As Sean celebrates Christmas without his family, his loneliness leads him to seek solace in alcohol, resulting in possible legal action from a patient.

A ventriliquist requests surgery from Sean to make him look like his hand puppet.

As Sean and Christian settle into their new business in Los Angeles, they operate on a movie producer whose chest was badly scarred by his dominatrix.

After suspecting that something more than just their Secret Santa game is going on, Sean confronts Christian and Julia about the secret they have been keeping.

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

A transgender man comes in requesting surgery to make him more masculine.

Candy Richards, the washed-up, narcissistic actress returns wanting butt implants to make her more African-American for her re-discovered roots. Meanwhile, Christian meets a feisty, chain-smoking lady named Roxy St. James at a cancer support group who asks him to perform a mastectomy to reduce the probability of her developing breast cancer. Sean becomes troubled when Olivia wants a full makeover for herself as she and Julia are planning to move back east. Olivia (unknown to everyone) is emotionally stressed to her breaking point after covering up her psycho daughter Eden's murder attempt on Julia. But it naturally all turns out bad... even for the innocent and the evil alike.

With Christian learning that he only has six months to live, he proposes marriage to Liz to live out his last days in peace. Liz's overbearing mother arrives in town and immediately begins criticizing everything about the upcoming wedding and Liz, who asks for a breast reduction to fit into her family's wedding dress. Meanwhile, Christian hires the flamboyant Logan Taper as his replacement, but he brings an unusual and disturbing fetish with him. While Sean continues to enjoy his secret romance with Teddy, he and Christian are called upon by a former client, Allegra Caldarello, for plastic surgery per her dying husband's wishes.

While Christian and Liz prepare for their upcoming wedding, Kimber finds herself homeless after both Ram and Eden kick her out. She asks Matt to look after their baby daughter while she finally learns about Christian and Liz's upcoming ceremony and naturally tries to talk to Liz from going through with it. Christian brings up an idea about being cryogenically frozen to save his life. Meanwhile, Sean does not know that the seductive Teddy has a double life as the nurse "Dixie Collins" in Las Vegas and is carrying on with the sleazy Dr. Harlan Frank, who is also unaware of her double life in L.A, and her homicidal tendencies. Elsewhere, Christian and Sean deal with a self-proclaimed vampire couple who ask for surgery to repair scaring from their regular blood drinking.

Christian and Sean struggle to keep their business thriving in a failing economy, and enlist another surgeon to attain additional income.

Sean is hit with an ethical and moral dilemma when he is offered a deal. In return for performing liposuction on an obese prisoner about to be executed, Matt would being released from prison. Christian, after discovering that Kimber is pregnant, orders her to have an abortion or lose him in the process. He does not want any more children. His issues an ultimatum when he promises to marry her if she goes through with the abortion. A desperate Kimber turns to both Liz and Mike for advice while deciding how far she is prepared to go for the man she loves. Also, Matt discovers information that could jeopardize his possible release from prison.

In the series finale, Christian agrees with Ava to operate on baby Raphael in exchange for her to stay out of Matt's life who has abandoned everyone to be with Ava. While preparing to leave for London, Julia worries about Sean's mental state of mind as he continues to be in denial about his feelings of abandonment. Liz is overwhelmed by Sean's excitement over her pregnancy when he adds her name to the practice and sets up a nursery at the office. Christian's worry about Julia moving far away, and a vision of the deceased Kimber forces him to reconsider his long-standing relationship with Sean. Also, Hiro Yoshimura is elderly Japanese porn star who comes to McNamara/Troy requesting surgery to remove a surgical scar before his big debut in an American porn movie.