The film opens on a birthday party at the Sawyer Farm for young Jedidiah (Boris Kabakchiev). His mother Verna (Lili Taylor) gives him his present - a chainsaw. She wants Jed to use it on a man they are keeping tied up as punishment for trying to steal one of their pigs. Jed hesitates but ultimately cannot bring himself to go through with it. Grandpa Sawyer takes the chainsaw from him and kills the thief.
Sometime later, a couple, Ted Hardesty (Julian Kostov) and Betty Hartman (Lorina Kamburova), are driving through the road when they see Jed in the middle of the street wearing a pig mask. After nearly running him over, Betty gets out of the car and hears Jed say he needs help. She follows him into a barn where Jed's brothers, Drayton and Nubbins, send Betty through a trap in the floor and severely injuring her. The Sawyers then drop an engine on Betty, crushing her. Her father, Sheriff Hal Hartman (Stephen Dorff), arrives hours later to learn that his daughter is dead. He knows the Sawyers killed her, and he aims his gun at Drayton's head, but he backs down at the urging of the other officers. Verna comes for her sons, but Hal takes Jed into custody to send him to an asylum.
We move ten years ahead to the asylum. Nurse Lizzy White (Vanessa Grasse) interacts with two patients - large and mute Bud (Sam Coleman) and polite Jackson (Sam Strike). Bud is said to have bludgeoned his foster family when they took something of his. Lizzy gets harassed by another more psychotic inmate, Ike (James Bloor), but the other two step in to defend her, which gets them in trouble with the guards.
Verna arrives that night to make a case to set Jed free with an injunction, but she is rejected. She decides to break into the facility, inciting a riot that turns violent when patients start running loose. As Verna tries to find Jed, Bud is subjected to electroshock therapy, with Ike up next. Lizzy attempts to hide with another nurse, only for a deranged patient to stab the other nurse to death before Jackson kills him. Bud is set free from therapy and he kills the orderlies. Ike and his girlfriend Clarice (Jessica Madsen) escape with Jackson, who takes Lizzy as a hostage. They steal a car, and Ike invites Bud to join them as a favor for getting him out of the electroshock session.
Hal meets with a new deputy, Sorrel (Finn Jones), to discuss the incident at the facility.
Back home, Verna receives a phone call notifying her that Jed has escaped the facility with other people.
The group stops at a diner after changing clothes. Clarice doesn't like the idea of bringing Lizzy along, with some part being jealousy over how pretty Lizzy is. Ike and Clarice make enough of a disturbance to annoy waitress Tammy (Nicole Andrews). When she brings them the check to kick them out, Clarice says they have no money, and Ike takes a gun from a nearby and starts shooting at people, with Bud getting shot in the chaos. He takes a shotgun and blasts Tammy's head off, and the group flees. Hal and Sorrel later arrive, with Hal stating he knows one of the Sawyers were involved.
The group arrives at an abandoned trailer to hide. They find the rotten corpse of the trailer's owner in the bathroom with a noose around his neck. After calming down, Lizzy tends to Bud's wound. Ike and Clarice later have sex and even include the corpse.
While everyone is sleeping, Lizzy tries to make a run for it but is caught by Ike. As he tries to attack her, Jackson shows up and starts beating Ike. Clarice aims her shotgun at them and escorts Jackson and Lizzy back to the trailer. After Ike insults Bud one too many times, Bud whacks him over the head and drags him to a rock where he crushes Ike's head.
In the morning, Clarice notes that Ike is missing. Jackson and Lizzy go after Bud before she can find him, and they find Bud next to Ike's corpse. Clarice is caught by Hal and brought to the trailer to get the others out. Clarice then insults Hal for going after delinquents as revenge for his "stupid dead girl." This provokes Hal into shooting Clarice in the head, which Jackson, Bud, and Lizzy witness. As Hal proceeds to continue his search for the others, the three hide in an animal carcass before moving forward.
Another deputy comes across the three and is attacked by Bud. He shoots Bud in the head, prompting Jackson to fly into a rage and kill the deputy by slamming the car door against his head. Lizzy freaks out and is forced to take the deputy's car with Jackson. They are chased by Hal, who shoots at them. Jackson is hit in the face and is disfigured, while Lizzy swerves and sends the car off the road.
Lizzy wakes up to find herself handcuffed to the back of Hal's car. She answers a dispatch call to Sorrel, saying she is near the barn. Sorrel then goes to Verna, as he was her informant. He tells her that Hal has taken Jed (who was Jackson the whole time) to the barn where Betty was killed. Verna then kills Sorrel and leaves him to get eaten by a pig. She then goes to the barn to get Jed and knock Hal out.
Verna brings her son home and proceeds to stitch up Jed's face and put a muzzle on him to hold everything together. She presents him with the chainsaw once again to use on Hal. Jed cuts off Hal's hands before running the chainsaw through his chest. Lizzy then tries to escape and is chased by the Sawyers. Before she reaches the main road, her foot gets caught in a bear trap. Jed approaches her with the chainsaw. Lizzy pleads with Jed, trying to appeal to his good nature while Verna urges him to kill her. Lizzy almost gets through to him until she refers to Verna as Jed's crazy mother, which makes him decapitate Lizzy. Verna tells Jed he has made her proud.
The next day, Jed's brothers feed Hal and Lizzy's remains to the pigs. Jed is then seen sewing up Lizzy's face into a mask, officially turning himself into...LEATHERFACE.
*CUT TO THE CHASE*
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A quartet of mental patients escape from an asylum with a nurse, Lizzy, as a hostage. They are pursued by Sheriff Hal Hartman, who wants revenge against the Sawyer family for the brutal murder of his daughter.
The patients are followed after a massacre at a diner. Three of them are killed, with Lizzy and the remaining patient, Jackson, getting caught by Hal. Jackson is revealed to be Jedidiah Sawyer, the youngest of the clan. His mother Verna rescues him and gives him the chainsaw he will later come to use. Jed kills Hal and later Lizzy after she insults Verna.
After Hal and Lizzy's remains are disposed of, Jed sews Lizzy's face into a mask, earning him the name Leatherface.
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