Sean and Christian's plastic surgeon rival Dr. Matt's one night stand with a pornographic 'fluffer' (guest star Marnette Patterson) results in a possible STD. Julia returns to undergraduate school, and strikes up a friendship with one of her fellow students (guest star Phillip Rhys). Christian's plan to seek porn stars as clients backfires. Sean fixes botched surgery on a transgender woman, and discovers he has a personal link to the hack surgeon responsible. Guest starring Sophia Bush and Roma Maffia. An obese woman requests drastic surgery in time for her upcoming high school reunion, leading Christian and Grace to butt heads over her mental state. Julia comes to terms with her parenting after facing criminal charges for flushing Frisky the gerbil down the toilet.

Grubman (guest star Ruth Williamson), who threatens McNamara/Troy with a malpractice suit after an accident during her surgery. Christian is forced to play hardball with ageing, widowed socialite Mrs. Sean operates on Matt's botched self-circumcision, while Matt discovers the truth about Vanessa (Kate Mara). Sean and Christian operate on identical twin sisters, who request surgery to look different from one another. Sean tries to encourage Liz (Roma Maffia) to return to work. Matt worries about sex with his girlfriend Vanessa (guest star Kate Mara) and her possible reaction to his foreskin, leading him to self-circumcision. Julia attempts to create direction in her life, and comes to terms with her recent actions.

Christian's feelings for Julia begin to affect his sex life. Grace Santiago, both professionally and personally. McNamara/Troy's new on-site psychologist (guest star Kevin Chamberlin) creates conflict between Sean and Christian, while at the same time Sean grows interested in an independent shrink, Dr. Guest starring Ruth Williamson and Roma Maffia. Aspiring model Kimber (guest star Kelly Carlson), the latest in a long line of Christian's conquests, discovers the ugly truth about his womanizing.

Sean's son Matt goes to Christian when requesting a circumcision. Sean's wife Julia struggles at home with her lingering feelings for Christian, stemming from a one-night stand they had together while in college. Best friends since college, Sean McNamara and Christian Troy run a successful plastic surgery practice in Miami, but Christian's unethical acceptance of $300,000 from a mobster desperate for a new face threatens both their friendship and their business.

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