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.

Джоан Ривърс, добре поддържана (не без помощта на пластичната хирургия) възрастна жена, решава да си върне естествения вид заради чувството, че лъже внука си. Но когато вижда как би изглеждала без всичките ѝ направени операции, бързо се отказва от идеята. Шон и Крисчън разкриват тъмната тайна на Ава. В резултат на това, Ава и синът ѝ завинаги изчезват от живота им. Шон се готви да посрещне смело следващата атака на Касапина. Но този път жертвата се оказва друг - Крисчън Трой.

Matt persuade Ava de partir vivre à Paris. Christian l'apprend et devient furieux, d'autant qu'il découvre le terrible secret de la jeune femme...

Während seine eigenen Wunden heilen, ist Sean dazu auserkoren den Schlitzer von Miami zur Strecke zu bringen ehe er sich ein weiteres Opfer sucht. Joan Rivers besucht die Praxis McNamara/​Troy um die beiden Chirurgen für einen extrem außergewöhnliche OP zu konsultieren. Bei seinem letzen Versuch, Matts Beziehung zu Ava zu beenden suchen er und Sean nach ihrem Ex-Ehemann Bratt.

Joan River megbeszéli Sean-nal és Christian-nal, hogy csinálják vissza az összes rajta végzett plasztikai beavatkozást, mert meg akarja értetni az unokájával, Christian-nal, hogy az embernek nem kell tökéletesnek lennie. Amikor azonban rádöbben, hogy fog kinézni a beavatkozásokat követően, úgy dönt, feladja az eredeti tervet és másnapra bejelentkezik arcfelvarrásra.

Joan Rivers contatta Sean e Christian per farsi eliminare tutte le plastiche subite negli ultimi anni. Christian scopre che Ava è un uomo. Insieme a Sean, incontra Barrett, il marito di Ava. Questa accetta di troncare con Matt, a patto che i due chirurghi finiscano il lavoro. Il destino di Adrian si compie. Sean vuole fare da esca per il "Macellaio", ma il killer colpisce Christian.

Joan Rivers, renumită pentru operațiile estetice făcute, se consultă cu medicii, însă cerințele ei îi uimesc chiar și pe Sean și pe Christian.

Termina la segunda temporada con un episodio en el que Sean está decidido a impedir que el agresor serial de Miami lastime a otra víctima a medida que sus propias heridas cicatrizan. Joan Rivers visita McNamara/Troy por una consulta sobre una cirugía cosmética sumamente inusual. Cuando Christian hace un último intento por terminar la relación de Ava y Matt, él y Sean localizan a su ex-marido.