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Seeing that Shay is pretty tells Tally that she failed in what she set out to do—that is, to support Shay in her decision to escape the pretty operation. In this sense, Tally has failed miserably as a friend. The way that Tally describes Shay shows how wildly different Shay is now—though Tally thought that Shay’s face was lovely before, now Shay is “elegant.” She isn’t the Shay that Tally knew, and given what Tally knows about pretties’ brain lesions, Shay is likely no longer an independent individual.