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

Christian and Sean are hired by the parents of a neo-punk rocker to have his tattoos and self-mutilation scars removed.

Sean makes a life-changing decision when he elopes to Vegas to marry Teddy, while she continues to hide her past as a serial killer of men to steal their life insurance policy. But Teddy takes action when an eccentric patient recognizes her from her days as 'Nurse Dixie' and Teddy again resorts to murder to protect her charade. Meanwhile, Mike asks Chrisitan for advice on courting Kimber, so Christian takes Mike to a cross-dressing boutique. Sean's estranged daughter, Annie, comes for a visit and reveals a serious mental and medical condition, while Matt decides to continue on his path of being the 'criminal mime'.

Christian has a hard time understanding his patient's anger-management problem. She is a large-breasted exotic dancer, named Jenny Juggs, and uses her massive cleavage as a weapon. Meanwhile, Christian and Sean grow suspicious of Matt being the store-robbing mime when he suddenly had large quantities of cash. Elsewhere, Teddy persuades Sean to invite Annie and Conor on a camping trip, where Teddy waits for the right time to murder him and the two kids for Sean's life insurance money. However, Teddy runs into some trouble of her own when she has a run-in at the camp site with another serial killer who's even sicker than she... and who turns out to be a killer of women.

Sean struggles to stay sane in the aftermath of Teddy's attempt on his life and her disappearance, and Matt's situation when he is injured while attempting to rob another convenience store. The perpetually angry and bitter Julia arrives back in town and she and Sean immediately begin quarreling over Sean's lack of insight. Matt, fearing jail time, flees from the hospital and attempts to persuade Kimber to come to Mexico with him. Also, Sean deals with a shocking revelation about Teddy when her past life as a 'black widow' comes out when the police arrest her killer who was aware of her plan to kill Sean. Abigail Sullivan is a local pianist who asks Sean and Christian to surgically remove an parasitic twin from her shoulder.

Julia's crafty and controlling mother, Erica, arrives in Los Angeles with her new Italian, boy-toy husband, Renaldo Panettiere, in tow. Shortly after her arrival, Erica announces to Sean and Julia her plans to take both Annie and Conor into her sole custody, manipulating an incarcerated Matt to testify against his dysfunctional parents in the process. Meanwhile, Mike announces his engagement to Kimber, an event which forces both Christian and Kimber to reconsider their own complicated relationship. Liz attempts to fix the situation between her and Christian. Elsewhere, Christian has sex with yet another random woman, Alexis Stone, a bartender who soon reveals that she is a male-to-female transsexual who wishes to undergo surgery to become a man once again.

Christian fields surgical requests from both Alexis who wants enhancements to her trans-gender surgery, as well as Matt's cell mate, Kessler, who wants an unusual favor. Meanwhile, Julia plots to get back at her manipulative mother after years of emotional abuse. While Sean and Julia try to form a united front for custody of Annie and Connor, Erica learns troubling details about her new Italian husband, Renaldo, who is not only a gigolo but a pervert.

A medical consultation with one of Liz's friends, named Lola Wlodkowski, causes Christian to examine his romance with Kimber. Meanwhile, Sean begins to emotionally heal after an encounter with a pair of perfection seeking patients, named Tracy and Skip, who model themselves in the exact likeness of Barbie and Ken dolls.

Christian reluctantly gives banker Bjorn Nilsson's magnificent adolescent adopted son Benny plastic surgery to physically resemble his father. Afterward, he's shocked to hear the boy is shamelessly exploited at exclusive party sex. Christian extracts $400,000 from Bjorn, who even tried weaseling out of paying, but although is need of money to pay his tax arrears, hands it all to make Benny independent of the swine. Sean has taken is his brother Brendan, who once again claims to have abandoned drugs. Christian's warnings seem to come true when valuables disappear. Brendan's buddy Jay proves utterly unworthy of free surgery.

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.

Three months later, as they prepare to accept a prestigious award from their alma mater, Sean grows increasingly tired of covering up Christian's numerous indiscretions, a pattern going back to their first initial meeting in college. Kimber, now married to Christian and working as an interior decorator, heads up the remodeling of the McNamara/Troy practice, but continues to worry about Christian's fidelity. Also, a new patient named Dan Daly, suffering from the self-mutilating disorder Lesch-Nyhan syndrome, comes to McNamara/Troy for reconstructive surgery.

Kimber grows frustrated by changes in Christian's physical appearance and his lack of respect for her new career, pushing her into the arms of her newest interior design client: Sean. Meanwhile, Christian refuses to operate on a former supermodel named Willow Banks, who wants to surgically alter her face in an effort to look ordinary. Also, Sean operates on Rupert Kenney, a survivor of an 18-year coma who wants to both look and feel like his younger self.

Kimber reaches an emotional crossroads in regards to both her crumbling marriage to Christian and her secret affair with Sean. Meanwhile, Christian comes to a point of clarity over his marriage while experimenting with the dangerous sex act of auto-erotic asphyxiation. Sean reunites with his humanitarian college friend, Dr. Curtis Ryerson, and becomes interested in performing more pro-bono surgery. Also, Sean and Christian fix the face of a man who survived a suicide attempt jumping from the Golden Gate Bridge.

Kimber's suicide devastates Christian, who seeks emotional comfort with her estranged mother, Brandy, who arrives in Los Angeles for the funeral. Sean postpones his trip to Africa with Curtis out of respect for Christian's pain despite knowing that the narcissistic Christian will get over it quickly. When Curtis goes to Africa alone, Sean has an intimate encounter with Curtis' doctor wife Sarah. Sean and Christian operate on a woman, Sheila Carlton, whose face was horrifically scarred by the pet chimpanzee owned by her best friend Jane, who herself is emotionally crippled with guilt over killing the animal to save her friend's life.

Sean and Christian are forced to re-visit past actions when Aurelia Gallardo, the daughter of the deceased crime lord Escobar Gallardo, shows up at McNamara/Troy seeking answers about her late father, stirring tremendous guilt within Sean. Meanwhile, Christian's decision to operate on a small-town girl, Virgina Hayes, seeking surgery to make her a Hollywood "10" backfires, exposing an elaborate con in the process.

Sean and Christian begin group psychotherapy in an attempt to resolve their escalating problems, with both revealing long-held secrets and their true perspectives on one another. Liz joins in with therapy too, revealing her own opinions on the Sean/Christian relationship, as well as a secret she has been keeping from Christian. Meanwhile, Matt announces his plans for his own future and introduces Sean and Christian to his fiancée Ramona.

Sean and Christian face a troubling future for their practice when they discover a growing market in "injectable" procedures, which many believe will signal the death of plastic surgery. While under anesthetic during face lift surgery, Christian enters a dream world where he encounters past patients, experiences Sean's disappointments, comes to terms with Kimber's death, and he meets his late biological father. Meanwhile, Liz dates a pharmaceutical rep who is separated from her husband.

Julia visits Sean and Christian in Los Angeles to share some life-changing news, and she also rejects romantic advances from both men. Meanwhile, Matt gets a blast from his past when Ava Moore, who caused immeasurable family chaos years ago, turns up as Matt prepares to marry Ramona. Also, Liz reveals that she's happily pregnant.

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.