The memoir is divided into four sections: "Childhood," "Adolescence," "Isolation," and "The Real Thing." In the first section, "Childhood," Grealy writes about growing up in a large, Irish family in New York. She describes her love of reading and her close relationship with her mother, who encouraged her to pursue her dreams, despite the fact that she was considered the "ugly duckling" of the family. Grealy also writes about her first cancer diagnosis, the subsequent surgeries to remove and reconstruct her jaw, and the start of her long struggle with body image.
In the second section, "Adolescence," Grealy describes her teenage years, which were plagued with medical treatments and low self-esteem. She continues to grapple with the physical effects of her cancer and surgeries, as well as her feelings of isolation and inadequacy. Grealy writes honestly about her experiences with bullies and self-doubt, as well as her complicated relationship with her family, particularly her father.
The third section, "Isolation," explores Grealy's struggles with depression and addiction as she attempts to reconcile her desire for normalcy with the limitations of her physical condition. She writes about her decision to attend Sarah Lawrence College, where she experiences both acceptance and rejection from her peers. Grealy's addiction to painkillers and her sense of alienation from the college community dominate this section; however, she also writes about her first positive sexual experiences and her growing sense of self as she begins to question the societal ideals of beauty and femininity.
In the final section, "The Real Thing," Grealy begins to find meaning and purpose in her experiences with cancer and physical deformity. She writes about her return to her family, her growing independence, and her work as a writer, which includes the publication of her first book, Autobiography of a Face. Grealy ultimately comes to accept her physical appearance and finds a sense of closure as she reflects on her adolescent struggles.
The central theme of Autobiography of a Face is the relationship between physical appearance and identity. Grealy candidly explores the ways in which her appearance affected her self-esteem, relationships, and experiences with bullying. Additionally, the memoir highlights the ways in which societal ideals of beauty exclude and marginalize individuals who do not fit into those ideals. Grealy's personal experiences serve as a powerful reminder of the importance of accepting and embracing diversity, including physical differences.
Overall, Autobiography of a Face is a poignant and honest memoir that offers a unique perspective on the complex relationship between physical beauty and personal identity. Grealy's story is a reminder that physical appearance is only one part of a person's identity, and that acceptance and love are essential for personal growth and fulfillment.