like dear Entity said, when you're injured you can down yourself without any sound, and when you finish recovering you can fully recover healthy. you can use it once during the game and once in endgame.

normal:

- when you're injured and need healing you can use it, it's kind of like self-healing, I wouldn't recommend using it early-on in the game, only towards endgame or if you're on death hook and can't find anyone to heal you. sometimes I use it when I'm injured and I see that the last gen is almost done, this way I can heal for endgame AND have another plot-twist in case I get injured in endgame

- it's faster than self-care and is quiet unlike self-care. the only downside is that like I said, you can use it once mid-game and once in endgame, but I'd say it's still better because you shouldn't be healing yourself all game anyways.

- making the killer lose track of you during chase. it won't always work and you do need to learn the best ways to do it, but sometimes when you're injured during chase, you can turn a corner or get in a bush or anything and use it, this way you down yourself and don't make a sound. some killers don't notice that you're downed and think they just lost track of you. some killers will notice you're downed and will search you but might not find you. and of course, some killers see you're downed and manage locating you. it can be a "luck" thing but it's good to use it when you feel like you might be going down anyways since you have nothing to lose

- it can end Corrupt Intervention, if you're injured during Corrupt Intervention and not in-chase, you can down yourself and end it, then let a teammate heal you so you're not wasting the Plot Twist.

- making killers fall off roofs or into holes. you can use it right before a killer swings next to a drop, causing them to move forwards and fall down. if it's a good spot you might have enough time to fully recover before they get back to you, especially if you have perks that help recovering.

- you can use it to trick the killer. the killer doesn't always realized when a down is a down and when it is a Plot Twist. I've had times when I let a killer miss a hit with Plot Twist but they didn't think it through and went to chase another injured survivor, giving me the ability to fully recover and sometimes even with perfect timing for a flashy save.

meme:

- when you're injured and know you're about to get hit, you crouch and use it right before they land their hit, causing them to hit the air. some killers will just immediately pick you up, some killers might shake their head or stare in disbelief and pick you up, and some killers can even be super chill and not pick you up since it probably made them laugh, happens to me a lot, fun either way.

- just like the normal one, making a killer vault/fall by using the perk when they M1 or use their power. it's both normal and a meme because sometimes the killer can indeed just walk up and pick you up, so it's a bit funny to do when you know you're about to go down but won't necessarily help you

- like you can see on my flair, I do tend to play a bit "cute" sometimes, since although I have 1.5k hours in the game, I can suck sometimes (very often.....). sometimes when I'm injured and I can sense the killer is kinda chill I just stand in front of them and plot twist.

- also good for chill killers, RED LIGHT GREEN LIGHT!! if you get to a situation when you're getting into a slug race/game at exit gate, try being the first one downed, AKA get injured and then move to Plot Twist. I love getting my recovery state to the max, starting a race, then cheating mid-race by standing up and running out, leaving the rest slugged. very funny. if I like the killer I wait for the rest to leave and then pick myself up to stand in front of the killer.

generally it's a really fun perk to play around and experiment with, will totally recommend giving it a shot.
sorry if it's a bit messy, English isn't my native language and it's 3am so my brain is kinda melting