Get comfortable for this might take some time to explain and if you have liquor then now is a good time to get it a flowing.
Comic style panels explain how an epidemic of organ failures devastated the planet in the future. The mega-corporation GeneCo emerged as a savior. GeneCo provides organ transplants, in addition to cosmetic surgeries. GeneCo is legally able to repossess defaulted organs. Clients who default on payments will be hunted down by Repomen; skilled assassins contracted by GeneCo to recover defaulted property by any means necessary.
The CEO of GeneCo, Rottissimo "Rotti" Largo (Paul Sorvino), discovers that he is terminally ill. Meanwhile, Shilo Wallace (Alexa Vega), a 17 year-old, believes she inherited a rare blood disease from her deceased mother. She visits her mother's tomb and runs into GraveRobber (Terrance Zdunich), who is digging up bodies. They flee from GeneCops and enter a massive space of dead bodies. After losing consciousness, Shilo wakes up to find her overprotective father, Nathan Wallace (Anthony Head), watching her. He has kept her locked away for 17 years, supposedly because of her blood disease. Shilo seems bitter towards her dead mother, Marni (Sarah Power), for giving her the genetic disease. Nathan prepares for work as the head Repo Man for GeneCo. Previously a surgeon, Nathan was forced by Rotti into becoming a Repo Man. Marni had left Rotti for Nathan, so Rotti secretly killed Marni and Nathan became convinced that he was responsible for her death. Rotti promised to keep it secret if Nathan agreed to work for Rotti as his top Repo Man.
Rotti's children, Luigi (Bill Moseley), Pavi (Ogre) and Carmela "Amber Sweet" Largo (Paris Hilton), are at a GeneCo warehouse, where Luigi and Pavi bicker over who will inherit GeneCo. This continues at the GeneCo Renaissance Fair, harassing Blind Mag (Sarah Brightman), GeneCo's opera singer, who is forced to work for GeneCo because she signed a contract with Rotti in exchange for a surgery to cure her blindness. Amber then taunts Mag about being her replacement. Rotti then introduces Shilo to Mag, who previously believed that Shilo had died at birth.
While repossessing a spine, Nathan calls Shilo, who is being guarded by Rotti's hench-girls. GraveRobber then helps Shilo escape. Rotti announces that Blind Mag will be performing her final song. GraveRobber then demonstrates the use of Zydrate, a euphoric pain-killer that is harvested from the brains of corpses. Those who are addicted to surgery, including Amber, need Zydrate to ease the pain. Amber arrives and gets a shot of Zydrate from GraveRobber, then explains that she will be replacing Blind Mag after Mag's eyes are repossessed after her final performance. GeneCops arrive and everyone scrambles to escape, except for Amber and her two valets, who support her as she passes out. GraveRobber and Shilo then depart and she quickly returns to her room before Nathan notices that she was gone. Nathan delivers the repossessed organs to Rotti, who gives Nathan his next target: Blind Mag. However, Nathan refuses. Rotti, Pavi and Luigi force Nathan to another victim, trying to guilt Nathan into repossessing Blind Mag's eyes, Nathan however still refuses to repossess Mag's eyes and leaves, Rotti then vows to have Nathan taken out.
Later, Blind Mag arrives at Shilo's house. Mag reveals that she is Shilo's godmother and that her and Marni were best friends. Blind Mag cautions Shilo not to make the same mistake that she did and also tells Shilo to make a happy life for herself. Nathan arrives home and forces Mag out after she scolds him for lying to her about Shilo's death. While Shilo claims that a repo man will repossess Mag's eyes Nathan insists that it is best to leave the problem alone. When she becomes upset, he asks her what chance has a seventeen year old girl. She then rebels and Nathan slaps her across the face, but then apologizes for hitting her.
Back at GeneCo, Amber complains to Rotti that her latest surgery ruined her face. Rotti tells her that "happiness is not a warm scalpel", he then gives in and tells Amber that his surgeons will fix her. After she leaves, Rotti signs his will, which shows Shilo as his sole benefactor. Nathan finds the GeneCops searching his basement. They accost Nathan however he kills them. Nathan finds Shilo has left and the GeneCops have stolen Marni's taxidermy body along with her dress on it to give to Shilo. Rotti phones Shilo and says that he would be honored if she wore the dress to the opera. The next scene shows Nathan, Shilo, Mag, Amber, GraveRobber, Rotti, Luigi, and Pavi preparing for the Genetic Opera.
Everyone arrives at the Opera, where a band's performance begins. Amber takes the stage for her premiere, but her performance is ruined when her face falls off, she picks up her fallen face off the floor and runs backstage feeling embarrassed. Mag takes to the stage and sings her final song, ending it with a final act of defiance by gouging out her eyes, stating that she'd rather be blind. Rotti cuts the cords suspending Mag, dropping and impaling her on a fence. Rotti assures that Mag's death is part of the performance and convinces the audience to stay seated by stating that he will cure Shilo's illness.
Shilo attacks the Repo Man in his gear by striking him in the back of the head with a shovel. She then realizes that the Repo Man is her father. On stage in front of the audience Rotti reveals that Nathan has been making Shilo ill by giving her poisoned medicine. Nathan explains that he was just trying to protect her from the cruel world. Rotti tells Shilo that if she kills her father she will inherit GeneCo. When she refuses, Rotti uses the last of his strength to shoot Nathan. Rotti then dies on-stage from his terminal illness. Shilo and Nathan bid farewell to each other and then Nathan dies. Shilo then leaves, free at last to live her own life.
In an epilogue, GraveRobber reads about the events of the opera from the previous night and reveals that Shilo has fled, leaving GeneCo with no legal heir. A scene during the end credits reveals that Amber became GeneCo's new CEO, "auctions her fallen face to charity as a symbol of GeneCo's commitment to change", Luigi murdered the top three bidders, and Pavi won the auction and he now "wears Amber's face with pride."