Old friends Sean (the family man) and Christian (the playboy) are partners in a plastic surgery office. Their relationship is under fire after Christian operates on a Colombian drug lord who pays him in drug money. Sean's family life is also in upheaval, and he is headed for a mid-life crisis.

Twin sisters want plastic surgery done to look different from each other. Sean moves out so he can experience life as a single man. Matt decides to try and perform a circumcision on himself after his girlfriend sees his penis. Christian is plagued with thoughts of Julia.

Matt accidentally hits Cara with Henry's car, and calls Sean in to help when Cara's mother, for religious reasons, refuses drugs and surgery to treat her injuries. Christian discovers that a patient used plastic surgery to hide a revolting crime and it brings up terrible memories of his own childhood.

Christian learns that Kimber and Merril are engaged. Escobar continues to have the surgeons do things for him. Liz is sent to Bermuda after being shot in the leg by one of Escobar's people. Sean goes to kill Escobar. Escobar makes a deal with Sean; a new face for their freedom. Christian learns, in the delivery room, that he is not the father of Gina's baby. Julia returns to get the paternity test she had done a while ago. The doctors do surgery on Escobar, and give him the face of a criminal even higher than Gallardo on the Most Wanted List - Armand Ortiz. Ortiz is arrested at the airport for bank robbing and killing a federal agent.

During Erica's facelift, Sean panics and can't do it. Christian is having some trouble too - he's slept with Erica, the night of Sean and Julia's wedding. The surgery continues. Later that day, Christian is having problems with Wilbur, so he calls Julia to come help him. She gets upset on how Christian can't handle his own responsibilities, and snaps at him for sleeping with her mother.

As Julia and Sean's daughter Annie faces puberty, they must both face the harsh realization of maturity and deal with their own issues about getting older. When Gina tells Christian he can no longer be involved in Wilbur's life, Christian is forced to reach out to an old flame in order to build a case to gain sole custody of Wilbur.

After a car accident due to cell phone use, Sean winds up in the hospital. As a result of the accident, Sean develops a phobia of driving and other dangerous things, causing a dent in his career. He thanks the car company because their safety features saved his life. The car company, wanting a point of view from this doctor who has been in a car accident, offers Sean a new car if he agrees to inspect the cadavers they use as crash test dummies after crash tests. Sean tries to take more risks, causing Julia to become upset. Trying to take more risks, Sean decides to go shark diving, and drags Matt along with him. After realizing how much he cares for his son, Sean decides not to follow through. Christian is reminded that his son is no longer in his life, and he turns for comfort in Julia, who reveals to him that Wilber is not his only son.

Natasha Charles, a blind woman, comes into have work on her eyes so she won't appear blind. Christian begins to fall for her, and he learns a great deal about beauty from her. In an attempt to get Sean back, Julia goes to a female plastic surgeon to have breast implants. Erica visits Julia in her new apartment, and has become upset with her new lifestyle. Erica talks to Sean, and he gets mad at her also. Natasha goes out on a blind date (no pun intended) with another blind person. Christian, at the same restaurant, tells him that she is not pretty like the man had hoped, and he leaves. Christian joins Natasha, and they go home together for an intimate night.

After Julia's accident in the previous episode, Julia turns to Sean and Christian to fix her face. Sean resists at first, but eventually decides to do it after Christian lies to him and says the woman that was going to fix her face botched several jobs. Sean tells Julia that he keeps trying to forgive her and wants to try to love her again, but that it wouldn't happen right away.

Julia has an adverse reaction to the anesthesia and dreams during her surgery. Ava shows up in her dream as a different form of life coach, and guides her through this surreal life. Julia is married to Christian, which seems happy on the outside, but is really falling apart on the inside. They run the Troy/Troy partnership firm. When Christian decides to leave the practice, Julia interviews another doctor - Sean, someone she knew from high school. Trying to catch up on old times, Sean invites Julia and Christian to dinner. They meet his wife, Megan O'Hara, and their son Matt, who is on the nerdy side and has a bug collection. Megan is three months pregnant with a girl they plan on calling Annie, named after his grandmother. Julia is upset after a visit to Liz, an OB/GYN in this world, who has two kids. Julia cannot have kids with Christian, who wanted to have a biological child since he was adopted. Kimber, Julia and Christian's three-way partner becomes pregnant, and Christian refuses to get rid of it. We are revisited by several characters, including Mrs. Grubman, Jude, and Julia's friend Suzanne.

When Julia wakes up in recovery, Sean is there waiting for her. She has realized that things would never work out with Christian, and that Sean was always the one she loved.

