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.

Christian learns that Kimber and Merril are engaged. Escobar continues to have the surgeons do things for him. Liz is sent to Bermuda after being shot in the leg by one of Escobar's people. Sean goes to kill Escobar. Escobar makes a deal with Sean; a new face for their freedom. Christian learns, in the delivery room, that he is not the father of Gina's baby. Julia returns to get the paternity test she had done a while ago. The doctors do surgery on Escobar, and give him the face of a criminal even higher than Gallardo on the Most Wanted List - Armand Ortiz. Ortiz is arrested at the airport for bank robbing and killing a federal agent.

Sean and Christian learn that they have to take a test in order to continue practicing. Sean and Megan visit a doctor to learn that there is nothing they can do for her. Mrs. Grubman returns to get an operation on her and her fiancé. Christian passes his test, but Sean walks out. Megan commits suicide. Julia finds out about Sean's affair with Megan.

Sean and Christian face the challenge of separating conjoined twins. The challenge is more complicated when Sean has difficulties working with Christian after learning the truth about Matt. Their constant bickering has been causing them to lose clients.

The Carver strikes at a sorority house. His identity is revealed. Ariel's dad kidnaps Matt and Cherry. Ariel's dad forces Matt to make a life threatening decision, while the carver tries desperately to get his last minute revenge. Julia discovers that there might be something wrong with her baby.

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.

Rhea Reynolds is found dead (apparently murdered by the carver). Christian is the prime suspect. A man with a very hollow face (caused by the HIV medication that he's taking) is this episode's patient.

Old friends Sean (the family man) and Christian (the playboy) are partners in a plastic surgery office. Their relationship is under fire after Christian operates on a Colombian drug lord who pays him in drug money. Sean's family life is also in upheaval, and he is headed for a mid-life crisis.

Dr. Merrill Bobolit, who's out of jail, needs Sean's and Christian's professional services. Escobar Gallardo wants them to perform surgery on his face. And Matt tells his family that he's married and that he and his wife are expecting a baby.

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 patient named Agatha Ripp comes in to McNamara/Troy. She reveals to Sean & Christian that she had a stigmata, but she says that it was a lie she said to the church so they would accept her, and that she really cut herself. People of the town turn to Agatha for blessing and renewed faith, despite claiming to be a fraud. When a "stigmata" appears on her legs, the doctors do a blood test to learn that it is not her blood. Meanwhile, Julia is experiencing shingles, which Sean attributes to guilt or pressure, and associates it with the Matt-Ava relationship. She breaks the news to Sean that the reason she is under so much stress - he is not Matt's father. Sean goes insane and aggressively hurts Julia. He rampages into the office where he beats Christian to the ground. He turns to the church, where he meets Agatha. She reveals everything was fake, and that a sister from the church snuck in and punctured her, and left her own blood so the church would not cut her program. Meanwhile, Liz reveals she is pregnant, but shuts Christian out, who wants to care for the baby. She experiences bruising and spotting, causing her to worry about 'the unknown'. Despite being impacted by Agatha, Liz has an abortion without telling Christian, who is upset that she got rid of the baby because she felt it would be handicapped.

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.

Sean and Christian are reunited with an old friend, Julia bonds with Sofia Lopez, and Christian and Gina clash over their differences in opinion concerning Gina's pregnancy.

Sean and Julia discover Matt has tried to circumcise himself. The business is sued by a faithful client after Sean accidentally leaves a surgical tool inside of her body. Meanwhile, Christian and Grace struggle with a mentally unstable patient.

A plane crashes just after take off in Miami. Julia's mother might be one of the passengers. Christian, Sean, Julia and Liz are all trying to save the lives of the people that survived the plane crash.

Twin sisters want plastic surgery done to look different from each other. Sean moves out so he can experience life as a single man. Matt decides to try and perform a circumcision on himself after his girlfriend sees his penis. Christian is plagued with thoughts of Julia.

Sean and Christian are perform a mico-liposuction on Joy Kringle, a woman who acts as Mrs. Claus during the Christmas season. During her lipo they find a seventeen year old fetus inside her. Julia is not feeling well. A blood test performed by Sean reveals why. She is pregnant.

Sean and Jude's respective secrets are revealed, and Merril offers Christian an interesting trade: Kimber for a Lamborghini. Christian accepts, but Kimber discovers the truth and exacts a small revenge.

