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.

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.

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.

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.

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.

A lottery winner offers Christian a fortune. Christian certainly needs the money since he's being blackmailed by James. Christian and Sean are trying to get Matt away from Kimber and Scientology. Sean offers something to Julia.

Mrs. Grubman is back for more Plastic Surgery this time she wants Christian to preform it after she has passed on. Sean and Julia have conflicts over Conor's Surgery.

Sean considers selling his shares of the practice to Christian and Michelle, although Michelle's past starts to threaten her future with Christian. Meanwhile, Escobar's wife needs cosmetic surgery.

Jealous over Sean's new-found fame, Christian convinces Sean to tape a reality show based on their careers as plastic surgeons.

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.

Christian attempts to cope in the aftermath of a death. Colleen feels threatened when another talent agency shows an interest in Sean's acting career.

A horribly disfigured man is worked on by Christian and Sean. Meanwhile, Sean hopes to strike up a relationship with the new anesthesiologist Teddy Rowe, and Christian goes for a check up with his oncologist.

When a newly married Erica threatens to take custody of Annie and Connor, Sean and Julia present a happy and united front to thwart her efforts. Christian bonds with a new patient as Mike reveals his future plans with Kimber.

Following a failed suicide attempt, a new patient seeks facial reconstructive surgery. Christian tries a risky maneuver with Kimber to heighten their marital passion. Sean performs pro-bono surgery with a charitable surgeon and former college friend in an attempt to quell his guilty conscious.

The teenage daughter of Escobar Gallardo seeks out Sean and Christian for answers about her late father, stirring tremendous guilt within Sean. A seemingly common cosmetic procedure for a struggling actress leads to chaos.