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.

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.

Matt is getting out of control, and Sean, Julia and Christian are trying to find a solution. Quentin and Christian help two students whose faces are glued to the behind of a third student. Christian starts losing interest in the threesome relationship between Kimber, Kit, and himself. He asks Quentin to get involved with Kit to take her off his hands.

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.

It's the year 2026. Conor is getting the whole family together. In the present, Julia and Sean's marriage is at a crossroads.

Sean's role on Hearts & Scalpels is expanded after he takes on an agent. A suspicious Christian questions Gina's motives for moving to Los Angeles and working at McNamara/Troy.