Joan Rivers consults with Sean and Christian to have all of her plastic surgeries undone, because she wants her grandson Cooper to learn that you don't have to be perfect. When she ultimately learns what she will turn out like after the work has been finished, she decides to give up on her original plan and asks the doctors to schedule her for a facelift the next morning. Matt is concerned about Ava, who seems obviously depressed. He suggests they go away to Paris and start a new life together, which she reluctantly accepts after some convincing. Matt goes to McNamara-Troy to steal drugs for her to take with them. Christian finds him, and gets upset when he learns Matt is going to Paris. Christian goes to have a talk with Ava, and when trying to make a point using sex, he learns that Ava is really a transsexual. Julia, Sean, and Christian spend the night researching, and trace their way to Maryland and a Gender Reassignment center.

After Christian's Carver attack, Sean must look for a new partner to keep the practice going. Sean has to surgically separate an obese woman from a couch she has spent the past three years on. Julia realizes that she has to make a decision about the future of her marriage.

A woman wants surgery to make her look like her when she was younger, to jog her Alzheimer-stricken husband's memory. Christian and Sean work on another Carver victim, who does not have the same physical attributes as the other victims.

Sean and Christian are perform a mico-liposuction on Joy Kringle, a woman who acts as Mrs. Claus during the Christmas season. During her lipo they find a seventeen year old fetus inside her. Julia is not feeling well. A blood test performed by Sean reveals why. She is pregnant.

The Carver strikes at a sorority house. His identity is revealed. Ariel's dad kidnaps Matt and Cherry. Ariel's dad forces Matt to make a life threatening decision, while the carver tries desperately to get his last minute revenge. Julia discovers that there might be something wrong with her baby.

Sean and Christian may be celebrating a milestone surgery, but it looks like the future of McNamara/Troy is in jeopardy. Julia tells Sean some devastating news about the baby. Christian decides to redecorate his apartment after a disturbing appointment with his psychiatrist.

Sean and Julia make a big decision regarding their unborn baby. Christian and Sean hit troubled waters with their new boss and begin to realize what it really means to have sold their business. Matt's family doesn't quite get his decision to pursue a new path in his life.

Sean and Julia are looking for a nanny. Sean wants to turn to Christian for support after his hidden desires are revealed. But Chistian is busy going to the gym because he thinks he's too fat.

A lottery winner offers Christian a fortune. Christian certainly needs the money since he's being blackmailed by James. Christian and Sean are trying to get Matt away from Kimber and Scientology. Sean offers something to Julia.

Mrs. Grubman is back for more Plastic Surgery this time she wants Christian to preform it after she has passed on. Sean and Julia have conflicts over Conor's Surgery.

It's the year 2026. Conor is getting the whole family together. In the present, Julia and Sean's marriage is at a crossroads.

Sean and Christian learn about the glamorous side of fame and the price that many are willing to pay for it. Julia visits Sean, Christian and Liz in Los Angeles with a surprise announcement.

Sean and Julia learn more about their new family dynamic as Sean resists Eden's advances. Kate reveals a secret compulsion. Matt comes to Los Angeles with some troubling news for his fathers.

A series of unfortunate events unfold for an unlucky Dawn Budge, who seeks reparative surgery from Sean and Christian. Annie and Eden start to form a sisterly bond, which unnerves Sean.

Sean discovers the secret between Christian and Julia. A hospitalized Matt bonds with his rehabilitation counselor. Eden suspiciously makes peace with Julia. Kimber and Ram reveal their future plans.

Tragedy strikes the McNamara/Troy family after Julia learns what has caused her ill health. A visitor from Christian's past brings revealing news. Sean finds the price of fame to be more expensive than it's worth.

After surviving the attack by Colleen, Sean's physical and emotional well-being are still feeling the effects. Meanwhile, Christian receives some disturbing news after lending Liz some moral support with her breast cancer scare.

Sean makes an important decision without consulting anyone; a morose Annie shows up in L.A. with a troubling medical condition; Christian gives Mike (Mario Lopez) tips on how to satisfy Kimber; and a new patient recognizes Teddy.

Christian struggles to understand a patient with big anger-management issues. Sean and Christian learn how Matt is earning an income, despite his attempts to keep it hidden from his family. Teddy arranges a camping trip with Sean, Annie and Conor in order to ease family tensions.

As Matt's crime spree catches up with him, Julia returns from New York to help in his recovery from surgery. Sean discovers devastating details about his marriage to Teddy. A new patient suffers from extreme separation anxiety.

When a newly married Erica threatens to take custody of Annie and Connor, Sean and Julia present a happy and united front to thwart her efforts. Christian bonds with a new patient as Mike reveals his future plans with Kimber.

Both Matt and Alexis Stone request unusual surgical procedures from Christian. Erica discovers the horrible truth about her new husband. After a lifetime of torment from her mother, Julia seeks revenge upon her.

Julia visits Sean and Christian in Los Angeles to share life-changing news -- and rejects romantic advances from both men. A great love from Matt's past who has caused immeasurable family chaos turns up as Matt prepares to marry Ramona. Liz reveals that she's happily pregnant.

Sean and Christian reflect on their relationship. They also remove a scar from an elderly Japanese man and have a surprise for Liz. Meanwhile, Christian makes a deal with Ava.