An ex-lover returns and leads Christian to a sexaholics meeting while Sean and Julia deal with an unexpected pregnancy.

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.

Ms. Caine wants an operation to get rid of her "cankles". Sean and Julia are still on the outs. Christian learns he's going to be a father. Julia steals Christian's brush to determine if he's the father of Matt. Sean and Grace learn that Ms. Caine has multiple personalities. Cara recovers and gets close with Matt and Henry. Henry develops feelings for her. Cara asks Matt to the prom. Henry tells Matt that he is going to confess to Cara what happened.

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.

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 has just turned 40, and he is already noticing it. His body is aging, and he has developed "the yips", making his performance during surgeries decline. Julia breaks the news to Sean that her mother, Erica, is coming to visit. Erica tells them that she wants a facelift - and she wants Sean to do it. Sean would prefer that Christian do it instead. Meanwhile, Christian is having problems with picky Gina, who is trying to keep Christian away from baby Wilbur, because it isn't his baby. Having his own problems with age, he is rejected by a 25-year old at a bar. Christian decides to hire a nanny, who he ends up having sex with, and later learns that she is giving the baby drugs to keep it from crying. Christian tries to convince Sean to have botox, but he refuses (at first). They perform surgery on a woman who was shot in the face nine months earlier. She is brought along by her gay friend. The two are having problems because the woman loves Chad, but Chad doesn't love her in that way, because he's in love with his boyfriend. We learn that Chad and the woman were planning on shooting each other, but she couldn't pull the trigger, so Chad was left unharmed.

During Erica's facelift, Sean panics and can't do it. Christian is having some trouble too - he's slept with Erica, the night of Sean and Julia's wedding. The surgery continues. Later that day, Christian is having problems with Wilbur, so he calls Julia to come help him. She gets upset on how Christian can't handle his own responsibilities, and snaps at him for sleeping with her mother.

Manya has had a "female circumcision" as a young child, so she wants to have corrective surgery. A man requests hair implants all over the exterior of his body. Sean meets Ava, a life-coach, and enlists her to help out Julia. In addition, Sean has problems with Erica, still staying at the house, and Christian has problems with Gina.

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.

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.

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.

Seeking fulfillment in his life, Sean becomes a surgeon for the Witness Protection Programme. A man suffering from Body Integrity Identity Disorder (BIID) threatens Christian's life in order to force him to amputate his perfectly healthy leg. Julia, Gina, and Liz develop a new skincare product that uses semen as the main ingredient. They keep the main ingredient a secret though. Joan Rivers is the first to test the product and loves it so much she decides to endorse it.

Christian still has second doubts about the wedding. Gina tries to convince Kimber to leave him. Matt's new girlfriend compares plastic surgery to the work of the Nazis.

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.

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.

Sean contrives to sell his portion of the practice; Michelle's connection with James finally ends, but not with James' boss; Gina is not happy to discover about Michelle's role in Wilbur's life; Matt tries to rekindle the spark with Kimber; and Poppy and Liz break up.

As Julia's health worsens, Christian falls back into old habits. Sean hires Gina as the new receptionist at McNamara/Troy in order to get back at Christian. Dawn Budge returns to McNamara/Troy after another unfortunate incident which requires cosmetic surgery.

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.