At an unspecificied time in the future everyone turning sixteen is given surgery to become “pretty.” Tally Youngblood is young woman, counting down the days to the procdure which despite being extremely intensive is considered worth it for a life of luxury and decadence among her peers. She’s waiting to be reunited with her best friend and enjoy the life of being pretty together.
That is until she meets Shay. The two bond over having lost all their friends to the surgery and waiting to join them. They sneak out of the city to the wasteland and Tally discovers that not only does Shay not consider herself “ugly” but she has no intention of having the surgerys. Instead she wants to run off with a mysterious boy named David to a secret group of insurgents who refuse to have the surgery. She invites Tally to come with her, but Tally refuses.
Shay runs away, leaving details on how Tally can find the group if she desires. On the day of her surgery, Tally is taken aside by Special Circumstances and told unless she finds Shay and betrays her to them, she (Tally) will be ugly for life. Tally agrees and sets out on her quest to find the rebels.
If that were all the story was, it might just be merely interesting. And though the story does follow a fairly predictable character arc for Tally (she finds the group, fits in better than Shay and decides to stay), the secret behind the surgery that Scott Westerfield reveals mid-way through the novel is far more fascinating. And it also goes a long way to explaining some of the behavoir by post-surgery characters in the novel.
Tally finds out that the surgery creates a specific kind of brain damage among all receipients. This twist explains why certain characters are so vapid and hedonistic in the story. Not only are the people being made to all be the same externally, they’re being made to think the same way, to no longer question anything and to live only for the pleasure of the moment. The process is reversible (theoretically) and all of these various storylines lead to one massive cliffhanger that had me curious to see where things go next