The unnamed narrator, a 23-year-old Chinese American woman and former piano prodigy, enters Holistik, a luxurious beauty and wellness store in New York City, after being recruited by Saje Bernsson, the store's glamorous founder, who recognized her as a once-famous pianist. Inside, the narrator notices Victor Carroll, a tech billionaire who owns Organic Provisions, Holistik's parent company. Lilith, the store's manager, equips her with a mandala, a silver pebble necklace that monitors supplement intake and, as the narrator later learns, tracks her emotional state.
An extended flashback reveals the narrator's past. Her parents, Ma and Ba, were pianists in China whose careers were destroyed by the Cultural Revolution, a decade of political upheaval that sent them to labor camps. After immigrating to America, they became piano teachers in New Jersey and trained their daughter, teaching her a secret technique that gave her playing a distinctive sound. Ba uploaded her practice videos online, where they gained a wide following. Conservatory professors in New York offered her a full scholarship and a stipend from an anonymous benefactor. At the Conservatory, she endured eight years of racist bullying and spent her stipend on clothes to fit in rather than sending money to her struggling parents. Her parents visited once a year for her recital, and with them in the audience her playing achieved a transcendent quality. After her final recital, her parents drove home and were in a severe car accident.
In the present, the narrator settles into Holistik while living in a damp basement apartment in Brooklyn. Through a dating app, she meets Henry Carroll, later revealed as the twin brother of Helen Carroll, a ceramicist and Victor's niece who grew up watching the narrator's practice videos. The two develop a close friendship through weekly piano lessons and dinners at Helen's home. Helen is skeptical of the beauty industry, while the narrator contends that beauty has always been one of the few ways women access power.
The narrator regularly visits her parents at Applebaum Care Facility, where they lie in a near-vegetative state from the accident, and struggles with mounting unpaid bills.
The narrator's body begins changing from Holistik supplements: Her skin lightens, her hair thickens and lightens, her lips inflate, and her nose restructures. Saje asks her to adopt a Western name, and the narrator discovers that two coworkers are Asian American women whose features have been transformed by Holistik products and who legally changed their names. A mascara causes extreme lash growth, and Lilith teaches her to fold the stretched skin into a double eyelid, a feature Asian classmates at the Conservatory obtained through surgery.
Disturbing incidents accumulate. Locked in the store alone one night, the narrator discovers dying animals in squalid conditions. She is knocked unconscious and wakes at Saje's home at the Organic Provisions farm in the Shawangunk Mountains, known as the Gunks. She finds surveillance equipment and a list of women's names, including her own. Through the monitors, she watches Saje and Henry use a massive rotating mirror to focus sunlight onto a cliff where enormous birds gather around a bundle that unfurls to reveal copper-colored threads resembling hair. Saje explains the scene as a sky burial, a funerary rite in which birds consume a corpse, and attributes it to indigenous farm workers, but the narrator discovers that indigenous peoples have not inhabited the region since the 1660s.
Financial desperation leads the narrator to Apothecare, an underground operation Saje presents as ethical sex work. The narrator descends into a hidden facility, is bathed and sedated, and remembers nothing afterward, waking at home with blood, bruises, and a signed contract she does not recall agreeing to.
The narrator's parents suddenly deteriorate, baffling specialists. Helen visits the hospital and gives the narrator an electronic keyboard and a ceramic sculpture of piano keys. The narrator plays for her parents for the first time in years, and their ragged breathing deepens into calm sleep.
During a semiannual review, Victor reveals he was the narrator's anonymous Conservatory benefactor and first encountered her after Helen, as a child, showed him the practice videos. He declares that creating beauty is life's highest purpose; the narrator privately disagrees, reflecting that compelling art lies in the tension between beauty and ugliness.
Helen's health collapses. The narrator and Lilith find her on her living room floor, bloated, losing hair, covered in white fuzz, barely lucid. Helen tells the narrator to stop taking everything and says she loves her. While the narrator is away at an Apothecare session, Helen vanishes and is later found dead at Bellevue Hospital. A forensic pathologist mistakes the narrator for Helen's family because they now look alike. Helen's lungs were inflamed by expanding bits of bone and plaster. Lilith, who originally took the Holistik job to investigate the company as a journalist, shows the narrator documents from Henry's room listing risks for "Volunteers" such as "spontaneous zygote multiplication" and "decrystallization of bone tissue."
During a later Apothecare session, the narrator partially wakes and observes a silver apparatus lowering a hectocotylus, an octopus reproductive arm, into her body for insemination. Separately, Conor Hearst, a former Conservatory classmate, returns the stolen family photograph and reveals recovered memories suggesting they were drugged at school. He describes recurring images of the narrator asleep on a piano with a long-haired man standing over her, implying Victor's predatory behavior extends back years.
The narrator learns her parents had kuru, a fatal brain disease caused by ingesting human tissue. The supplements she brought them from Helen's supply at the Gunks contained traces of human bone processed from sky burial remains. Her parents have died. She stops all supplements and tears off the mandala. In the mirror, she sees she has been transformed into Helen's likeness, her parents' features erased from her face.
She coats her skin with Vaseline to block the sedative cream and attempts to stay conscious during her next Apothecare session, but she is discovered. Saje orders her transferred to the Gunks compound, where Victor binds her and explains Everlasting: a hybridization program designed to produce children through shorter pregnancies with no lasting changes to the mother's body. When the insemination results are negative, Victor drugs her again.
She wakes on the cliff in a pile of unconscious or dead women, including Lilith and Astrid, a Holistik employee, positioned for the birds. She climbs to the mirror structure and redirects concentrated sunlight onto Victor, Saje, and Henry, setting them ablaze. Her hands are severely burned, the skin melting to expose bone. She staggers to a phone, but Victor, still burning, follows and strangles her.
She wakes in a hospital, her body permanently altered: hands webbed, skin greenish and pocked. News reports reveal Organic Provisions inseminated women with animal reproductive material without consent. Victor remains missing. The narrator visits Saje, now institutionalized under a mental disorder defense, who reveals the full conspiracy: The dating app that brought the narrator to Henry was controlled by Victor, who maintained surveillance since the Conservatory. Saje confirms the first Apothecare session involved actual sex once; all subsequent sessions were insemination procedures. Helen's death was unintentional, caused by her unknowing consumption of experimental products at the Gunks.
The narrator begins playing piano again with her altered hands, developing a new technique and uploading videos that attract millions of viewers. She keeps the family photograph above the piano next to Helen's ceramic sculpture and plays for her parents, for Lilith, and for Helen. She serves as "the throat by which my parents are sung and sustained" (251), continuing to play because she knows there is no real beauty without ugliness.