Two recurring characters are introduced in an episode that teaches the odd-couple plastic surgeons a few lessons about moral boundaries. Patti D'Arbanville plays Wallis Forsythe, a pornography mogul who meets Christian at a party and agrees to send some business his way. And Joey Slotnick plays Merrill Bobolit, a hack surgeon who's more successful than Sean and Christian because of his willingness to take on any client. Forsythe's easy money and Bobolit's sleazy competition inject a dose of conflict into Sean and Christian's partnership--as if it needed any more of it!

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.

Ms. Caine wants an operation to get rid of her "cankles". Sean and Julia are still on the outs. Christian learns he's going to be a father. Julia steals Christian's brush to determine if he's the father of Matt. Sean and Grace learn that Ms. Caine has multiple personalities. Cara recovers and gets close with Matt and Henry. Henry develops feelings for her. Cara asks Matt to the prom. Henry tells Matt that he is going to confess to Cara what happened.

Bobbi Broderick comes to McNamara/Troy to have lipo so she could get a job at Saks. During the consult, she doesn't bother to read the contract she signs. After the lipo doesn't turn out to standards, she tries to get revenge against the firm by showing everyone how it "ruined her life" by showing up in restaurants and the lobby of the firm itself. Julia asks Ava to help Matt with his grades, and Ava eventually offers Matt sex in order to focus more on his schooling. Julia tries to speak with Ava about a trouble from her past - a huge mistake she made in college - and Ava realizes it involves Matt's paternity. A woman whose lips were burnt off goes in for a consult, and learns that the doctors would have to take skin from her vagina to fix her lips. She decides to do it, because her husband has never been intimate with her down there. Sean feels uncomfortable about the woman lying to her husband where the skin has come from. She tells her husband it has come from the back of her legs. Meanwhile, as Matt becomes more attracted to Ava, he is arrested after being caught masturbating outside her window. He seeks Christian to bail him out because he thought he could trust him, but Christian becomes upset for his ignorance. Matt lashes back by saying that he already has a father, and he doesn't need another one. After Ava and Matt finally have sex, the next morning Matt learns Ava has a son named Adrian - and they're the same age.

A patient named Agatha Ripp comes in to McNamara/Troy. She reveals to Sean & Christian that she had a stigmata, but she says that it was a lie she said to the church so they would accept her, and that she really cut herself. People of the town turn to Agatha for blessing and renewed faith, despite claiming to be a fraud. When a "stigmata" appears on her legs, the doctors do a blood test to learn that it is not her blood.

Meanwhile, Julia is experiencing shingles, which Sean attributes to guilt or pressure, and associates it with the Matt-Ava relationship. She breaks the news to Sean that the reason she is under so much stress - he is not Matt's father. Sean goes insane and aggressively hurts Julia. He rampages into the office where he beats Christian to the ground. He turns to the church, where he meets Agatha. She reveals everything was fake, and that a sister from the church snuck in and punctured her, and left her own blood so the church would not cut her program.

Meanwhile, Liz reveals she is pregnant, but shuts Christian out, who wants to care for the baby. She experiences bruising and spotting, causing her to worry about 'the unknown'. Despite being impacted by Agatha, Liz has an abortion without telling Christian, who is upset that she got rid of the baby because she felt it would be handicapped.

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.

Beauty is a curse on the world. It keeps us from seeing who the real monsters are.

Another victim of the Carver shows up to have his face fixed - this time it is a male, who was both raped and carved. They agree to fix him. A local news station does an interview with Sean about the pro bono work on Carver victims. The Carver finds his way into Sean's home. After Sean gets out of the shower, the Carver drugs him up and has a conversation with him. He slices his right cheek, and tells him that if he fixes another one of his "masterpieces", he is going to kill him. Julia helps him recover, and Sean tries to win her back - but she reminds him that she is happy with Kevin.

Meanwhile, Gina tells Christian that she is HIV positive, meaning that Christian may be also. He calls his past lovers, including Manya, Erica, and Grace. He visits Kimber on the set of a porn movie, which she is directing. She tells him that she got tested quite recently because she's in the business, and that she's clean, which slightly relieves Christian. He has one more call to make - James and Wilbur (now known as Gabriel). They both come to visit, and Christian becomes very emotional. Christian's tests come back negative, and he visits Gina in the hospital with the good news. He lies down next to her in her hospital bed after a heartwarming conversation, and they fall asleep together.

Sean and Christian visit a mortuary where an employee created a woman from body parts of other women. They operate on a German woman. Sean is at a gathering of people over 65, trying to sell them some procedures. Gina and Julia are in business together.

Christian and Quentin disagree over the ethics of an extremely dangerous operation that would enhance their medical reputations. Sean is thinking about giving up everything and disappearing into the Witness Protection Program with Nikki and her son.

Sean wants Quentin out of the practice after finding out that he's dating Julia. Christian seems to be ok after Kimber leaving him, but his actions indicate otherwise.

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 contrives to sell his portion of the practice; Michelle's connection with James finally ends, but not with James' boss; Gina is not happy to discover about Michelle's role in Wilbur's life; Matt tries to rekindle the spark with Kimber; and Poppy and Liz break up.