The narrator of the story, Shannon McFarland, is a disfigured former model who goes by multiple pseudonyms, notably Daisy St. Patience and Bubba Joan—identities given to her by Brandy Alexander. The novel opens in medias res on the wedding day of Evie Cottrell, whose house is burning to the ground. Brandy, who has been shot by Evie, asks the narrator to tell her life story. Her memories of her life and her relationship with Brandy are told in a non-linear sequence.
The narrator is the daughter of a farmer. Her older brother, Shane, was kicked out of the house for being gay after contracting gonorrhea. After their parents receive a phone call from a stranger that Shane is dead from AIDS, they become obsessive supporters of gay rights, so that even in death, Shane gets more parental attention than the narrator. This attention is a large source of resentment for the narrator towards her brother, and she sought a career in modeling in attempt to get attention for herself.
The narrator's best friend in modeling school is Evelyn "Evie" Cottrell, who begins a secret relationship with the narrator's boyfriend, Manus Kelley, a police officer. While driving down the highway, the narrator is mysteriously shot in the face and her jaw is torn off. She immediately drives to the hospital and recovers, but her lower jaw is lost; she keeps her disfigured face veiled and her modeling career has been destroyed. In group speech therapy she meets Brandy Alexander, a trans woman. During sessions, Brandy instructs the narrator in how to give herself a new life and a new identity, and gives her a new name, Daisy St. Patience, the first among many new identities.
Evie begs the narrator to come live with her but leaves for Cancún as soon as she arrives, leaving the narrator alone. The first night, Manus breaks into the house with a knife. Because of the rapid non-linear motion of the novel's events, the narrator has often referred to Manus as "Seth", an identity given to him by Brandy, and it is not until this moment in the novel that it becomes clear that Manus and Seth are the same person. When Manus and Evie's affair is exposed, both claim that the other shot the narrator. The narrator sets fire to Evie's house and overpowers and then forces Manus to ingest pills before locking him in the trunk of his own car.
The narrator flees to the hotel room where Brandy lives. She meets Brandy's roommates, the Rhea sisters, a trio of drag queens who are paying for Brandy's sex change operations. The narrator learns that Brandy is actually Shane, who strives to look like her sister (the narrator) through surgery. Brandy is unaware of the narrator's true identity and wants to find her sister. Brandy, the narrator, and Manus leave to travel the country. They frequently pretend to be wealthy clients to view expensive homes that are for sale and steal whatever drugs they can find, alternately ingesting or selling them. Later, the narrator learns of Brandy's stories of sexual abuse by police officer Manus as a teenager, leading to Shane's contracting gonorrhea, being assumed to be gay, and being kicked out. "Brandy" divulges that she is not actually transgender—Shane, not wanting to be himself after what he endured, has chosen to become a woman because he sees it as a way to disfigure himself and lose any sense of identity to become beyond the control of others.
One day the trio is viewing a home and realize that the realtor is Evie's mother, who reveals that Evie herself transitioned at a young age and that her parents are marrying her off to save themselves trouble. The trio attend the wedding. The narrator sets fire to Evie's house, thus returning to the opening scene of the novel.
It is revealed that Brandy originally met Evie in a transgender support group, in which Evie told Brandy of the narrator's accident. Brandy reveals she has always known that the narrator was her sister, Shannon McFarland. In turn, Shannon reveals that she shot herself in the face to escape from being beautiful and beholden to her career and relationships, mirroring Shane's decision to transition.
Later, at Brandy's side while she recovers in a hospital, Shannon determines that she has never truly loved anyone except her brother. Leaving her pocket book with all of her identification, she tells a sleeping Brandy that since Shane is still confused about what he wants out of life, he can have the only thing she has left, her identity as Shannon McFarland. The novel ends with Shannon leaving the hospital and into the world to find a new start.
In the Remix version, it is revealed that Shannon, now going by Daisy St. Patience full-time, has established a cemetery after her parents have died, in which people can buy plots for relatives they disliked with spiteful sayings carved into the tombstones. She also creates a group for disfigured women called "Elephant Women". In the end, she marries an unidentified man.
