The film starts out with children at school gossiping about the Kuchisake onna. The movie follows various children and teachers at school and at home showing the viewers among other things, that 1) Someone has drawn Kuchisake on a pictures on a blackboard, 2) Three boys go to a park where the Kuchisake onna apparently likes to show up at 5 pm, hoping to catch sight of her and 3) A young student Mika does not have the best home life as her mother tells her she hopes the Kuchisake onna gets her, before she proceeds to smack Mika around. A teacher goes to the blackboard to erase the Kuchisake onna pictures and hears “Am I pretty?” An earthquake then breaks out and a dead  woman comes out of the closet. The earthquake ends and we go back to the boys in the park. It’s 5 pm and Kuchisake onna shows up with a huge pair of scissors, grabs one of the boys and disappears.

The next day, rumors are really flying as the news is reporting a boy was kidnapped by a woman dressed as Kuchisake onna. After school the teachers walk students to where their parents can pick them up as a safety measure but Mika doesn't want to go home with her mom. Mika's teacher Kyoko agrees to stay with her and goes on a walk with her, asking if she had a fight with her mom and offering to help them make up. Mika reveals her mom’s been beating her by showing Kyoko her bruises. Kyoko tries to defend Mika's abusive mother and gets upset, screaming at Mika when Mika says she “hates her mother.”  Mika runs off with Kyoko following, and the Kuchisake onna shows up and grabs Mika. She struggles, knocking off the Kuchisake onna's mask and revealing her hideously disfigured face. Then the Kuchisake onna walks off with Mika, right past Kyoko who is too terrified to even try and save her student.

Later after the police have been called and don't believe Kyoko's claim that the kidnapper really is the Kuchisake onna, Kyoko goes home and calls her ex-husband, asking to speak with their daughter. He lies saying the little girl is asleep. We find out Kyoko herself is an abusive mom as we see her in a flash back, accusing her little girl of loving her father more and the daughter answering that she does, “because she hates her mommy for hitting her,” to which Kyoko hits her. Kyoko is approached by the teacher, Noboru, who erased the Kuchisake onna picture earlier and heard “Am I pretty?” He shows Kyoko a picture of a woman who looks just like the Kuchisake onna only without the disfigurement, and Kyoko demands that they go to the police with the picture. Noboru tells her it wouldn't help – that the picture is 30 years old – and that he heard the Kuchisake onna voice when the unnamed boy and Mika were attacked, and is going to follow the voice when he hears it again to try and prevent another kidnapping. Hearing this, Kyoko demands to go with him.

Kyoko and Noboru do manage to save a boy from the Kuchisake onna and then Kyoko stabs her repeatedly, only to learn that the she possess innocent people to interact with the living, and they have just killed a poor house wife and mother of two girls the Kuchisake onna was possessing. Leaving the Kuchisake onna free to take another host. Noboru eventually reveals to Kyoko that the Kuchisake onna is the spirit of his mother and that she was abusive to him and his siblings. They then follow clues they’ve gathered from the gossip the children of the area are spreading about the Kuchisake onna until they manage to find where the Kuchisake onna is keeping Mika which is Noboru's childhood home.

As they walk into the house, Noboru sees a knife on the floor, and we learn through a flashback that Noboru's mother was bipolar, one minute sweet and the next crazy, and that she begs Noboru to "Aim at my neck", or next time she goes crazy she might kill him. Noboru slits her mouth when she becomes crazy instead and stabs her in the stomach. Looking down at his dead and horryifying looking mother, young Noboru puts a surgical mask over her slit mouth and a long coat over her stab wound, then hides her in a closet. Noboru then looks inside the closet to see a big hole, which leads to a cellar where Mika, and all the other victims, were being held. They then have a big final battle at that includes Mika's mother who's also Kuchisake onna. Kyoko and Mika make it out alive, but Noboru dies by Kuchisake onna. In the end Kyoko is in the park alone with her ex-husband and daughter. She asks her ex-husband that if she can talk to her daughter, saying approves it - just a moment. Kyoko and her daughter Ai were alone. Kyoko says she's so sorry. They embrace. Then Kyoko starts to cough, showing herself possessed by Kuchisake onna. As the screen turns to black Kuchisake onna whispers "''Aim at my neck''" as the credits then roll.....

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