Alison's whole world changes when her mother marries plastic surgeon Conrad Dunn. She moves into a megamansion in the Hollywood Hills, leaves her public school behind for a prestigious prep school, and makes new friends. Her new friends have all had cosmetic work done on them by Alison's stepfather and give her suggestions on what she should have done.

Although the thought of it creeps her out at first, she agrees to accept breast augmentation as a 16th birthday present. Her mother, Risa, also begins to contemplate having a nip or tuck done as she struggles with comparisons to Conrad's late first wife, whose model-perfect looks were crafted by Dunn. At the same time, murders are being committed around L.A. by the so-called Frankenstein Killer, who takes victims' glands and a facial feature. When the features are put together, whose face will it be?

Saul's compelling 35th novel preys on society's obsession with beauty and perfection and imposes it on an innocent young woman.