It would have helped a lot," she said.
Instead, she told the boy she had a cut.
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On the wall of his office in an exclusive waterfront condo tower, Salzhauer has hung framed copies of all the Life & Style articles he has been quoted in about plastic surgery to the stars, from Cameron Diaz's derriere to Pamela Anderson's bust. But the reality is that the bulk of his patients are regular mothers seeking to repair the effects of childbearing.
Many arrive with children in tow. Salzhauer sometimes finds himself having to explain the procedures to them.
"What I noticed is that a lot of parents don't tell their children what's happening," he said, "and it can result in a lot of inappropriate responses from the child. They can become very angry or afraid. I've had children ask me if their mother is dying."
When news of his book hit the Internet recently, Salzhauer suddenly found himself fielding calls from CNN and Newsweek.
"My beautiful scarring-me-forever Mommy," was the headline on Entertainment Weekly's story.
"This book is a reflection of our times," one blogger blazed.
Tampa psychologist Leslie Rainaldi also worries about the book's ramifications.
"This message that I need to be physically in some ways perfect to be okay is a very strong message to pass on to children and has implications for throughout the child's life," she said.
Even fellow plastic surgeons had doubts. "Rather than needing to look prettier, I believe the message should be wanting to look better for her age, or she's never liked the bump on her nose," said Randy Buckspan, a St. Petersburg plastic surgeon.
Salzhauer argues that the message "prettier equals better" was not initiated by his book. Childhood favorites like Sleeping Beauty, Snow White and the Seven Dwarfs and The Ugly Duckling have carried that message to children for ages.
Salzhauer, an Orthodox Jew who prays privately three times a day and says he and his wife give 20 percent of their income to charity, struggles heavily with the blitz on his ethics.
"I'm a hard-working father of four who's trying to do the right thing," said Salzhauer.
He says he tells his daughter, 8, that inner beauty is important. "At the same time, she knows people don't only look at inner beauty. That's not the way it works."
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Proof may be in the patients who stream through the door of Salzhauer's blossoming practice. Sometimes he sees 30 patients a day, most of them women.
Nationally, women account for the bulk of plastic surgery patients, getting 10.7-million cosmetic procedures in 2007, according to the American Society of Plastic Surgeons. The most popular surgical procedures were breast augmentation and liposuction, like Salzhauer's patients.
Many of his patients see nothing wrong with his book.
Diane Kupack, 37, who has eight children and recently restored her breasts with silicone implants, said she sat her children down before the surgery to read it to them. One asked if she had breast cancer.
"I explained to them the doctor was going to help me put back in what I'd lost," Kupack said, "and the book made it easier."
She did wonder about the message she was sending to her daughters. Still, "it was something that really bothered me. I felt like I had the breasts of a 90-year-old woman."
As Salzhauer examined the work he did around Sheila Calderon's eyes recently, the mother of a 10-year-old girl said the book was good for parents like her who are okay with plastic surgery.
"It's a personal choice for everybody," said Calderon, 38, of West Palm Beach, "and when she gets older and wants to get it done, I'll support her."
Times researcher Carolyn Edds contributed to this report.