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Florida: Former FBI investigator Will Graham lives a quiet life with his wife Molly and step-son Kevin having retired from the Bureau after a particularly traumatic case. Graham has a singular talent - he can think like the murderers he once chased - which makes him invaluable to his superiors.
Though retired, Graham is visited by his former boss, Jack Crawford, who needs his help - a killer is slaying whole families on a "lunar cycle." Having slaughtered two families already, the Leeds' and the Jacobis, the time is rapidly approaching for the killer to strike again.
Crawford wants Graham to return to the Bureau to help solve this one last case. Graham is reluctant, but his conscience leaves him unable to refuse the request, much to Molly's dismay.
Graham begins his investigation, immersing himself in the mind of the killer. He visits the Leeds house and stalks the deserted building, getting a feeling for what went through the killer's mind as he slaughtered the family. His understanding of the murderer's motives are helped when he studies a video recording of some home movies the family had filmed. Graham's first breakthrough comes when, studying the tape, he realises that the killer would not be able to resist touching his victims with his bare hands and asks the forensics lab to dust the bodies for prints.
At a police briefing the next morning, Graham learns that the investigating officers have taken to calling the killer The Tooth Fairy for his habit of biting his victims with distinctive teeth. He also learns that his intuition has paid off - partial prints have been found on eyeball of one of the victims and the toenail of another.
Outside, Graham is confronted by sleazy tabloid journalist Freddie Lounds who wants to know why Graham is involved. Years before, while Graham lay in hospital recovering from horrific wounds inflicted on him during his capture of deranged serial killer Dr Hannibal 'the cannibal' Lecktor, Lounds had managed to take and publish photographs of the comatose Graham. Enraged, Graham attacks Lounds and has to be calmed by Crawford.
Graham now has to face his own demons and turns to the only man he believes can help him track down the killer - Lecktor. Graham visits the former psychiatrist at his maximum security cell in Chesapeake State Hospital for the Criminally Insnae and endures an uncomfortable interview. Lecktor, a fiercely intelligent man, tries to play mind games with Graham who is clearly distressed at coming face-to-face again with the man who came so close to killing him. Lecktor taunts him and Graham's discomfort overcomes him and he flees the hospital. Outside, he is photographed at a distance by Lounds, still on the trail of a good story.
Back in the hospital, Lecktor is granted a phone call, ostensibly to his lawyer, though he cleverly manages to contact a publisher, claiming to be a representative of Graham's psychiatrist, Dr Sidney Bloom, and uses his charm and cunning to obtain Graham's home address.
Still shaken by his confrontation with Lecktor, Graham flies to Birmingham, Alabama, to visit the home of the first victims, the Jacobi family. Prowling the grounds, Graham climbs a tree and makes two discoveries - a strange symbol carved into the bark of the tree trunk, and the fact that both houses had large yards, easily visible from a distance, into which the killer could peer to study his chosen victims.
When Graham calls Crawford with news of his findings, he receives disturbing news - Lounds' paper, the down-market Tattler, has published his photograph alongside a sensational article by Lounds. While Graham and Crawford are talking, more news comes in - Dr Frederick Chilton, head of the Chesapeake State Hospital, calls to tell them that staff have found a note in Lecktor's cell, apparently from The Tooth Fairy, inviting the doctor to communicate with him. Part of the note has been destroyed, scored with a felt tip pen before being torn out.
Graham quickly flies back to Washington while Crawford walks the note through the various forensic tests that need to be made before the note is returned to the cell - Lecktor, who is being held on the pretense that his cell needs cleaning, must not find out that the FBI have the note in case he finds a way to warn the killer. The tests turn up a few prints (which cannot be identified) as well as some clues as to what was on the missing piece of the note. Using high-tech equipment, Bureau investigators are able to make out some of the remains of the muissing letters and agree that The Tooth Fairy has asked Lecktor to respond to him via the personal ads in the Tattler.
