Liz collapses during a procedure due to kidney failure. Needing a donor, Christian tells her that he and Sean will get tested for compatibilty, but Sean is apprehensive about the idea.
Christian and Sean celebrate their five-thousandth surgery together. Christian, feeling empty, sees a psychiatrist who startles him when she asks if he is in love with Sean. Disturbed, he decides to redecorate his apartment. Julia learns devastating news about her baby.
Sean helps a man with a deformed face. Christian helps a stripper with large breasts and a young boy who is in need of guidance. Sean and Julia make a big decision together regarding their unborn baby. Matt sees Kimber at the gym. She tries to get him involved with Scientology, which angers Christian. Christian and Sean butt heads with their new boss which makes them question their decision to sell the business.
Christian discovers there is a less-than-flattering sex tape of himself circulating on the internet. He asks Sean to give him some liposuction, but Sean refuses, offended that Christian would even ask him while his handicapped son is about to be born.
A lottery winner comes in wanting massive plastic surgery for herself, her daughter, and her husband. When they turn on her, she makes Christian an offer that would help him pay off James. Sean and Christian try to bribe Matt away from Scientology. Sean buys Julia a ring and asks her to marry him again.
Monica Wilder comes back into Sean's life, and refuses to leave. Sean, afraid of Julia finding out about their affair, considers killing Monica. Faith Wolper, Christian's therapist, admits she has a sex addiction and a tattoo she needs removed. Burt Landau discovers that Christian and Michelle are having an affair. He threatens to divorce Michelle and take away Christian's business if the two don't perform sexual acts in front of him.
Mrs. Grubman wants plastic surgery after she dies. Meanwhile, Sean and Julia clash over the specifics of Conor's corrective surgery.
James uses Christian and Michelle to get another kidney, after Asian mobsters threaten her life. Meanwhile, Liz tries to get in shape and hot for her new girlfriend, Poppy; and, Marlowe wants longer legs.
Sean and Christian perform delicate face replacement surgery on Escobar Gallardo at the request of freed Dr. Bobolit. Meanwhile, Matt reveals that his wife is pregnant, but Christian is convinced it's his child so, during surgery to remove her breast implants, takes a sample of her amniotic fluid in order to conduct a paternity test. And, Sean reveals he had an affair.
In the year 2026, Conor tries to heal his emotional scars by bringing his family together. In the present, Julia realizes she can only be happy by herself.
Sean's grief causes him to take the case of a woman who wants her husband's ashes inserted into her saline breast implants so that he can always be close to her heart. Meanwhile, Christian questions his ability to commit to one person, but proposes to Michelle anyway. And, James demands the use of Sean and Christian's facility for her own operations.
Sean's drinking problem during Christmastime could land him in some legal hot water; Christian is surprised by Wilber's return; and, James needs Michelle to help her fill her Christmas kidney quota by any means necessary.
Michelle decides to sign Wilbur's adoption papers. When Gina hears about it, she is furious and abducts Wilbur. James commits suicide. Michelle think that she is now free, but Gallardo, who was James's boss, makes her work for him. Sean decides to sell his portion of the practice. Matt and Kimber try to spice up their love life. Liz breaks up with Poppy.
Sean plans his move to Los Angeles. Escobar's wife needs reconstructive surgery on her breast. When Sean and Christian refuse to do it, Escobar turns to Michelle. Christian catches her, and he and Sean take over. Once Escobar's wife has recovered from surgery, she shoots Escobar in the head.