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.

Sean and Christian learn that they have to take a test in order to continue practicing. Sean and Megan visit a doctor to learn that there is nothing they can do for her. Mrs. Grubman returns to get an operation on her and her fiancé. Christian passes his test, but Sean walks out. Megan commits suicide. Julia finds out about Sean's affair with Megan.

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.

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.

A plane crashes just after take off in Miami. Julia's mother might be one of the passengers. Christian, Sean, Julia and Liz are all trying to save the lives of the people that survived the plane crash.

Dr. Merrill Bobolit, who's out of jail, needs Sean's and Christian's professional services. Escobar Gallardo wants them to perform surgery on his face. And Matt tells his family that he's married and that he and his wife are expecting a baby.

Sean considers selling his shares of the practice to Christian and Michelle, although Michelle's past starts to threaten her future with Christian. Meanwhile, Escobar's wife needs cosmetic surgery.

Sean and Christian are reunited with an old friend, Julia bonds with Sofia Lopez, and Christian and Gina clash over their differences in opinion concerning Gina's pregnancy.

Sean drinks to a great extent as he spends a depressing Christmas without his family; Christian gets an surprising gift when a 3-year old Wilber comes back into his life; and James pressures Michelle to help as she takes forceful measures to fill her holiday kidney quota.

When local model Naomi Gaines is raped & disfigured by an attacker named "The Carver", Sean decides to repair her injuries on a pro-bono basis, thrusting McNamara/Troy into the local media spotlight, trying to overcome the slander caused by Bobbie Broderick. After getting caught sneaking into the house late at night, Matt lies by telling his parents he was studying with Ava's son Adrian. Adrian is forced to play along with the subject when Julia invites them all to dinner. Adrian reveals Matt & Ava's relationship, causing Julia to lash out at Ava & Matt. When Matt becomes uncomfortable with his increasingly demanding relationship with Ava, she reveals to him the secret that his mother is keeping from him.

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.

Christian finds out that Kimber didn't ditch him at the altar but was abducted by the carver. Quentin is a Carver suspect. Julia has bad dreams about her pregnancy. Sean is threatened into doing pro bono work on the transgender woman who was beat up by Matt.

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.

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.

Sean and Julia discover Matt has tried to circumcise himself. The business is sued by a faithful client after Sean accidentally leaves a surgical tool inside of her body. Meanwhile, Christian and Grace struggle with a mentally unstable patient.

Sean and Jude's respective secrets are revealed, and Merril offers Christian an interesting trade: Kimber for a Lamborghini. Christian accepts, but Kimber discovers the truth and exacts a small revenge.

Sean soon discovers that Monica Wilder doesn't intend to leave him alone. Christian's therapist has an obsessive torment to reveal. And Burt Landau proposes an unusual solution upon learning that Christian and Michelle are having an affair.

Even though he doubts his ability to maintain a long term relationship Christian proposes to Michelle and a lonely Sean takes a pathological case for rationalities that have as much to do with himself as with the patient, and James requires to use McNamara/Troy for her own operations.

Someone is vandalizing Christian's possessions, and he attempts to find the culprit. A chemotherapy patient who is considering breast implants brings excitement to Sean's life, and Matt finds himself in a threesome with Vanessa and Riley.

Christian's difficulties with Kristin are exacerbated when his feelings for Julia are revealed. Jude is hired as an intern, to sexy and disastrous results. Matt is caught mid-threesome by Julia.

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.

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 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.

After having a nipple bitten off by her dog, Shari Noble comes in to have it reconstructed before her husband returns from Iraq. Julia meets a breast-feeding expert. Christian and Liz hit a lesbian bar where Christian tries to attract one of the women there but she's attracted to Liz instead. Sean and Christian meet with a kidney specialist for one of their patients.