This is a absolute must have for any self-respecting Tzimisce player or any ST that need some Vicissitude goodies for their NPC's or PC's. This book offers a wide range of applications for Vicissitude; including Alterations a new mechanic system for the various modifications a Tzimisce or any user of Vicissitude may apply to itself or others with the correct knowledge. It also includes a lovely list of Tzimisce war-ghouls of various types and their stats. All of it is really well balanced along with the system for them being easy to grasp. Overall I enjoyed the book thoroughly. I am sure The Eldest itself would be pleased with what is in it.