They manage to find an ad that Lecktor has placed in the upcoming issue but are unable to figure out the strange code that Lecktor uses. The investigating team agree that the key to the code was in the part of the note that Lecktor destroyed. Crawford and Graham now have face a dilemma - do they let the ad run, not understanding the message that Lecktor has passed to the killer, or do they pull it and tip The Tooth Fairy off that they're closing in on him. Unable to place their own dummy ad in time, they decide to let the ad run and try to decipher it later.
In the meantime, Graham comes up with a risky plan of his own - he is going to use Freddie Lounds to set himself up as bait to draw the killer out. Graham agrees to an interview with Lounds, during which he deliberately goads the killer, and arranges to have a photographed published with enough background detail to give the killer clues as to where Graham supposedly lives.
The trap is set and Graham waits nervously for the killer to come to him. But the massive police stakout comes to nothing and all they turn up is one terrified jogger who a jittery Graham mistakes for the killer.
Meanwhile, Lounds is captured in an underground car park by The Tooth Fairy, real name Frances Dolarhyde, who drugs him and takes him back to his home. Lounds is forced to look at pictures of the murdered families while Dolarhyde rants at him, before being made to recite a message into a tape recorder retracting his article. Dolarhyde then bites Lounds' lips off, straps him to a wheelchair and takes him back to the car park from where he was abducted. There, the killer sets fire to the reporter and sends him careering down a steep slope.
The FBI, meanwhile, have fionally managed to crack the code in Lecktor's note and Graham is horrified when eh's told what the message is - it passes on Graham's address and urges the killer to turn his attention to Molly and Kevin. In Florida, Molly and the boy are taken into protective custody by local police where Graham is able to briefly join them before returning to the hunt for the killer.
Dolarhyde works at a film processing laboratory and, while trying to obtain some infra-red film to record his next atrocity, meets blind co-worker Reba McClane. Instantly smitten by her, he offers her a lift home and is astounded when she seems genuinely interested in him. He arranges to take her to a local zoo where an animal orthodontist is working on an anaesthatised tiger. Dolarhyde watches with rapt attention as Reba caresses the sleeping animal.
While Graham becomes increasingly embroiled in the killer's disturbed thinking, Dolarhyde and Reba's relationship flourishes and he finally works up the courage to take her home. While he watches film of the next family he intends to "change," an unwitting Reba seduces him and they end up in bed, an experience that just seems to disturb him even more.
Their relationship takes a dangerous turn when Dolarhyde calls on Reba one night and sees her with another worker from the plant. He mistakes the man's attempts to remove grit from Reba's eyes as sexual betrayal and guns the man down as he tries to leave. He forces his way into Reba's house, telling her that "Frances has gone. Gone for ever."
Time is running out for the investigators. The full moon is approaching and Crawford has an impossibl edecision to make - do they press on, or do they just wait for the killer to strike again and see if there's anything they can use in the aftermath. But Graham refuses to give in and soon starts making the intuitive leaps for which he is famed - he realises that for the killer, seeing is everything, that his "primary sensual intake" is through his eyes. This leads him to deduce that the killer must have seen the familes before he killed them - he would have needed time to study them before he visited them. Other clues on the videos of the family home movies lead him to the breakthrough the team have been looking for - the killer has seen these very films.
They quickly determine that both sets of home movie footage were developed at the same processing plant and they rush to Missouri to sort throug hthe personnel files. They identify the killer as Frances Dolarhyde and rush to his house.
Inside, Dolarhyde is preparing to kill the drugged Reba. Just as he is about to deliver the fatal blow, the police arrive and Graham dramatically leaps through through a large window to distract the killer; for his efforts he is badly beaten by the killer. Dolarhyde and the police engage in brief but bloody gun battle at the end of which Dolarhyde and a couple of cops lie dead.
The nightmare over, a battered and bloodied Graham
is finally able to return to his family and his much deserved retirement.
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