Beauty is a curse on the world. It keeps us from seeing who the real monsters are. Another victim of the Carver shows up to have his face fixed - this time it is a male, who was both raped and carved. They agree to fix him. A local news station does an interview with Sean about the pro bono work on Carver victims. The Carver finds his way into Sean's home. After Sean gets out of the shower, the Carver drugs him up and has a conversation with him. He slices his right cheek, and tells him that if he fixes another one of his "masterpieces", he is going to kill him. Julia helps him recover, and Sean tries to win her back - but she reminds him that she is happy with Kevin. Meanwhile, Gina tells Christian that she is HIV positive, meaning that Christian may be also. He calls his past lovers, including Manya, Erica, and Grace. He visits Kimber on the set of a porn movie, which she is directing. She tells him that she got tested quite recently because she's in the business, and that she's clean, which slightly relieves Christian. He has one more call to make - James and Wilbur (now known as Gabriel). They both come to visit, and Christian becomes very emotional. Christian's tests come back negative, and he visits Gina in the hospital with the good news. He lies down next to her in her hospital bed after a heartwarming conversation, and they fall asleep together.

Someone is vandalizing Christian's possessions, and he attempts to find the culprit. A chemotherapy patient who is considering breast implants brings excitement to Sean's life, and Matt finds himself in a threesome with Vanessa and Riley.

After a car accident due to cell phone use, Sean winds up in the hospital. As a result of the accident, Sean develops a phobia of driving and other dangerous things, causing a dent in his career. He thanks the car company because their safety features saved his life. The car company, wanting a point of view from this doctor who has been in a car accident, offers Sean a new car if he agrees to inspect the cadavers they use as crash test dummies after crash tests. Sean tries to take more risks, causing Julia to become upset. Trying to take more risks, Sean decides to go shark diving, and drags Matt along with him. After realizing how much he cares for his son, Sean decides not to follow through. Christian is reminded that his son is no longer in his life, and he turns for comfort in Julia, who reveals to him that Wilber is not his only son.

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.

Matt accidentally hits Cara with Henry's car, and calls Sean in to help when Cara's mother, for religious reasons, refuses drugs and surgery to treat her injuries. Christian discovers that a patient used plastic surgery to hide a revolting crime and it brings up terrible memories of his own childhood.

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.

Sex gone wrong causes Christian to break his nose, but Christian is worried that Sean's medical condition will keep him from performing the corrective surgery. He consults a rival (female) plastic surgeon across town. Christian and Gina have sex, but she gets upset when Christian tells her that he's imagining the female plastic surgeon instead of her. Gina tells him that he looks hideous, so Christian decides to operate on his nose himself, which goes terribly wrong. Christian, trying to show that the McNamara-Troy partnership is worth something, tells Sean that he wants him to fix his nose. When Sean panics, Christian decides to go through the surgery without anesthesia, so they can do it together. Sean performs the surgery successfully. Meanwhile, Matt learns that Harry has been arrested for raping Cara Fitzgerald, and that Harry has told the authorities about the hit-and-run, and that Matt was involved. While under oath, Matt says that he had no involvement with the car accident.

Natasha Charles, a blind woman, comes into have work on her eyes so she won't appear blind. Christian begins to fall for her, and he learns a great deal about beauty from her. In an attempt to get Sean back, Julia goes to a female plastic surgeon to have breast implants. Erica visits Julia in her new apartment, and has become upset with her new lifestyle. Erica talks to Sean, and he gets mad at her also. Natasha goes out on a blind date (no pun intended) with another blind person. Christian, at the same restaurant, tells him that she is not pretty like the man had hoped, and he leaves. Christian joins Natasha, and they go home together for an intimate night.

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.

A woman wants surgery to make her look like her when she was younger, to jog her Alzheimer-stricken husband's memory. Christian and Sean work on another Carver victim, who does not have the same physical attributes as the other victims.

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.

Sean discovers the secret between Christian and Julia. A hospitalized Matt bonds with his rehabilitation counselor. Eden suspiciously makes peace with Julia. Kimber and Ram reveal their future plans.

After being rejected by Kimber on account of his post-surgery scars and with his chemotherapy making him sick, Christian seeks support from Liz, which leads to a surprising sexual encounter between them. Sean discovers his new lover (Jaime Ray Newman) has a disturbing fetish, and further alienates Julia and Matt when they learn that he has been faking his need for a wheelchair. Raj has a life-altering sexual encounter with the wife (Beth Gargan) of McNamara/Troy's latest patient.

Christian refuses to perform surgery on a model who wants to drastically alter her beauty. Awakening after a decades-long coma, a new patient seeks surgery from Sean in order to regain his lost youth. Kimber redecorates Sean's new apartment.

A medical consultation with Liz's friend leads Christian to contemplate his relationship with Kimber. Sean begins to heal emotionally following an encounter with a perfection-seeking patient.

