Sean's 40th birthday approaches, which has him wondering whether or not his life is beginning a downward slope or just starting to take flight. He must be honest with Christian when the onset of palsy in his hand worsens, possibly to the detriment of his career.
Christian must come to terms with his own narcissism when he breaks his nose during a wild bedroom romp. Sean continues to grapple with the palsy in his surgical hand and decides to come clean with Christian, but still isn't sure how to save his career. Meanwhile, Matt is called upon to help his friend Henry, but the generous action means he has to admit to the hit-and-run accident involving Cara Fitzgerald.
Sean and Christian are faced with the challenge of a Somalian woman who wants the team to reconstruct her genitalia, which has been mutilated in accordance with her country's customs, and in effect, reconstruct her sense of sexual worth. Meanwhile, Sean tries to get Julia to see a therapist in hopes that she can begin to work through her growing inner turmoil.
As Annie begins to deal with puberty, the changes force Sean and Julia to confront their own aging process. Meanwhile, Christian is told by Gina that he can no longer have Wilbur in his life, desperately prompting him to ask an old lover for help in gaining full custody of the baby.
Sean decides to be more bold with his life after escaping death in a car accident. Sean and Christian are faced with the challenge of performing plastic surgery on a frostbite-ravaged mountain climber. Meanwhile, Christian becomes the last bastion of confession for a troubled Julia, who wishes to open up to him about a harrowing secret.
Sean and Christian are the recipients of an angry patient's wrath over lipsuction gone awry. Ava tries to aid Matt in his studies using some unorthodox methods. Meanwhile, Christian makes a gesture to help Liz's fertility problems.
Sean offers to reconstruct the face of a model, injured at the hands of an assailant, at no cost, which brings the practice some big media attention. Meanwhile, Matt's world is threatened by a revelation from Ava, who is forceful about taking their relationship to the next level.
Sean and Christian help a prostitute who claims to have stigmata wounds. Julia reveals to Sean that Matt is not his son. Meanwhile, Liz decides to have an abortion when she finds out her baby might have birth defects.
Sean tells Christian that he wants to end their partnership. As their last scheduled job together, they fly to New York to assist in the separation of conjoined twins.
Sean begins to spend more time with Kimber when he helps her with a business endeavor, while at the same time he is in the process of ending his marriage to Julia. Meanwhile, a male journalist wants to get breast implants in order to gain a greater understanding of his wife's breast cancer.
Christian unexpectedly falls in love with a blind patient who has the intuition to look beyond his surfaces. Meanwhile, Julia decides to make changes for the better in her life after feeling down about Sean's busy new social life and his rejection of any kind of a martial reunion.
Julia is left an emotional and physical mess after an accident brought on by drugs, which leads her to run to Sean for some treatment. She undergoes surgery, but the effects of the anaesthetic put her into a state of fantasy where she can imagine a married life with Christian instead of Sean.
Sean and Christian learn that Merrill Bobbolit has been reduced to performing dangerous procedures in a low-rent, backroom practice, prompting Christian to try and help him regain his career's lustre. Meanwhile, Ava coaxes Christian into performing surgery on Matt and Adrian's school principal in order to stave off their impending suspensions.
Sean and Christian repair a woman's facial damage, incurred by her abusive spouse, but quickly learn that their assistance is only perpetuating the angry spouse's behavior. Meanwhile, Sean and Julia attempt to protect Matt by getting to the bottom of Ava's unsettling relationship with Adrian.
As Sean continues to offer free treatment to victims of a serial killer's attacks, he soon finds himself in danger as the killer turns him into another member of a growing line of victims. Meanwhile, Gina delivers a crippling emotional blow to Christian.
Sean resolves to stop the attacker that's running rampant across Miami leaving victims in its wake. Sean and Christian receive a visit from Joan Rivers, who discusses the possibility of a rather strange surigcal procedure. Meanwhile, Christian tries to get Matt away from his relationship with Ava, as he and Sean track down her ex-husband.