Sean weighs a major decision concerning the practice, and Michelle's dark past comes to light, threatening her relationship with Christian. Meanwhile, Escobar seeks cosmetic surgery for his wife, who was attacked by an enemy of his.

Sean comes to a decision regarding his future, but first he performs a face-lift on a ventriloquist who tells him he needs the surgery to "compete" with his puppet. Meanwhile, Gina returns with a request regarding Wilbur that Christian is not inclined to grant; James ends her association with Escobar; Matt attempts to rekindle the spark with Kimber; and Liz breaks up with Poppy.

Sean drinks heavily as he spends a gloomy Christmas without his family; Christian receives an unexpected gift when a 3-year-old Wilbur comes back into his life; and James forces Michelle to help as she takes drastic measures to fill her holiday kidney quota.

Christian proposes to Michelle even though he doubts his ability to maintain a long-term relationship; a lonely Sean takes a morbid case for reasons that have as much to do with himself as with the patient; and James wants to use the McNamara/Troy OR for her own operations.

The episode starts out with Conor, now at 20, having a discussion with a psycologist. Conor is finally at long last, having his re-constructive surgery on his right hand, in just two days. But before the surgery takes place, Conor wishes to tie up some loose ends of his past, which is why he is seeing a psychologist.

Merrill Bobolit returns, knowing some very interesting information about Sean and Christian. This information leads back to crime lord Escobar Gallarado, who blackmails the surgeons into repairing his burned face. Sean confronts Marlowe, and the truth flows from everyone, including Matt, who's news shocks everyone.

Liz has cosmetic surgery at the request of her new girlfriend, Poppy; a desperate James uses Christian to lure Michelle into helping her steal another kidney; and Sean offers a surgical consult to Marlowe, who wants a leg-lengthening procedure in order to impress the woman he loves.

A secret from Sean's childhood compels him to move up Conor's surgery, despite Julia's apprehension and Marlowe's objection. Mrs. Grubman visits Christian to make her final request for cosmetic surgery. Julia and Marlowe use Conor to mask their changing relationship.

Liz collapses at work, because her sole kidney is only working at 10% anymore. Christian and Sean are going to take the test if they can donate one of their kidneys. Burt Landau wants a re-constructive surgery for his face after a stroke caused by the side effects from Viagra.

Therapist Faith Wolper asks Christian to remove a tattoo from a sensitive area of her body, and Burt Landau asks him to remove something from a sensitive area of his body. Later, Burt hits a nerve with Christian and Michelle. Meanwhile, Sean and Julia's second honeymoon is jeopardized by nurse Marlowe Sawyer's illness, but Monica Wilder volunteers to fill in. Sean doesn't think it's a good idea.

A lottery winner wants Christian to perform extensive plastic surgery on her---and her husband and daughter. Christian does so, and more. He can certainly use the money because James is blackmailing him over his affair with Michelle. Elsewhere, Christian and Sean try to win Matt's affection with a Porsche, but he's leaning toward Kimber and Scientology; and Sean buys an engagement ring for Julia.

Shari Noble comes in with one of her nipples bitten off, apparently by her dog. She wants it reconstructed before her husband returns from Iraq. Christian goes to a lesbian bar with Liz, where he tries to attract the attention of a woman but she's attracted to Liz instead. Sean and Christian meet with a kidney specialist for a patient of theirs. Julia talks with a breast-feeding expert.

Sean and Julia interview a possible nanny. They both like her a lot. Sean got a hybrid car. Christian goes to the gym and is envious of another plastic surgeon there who's in much better shape than he is. Christian encounters a changed Matt in the gym.

A rich gay man wants to have his younger boyfriend's face remolded in his image, but Christian thinks it's a bad idea. Christian also performs a breast reduction on a lap dancer for free, but new boss Michelle thinks that's a bad idea. She also doesn't approve of Sean's pro-bono work for a disfigured young man. Meanwhile, Matt runs into Kimber, who introduces him to Scientology.

While celebrating their five-thousandth surgery, Christian and Sean meet Jill and Riley White, mother and daughter – whom Christian takes home to help with his celebration. Christian is very attracted by Riley; but ever since his break-up with Kimber, he hasn't been able to have a stable relationship, and refuses to kiss either of the girls. He starts to consult with a shrink about the direction that his life has taken and the shrink brings up some very interesting questions about his relationship with Sean.