Manya has had a "female circumcision" as a young child, so she wants to have corrective surgery. A man requests hair implants all over the exterior of his body. Sean meets Ava, a life-coach, and enlists her to help out Julia. In addition, Sean has problems with Erica, still staying at the house, and Christian has problems with Gina.

As Julia and Sean's daughter Annie faces puberty, they must both face the harsh realization of maturity and deal with their own issues about getting older. When Gina tells Christian he can no longer be involved in Wilbur's life, Christian is forced to reach out to an old flame in order to build a case to gain sole custody of Wilbur.

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.

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.

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.

Maids and servants of a wealthy woman have a party while she is out of town, and they hire a cheap plastic surgeon to give them all Botox -- Merrill Bobolit. The women all have adverse reactions to it, and one of them comes in to have it fixed because bulges have formed on her forehead. Bobolit has now partnered with Madam Rose, who owns a chain of beauty salons. He performs unsanitary plastic surgery for lower prices in her basement, and they proudly promote this new invented "Bobotox". Christian tries to talk some sense into him, and eventually learns that Merrill is hooked on the anesthesia, and is constantly high on it - even during surgery. Christian acts as his sponsor in an AA-type rehabilitation group. Merrill becomes furious with Christian after a girl he wanted flirts with Christian.

Meanwhile, Matt gets upset at Adrian for wearing his leather coat to school while soliciting drugs to other students. After Adrian refuses to give him the coat back, they get into a fist fight. Since the coat belongs to Matt, the drugs in the pocket are pinned on him. Christian is called in instead of Sean along with Ava, and Ava comes up with the idea to bribe the principal, Ms. Wentworth, with pro bono plastic surgery. After getting off free because of the surgery, Adrian and Matt decide to be friends. While having a conversation in the bathroom at school, Adrian urinates in one of the soap dispensers, and both Matt and Adrian get called to the principal's office again. Sean comes in this time along with Ava, and he forces the truth out of Adrian and Matt, and snaps at Ava. Sean punishes Matt by sentencing him to spending his afternoons at the office doing handiwork and cleaning. Matt realizes he likes spending time there.

Adrian has had the last straw with Ava's harsh treatment, and they share a meaningful moment as mother and son, but it turns weird when they begin to make out.

Sean and Christian repair the face of a woman abused by her husband; Sean and Julia confront Ava about her relationship with her son Adrian.

Joan Rivers consults with Sean and Christian to have all of her plastic surgeries undone, because she wants her grandson Cooper to learn that you don't have to be perfect. When she ultimately learns what she will turn out like after the work has been finished, she decides to give up on her original plan and asks the doctors to schedule her for a facelift the next morning. Matt is concerned about Ava, who seems obviously depressed. He suggests they go away to Paris and start a new life together, which she reluctantly accepts after some convincing. Matt goes to McNamara-Troy to steal drugs for her to take with them. Christian finds him, and gets upset when he learns Matt is going to Paris. Christian goes to have a talk with Ava, and when trying to make a point using sex, he learns that Ava is really a transsexual. Julia, Sean, and Christian spend the night researching, and trace their way to Maryland and a Gender Reassignment center.

Sean hires Quentin Costa for six months during Christian's convalescence. The two remove tattoos from a former MS-13 gang banger using cutting edge laser technology. Matt finds Adrian dead in Ava's house when searching for a plane ticket to Paris. The police thinks it's suicide. Julia calls Erica to help Matt deal with questions regarding his sexuality. Christian and Liz operate to repair a scar on the face of a female gorilla, Kiki.

Julia visits Sean and Christian in Los Angeles to share life-changing news -- and rejects romantic advances from both men. A great love from Matt's past who has caused immeasurable family chaos turns up as Matt prepares to marry Ramona. Liz reveals that she's happily pregnant.

Sean and Christian reflect on their relationship. They also remove a scar from an elderly Japanese man and have a surprise for Liz. Meanwhile, Christian makes a deal with Ava.