Sean y Christian luchan por mantener la empresa durante la crisis. Matt y Kimber obtienen resultados mixtos en sus carreras.

Christian y Kimber montan un negocio juntos, mientras que Sean busca una solución para su insomnio.

Sean toma una decisión que cambiará su vida. Christian aconseja a mike sobre su relación.

Christian tiene problemas para comprender la ira de un paciente. El secreto de Matt sale a la luz. Teddy, Sean, Annie y Connor van de cámping.

Julia vuelve de Nueva York para ayudar en su recuperación de la cirugía. Sean descubre detalles escabrosos de su matrimonio con Teddy. Uno de los pacientes sufre una ansiedad extrema.

Sean intentó suicidarse, la madre de Julia quiere la custodia y Christian está celoso de Kimber al verla con otro. Alexis deja a Christian en shock.

Alexis vuelve a visitar Christian con la dudosa petición de Matt. Sean y Julia se vengan de Erica y se revela algo preocupante sobre su nuevo marido.

Christian conoce a una amiga de Liza y descubre su otro lado. Sean tiene dificultades para superar una difícil consulta con una pareja muy exigente.

Christian tiene que enfrentarse a una deuda creciente y Sean recibe una visita sorpresa...

Sean vacila cuando a McNamara/Troy les pide que operen a un preso. Kimber recibe una noticia que cambiará la vida de Christian.

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 y Christian comienzan la terapia de grupo en un intento por resolver sus problemas crecientes, revelando ambos secretos guardados por mucho tiempo y sus verdaderas perspectivas sobre el otro. Liz también se une a la terapia, revelando sus propias opiniones sobre la relación entre Sean y Christian, así como un secreto que ha estado ocultando de Christian. Mientras tanto, Matt anuncia sus planes para su propio futuro y presenta a Sean y Christian a su prometida 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.