Directed by the visionary photographer Mika Ninagawa, Helter Skelter is a hallucinatory descent into the grotesque underbelly of the Japanese idol industry. It serves as a candy-colored nightmare that blends high-fashion aesthetics with visceral body horror to critique the disposable nature of fame.

The story follows Lilico (Erika Sawajiri), the undisputed queen of the fashion world. To the public, she is a goddess of natural perfection; in reality, her entire body — save for her eyes, hair and private parts — is the result of extreme, illegal plastic surgery.

Much like her character Lilico, actress Erika Sawajiri was a controversial figure in the Japanese media. After a highly publicized fallout with the press and a five-year hiatus, Helter Skelter served as her massive return to the screen. Her performance was widely praised for its raw, manic intensity.

As her body begins to reject the procedures, leading to black bruises and skin leakage, Lilico’s mental state also begins to rot. She becomes a volatile tyrant, desperately clinging to her status while her younger, natural rival, Kozue (Kiko Mizuhara), threatens to replace her. The film culminates in a frantic exploration of identity, asking what remains of a person when their physical self is entirely manufactured.

Ninagawa’s signature style, defined by hyper-saturated primary colors, dense floral arrangements and high-contrast lighting, is used here to create a sense of claustrophobia. The world she creates is so bright and perfect that it becomes nauseating. Plus, many of the ads and magazine covers seen in the film were treated as real marketing, effectively using the same tools of the fashion industry it seeks to criticize, blurring the line between the movie’s world and real-life consumerism.

Adapted from Kyoko Okazaki’s 1996 josei manga, the film honors a creator widely considered a pioneer of the medium. Okazaki is celebrated for her signature flat aesthetic and her unflinching exploration of female sexuality and the crushing isolation of urban life.

Tragically, just as her influence was reaching its peak, Okazaki’s career was derailed by a devastating accident. In May 1996, she and her husband were struck by a drunk driver in a hit-and-run in Tokyo’s Shimokitazawa district. While her husband was able to recover within a month, Okazaki suffered catastrophic injuries, including a fractured skull and internal organ failure, that left her unconscious for a prolonged period and permanently altered the course of her life and work. Despite this forced retirement, Okazaki’s influence remains immense; her existing body of work continues to thrive through constant reprints and high-profile media adaptations.

Also: There’s no way that Coralie Fargeat didn’t see this before she made The Substance.

This 88 Films release has audio commentary by Tori Potenza and Amber T.; interviews with Erika Sawajiri and director Mika Ninagawa; behind the scenes footage; the production site press conference; the Japanese premiere stage greeting; the opening day stage greeting; a Taipei Film Festival introduction by Mika Ninagawa; a stills gallery; teasers and trailers; a booklet essay by Violet Burns and original and newly commissioned artwork by Luke Insect. You can get it from MVD.