This work describes a young girl, Barbara, growing up in a poor rural Alabama family with a charismatic but abusive father and a nurturing mother unable to leave him, even for the sake of the children. Barbara suffers facial malformation, partly because of malnutrition and no access to dental or medical care.

Her gums cannot close over her buck teeth, her skull is longer and narrower than it should be, her bite does not close properly, and she has several black moles on her face. When she finally has major facial surgery, she is in her late twenties with a six year old son. He does not recognize the pretty women who comes home from the hospital.