Published in 1994, Autobiography of a Face is award-winning poet Lucy Grealy’s prose debut, a widely-celebrated memoir concerning the author’s struggles with cancer and disfigurement.

At the age of 9, Lucy collides with a classmate during a game of dodgeball. The subsequent toothache leads her to seek medical assistance and doctors discover that she has Ewing’s sarcoma, a form of cancer with a 5% survival rate. She undergoes an operation to remove half of her jaw, which is followed by two-and-a-half years of chemotherapy and radiation treatment. Unsure how else to support her daughter, Lucy’s mother repeatedly encourages her to be brave and not cry during these unpleasant treatments and often chastises her when she does weep, leading Lucy to begin suppressing her emotions and masking her pain and fear, in order to win her mother’s approval and love.

At school, Lucy is regularly teased and bullied for her disfigured face and the baldness caused by her chemotherapy treatment. Gradually, the taunts begin to affect her, making her self-conscious and anxious about her appearance, something she had not considered before being exposed to the cruelty of other children. The effects of this treatment worsen as Lucy grows older and becomes more convinced of her supposed ugliness. She keeps hoping that facial reconstruction surgery will “fix” her appearance and that this will, in turn, “fix” her life. However, several operations are unsuccessful and Lucy becomes convinced that she will never know love.

Throughout her struggle, Lucy finds solace in fantasies and in spending time with horses, creatures she values for their nobility and the fact that they do not judge her by her appearance. Still convinced that her “ugliness” means that she will never form a romantic relationship, she decides to try and move beyond the seemingly petty fixation on physical beauty to focus on higher, nobler forms of beauty instead. In doing so, she adds her desire to be attractive to the list of suppressed emotions. When she starts attending college, this manifests in a fanatical devotion to poetry and the adoption of intentionally unattractive fashion choices intended to show the world that she does not care about her appearance. She gains a number of close friends at college who also embrace the role of outsider and outcast and who, to Lucy’s surprise, actually enjoy her company. With these new friends, she feels accepted by other people for the first time in her life.

Despite these developments, Lucy still feels deeply unattractive and desperately wants to develop romantic and sexual relationships. When she finally meets her first lover at graduate school, and later begins a string of short-term relationships, she finds that she still does not feel beautiful. When two new operations successfully reconstruct her face, she is shocked to discover that she does not recognize the face that looks back at her in the mirror. She is also shocked to learn that being beautiful has not solved all of the troubles in her life. However, as the book draws to a close, she comes to terms with her life, begins questioning her understandings of physical beauty, and ultimately realizes that her issues have their roots in her low self-esteem and negative self-image. Through this, she learns how to accept herself and begin her life properly, with her new face and a new outlook.