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

Secrets are revealed and past pains are uncovered as Sean and Christian begin psychotherapy together. Liz and Matt divulge their own confidences when they each join a therapy session.

As Season 6 begins, Christian has news for Liz and the economic downturn has hit McNamara/Troy hard. But the boys might have found a lifesaver in Dr. Mike Hamoui (Mario Lopez), who's now in L.A. and has found a very profitable niche specialty. Meanwhile, Sean's relationship with Teddy Rowe (now played by Rose McGowan) has blossomed, and Matt, who's down on his luck, takes up mime.

When Sean and Christian win a prestigious award from their alma mater, Sean recalls their college years and endures past pains. A new patient who self-mutilates due to a genetic disorder comes to McNamara/Troy for reconstructive surgery.

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.

Christian has a crisis of conscience when Kimber's mother Brandy visits Los Angeles. Complications arise as Sean prepares for his trip to Africa. A patient requires multiple cosmetic procedures after suffering an attack by a wild animal.

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.

Concerned that cosmetic surgery is no longer in vogue, Sean and Christian make a unique attempt to market their surgical practice to boost a lagging clientele. Liz goes on a date with a pharmaceutical representative who is separated from her husband. Christian's unconscious existential crises, including his loss of Kimber, come to light.

Christian's colossal financial debt leads him to deception. An unexpected visitor stirs insecurity within Christian and brings joy to Sean. Christian bonds with a young patient when he learns about his adoption.

It's the year 2026. Conor is getting the whole family together. In the present, Julia and Sean's marriage is at a crossroads.

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.

Christian struggles to understand a patient with big anger-management issues. Sean and Christian learn how Matt is earning an income, despite his attempts to keep it hidden from his family. Teddy arranges a camping trip with Sean, Annie and Conor in order to ease family tensions.

Sean experiences an ethical and moral dilemma when McNamara/Troy is requested to perform a surgical procedure on a prison inmate. Kimber questions how far she will go to keep Christian when they receive life-changing news.

Sean makes an important decision without consulting anyone; a morose Annie shows up in L.A. with a troubling medical condition; Christian gives Mike (Mario Lopez) tips on how to satisfy Kimber; and a new patient recognizes Teddy.

Liz's new gilfriend, Poppy, wants her to have cosmetic surgery. James makes Christian and Michelle help her steal another kidney. Sean offers consultation to Marlowe, who wants longer legs.

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.

Sean and Julia make a big decision regarding their unborn baby. Christian and Sean hit troubled waters with their new boss and begin to realize what it really means to have sold their business. Matt's family doesn't quite get his decision to pursue a new path in his life.

After having a nipple bitten off by her dog, Shari Noble comes in to have it reconstructed before her husband returns from Iraq. Julia meets a breast-feeding expert. Christian and Liz hit a lesbian bar where Christian tries to attract one of the women there but she's attracted to Liz instead. Sean and Christian meet with a kidney specialist for one of their patients.

Matt is getting out of control, and Sean, Julia and Christian are trying to find a solution. Quentin and Christian help two students whose faces are glued to the behind of a third student. Christian starts losing interest in the threesome relationship between Kimber, Kit, and himself. He asks Quentin to get involved with Kit to take her off his hands.

Sean drinks to a great extent as he spends a depressing Christmas without his family; Christian gets an surprising gift when a 3-year old Wilber comes back into his life; and James pressures Michelle to help as she takes forceful measures to fill her holiday kidney quota.

Christian decides to employ Dr. Logan Taper for the practice, while Sean is revisited by a former client from Miami to have plastic surgery so she can attract suitors once her husband dies.

A series of unfortunate events unfold for an unlucky Dawn Budge, who seeks reparative surgery from Sean and Christian. Annie and Eden start to form a sisterly bond, which unnerves Sean.

Matt becomes envious of Sean and Raj bonding together. Christian and Liz give their relationship another chance. Raj's father pays a visit to see his son.

A patient inspires Sean to take his relationship with Kate in a new direction. Eden uses extreme methods to persuade Christian to perform surgery on a friend. Kimber reaches out to an former business associate when she and Matt fall on hard times.

Sean soon discovers that Monica Wilder doesn't intend to leave him alone. Christian's therapist has an obsessive torment to reveal. And Burt Landau proposes an unusual solution upon learning that Christian and Michelle are having an affair.

Sean and Christian learn about the glamorous side of fame and the price that many are willing to pay for it. Julia visits Sean, Christian and Liz in Los Angeles with a surprise announcement.

Sean experiences the ugly side of Hollywood in the form of a television critic. Matt experiences a special bond with one of Christian's patients. The cause of Julia's ailing health is discovered.