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S04E01: Cindy Plumb
Sean and Christian celebrate 5,000 surgeries together. A 50-year-old phone-sex operator wants her voice rejuvenated. Christian begins to see therapist Faith Wolper (Brooke Shields). Julia has devastating news.

S04E02: Blu Mondae
An older man (Richard Chamberlain) brings in his boytoy for some surgery. Sean wants to help a man born with deformities. Christian does pro bono work on a stripper, much to Michelle’s dismay. Matt meets up with Kimber and finds a new method of therapy.

S04E03: Monica Wilder
Christian goes to the gym and is envious of another plastic surgeon there who’s in much better shape than he is. Julia and Sean begin looking for night nurses for their unborn baby. Christian encounters a changed Matt in the gym. Conor McNamara is born.

S04E04: Shari Noble
A woman comes to McNamara/Troy with an interesting predicament. Christian tries to seduce Michelle. Sean debates about Monica some more, with help from an old lover and a former enemy. Julia has trouble breastfeeding. Liz falls into a trap.

S04E05: Dawn Budge
A powerball winner desires liposuction for herself, a penis enlargement surgery for her husband and breast implants for her daughter. Sean proposes to Julia. Matt moves out after his parents pressure him to quit Scientology. Christian scrambles for money after James (Jacqueline Bisset) threatens to blackmail him for sleeping with Michelle.

S04E06: Faith Wolper, PHD
Christian has a homosexual dream. Therapist Faith Wolper has a tattoo removed, but ends up getting another. Christian and Michelle are in a bind when their relationship is exposed to Burt. Sean is haunted by Escobar as Monica threatens to tell Julia and the police that Sean raped her, until Sean gets a surprising solution to his situation.

S04E07: Burt Landau
Christian breaks off his agreement with Burt. Burt is incapacitated by a sudden stroke under dubious circumstances. Liz searches for a kidney donor. Sean is a match, but is concerned by the possibility of donating.

S04E08: Connor McNamara
Julia and Marlowe try to postpone Conor’s procedure after reviewing the risks. Sean reveals something about his past to Julia. A dying Mrs. Grubman makes an appointment with McNamara/Troy for one last surgery

S04E09: Liz Cruz
Liz’s new girlfriend Poppy (Alanis Morissette) pushes Liz to improve herself. James is threatened by someone, and she forces Michelle to make a very difficult decision. Marlowe wants his legs lengthened so he can be with the woman he loves…Sean’s wife, Julia.

S04E10: Merrill Bobolit
Merrill Bobolit returns, knowing some very interesting information about Sean and Christian. This information leads back to crime lord Escobar Gallardo, who blackmails the surgeons into repairing his burned face. Sean confronts Marlowe, and later the truth flows from everyone–including Matt, who shocks everyone with his news.

S04E11: Conor McNamara
A hurricane is heading towards Miami and everyone must evacuate the area. Julia discovers the only way she can take care of herself is by leaving with Conor and Annie for New York. Flashforwarding to 2026, Conor discusses his family problems with a psychiatrist as he prepares for surgery. Conor then reunites the now estranged McNamara family at a dinner to discuss his surgery. This episode is widely considered to be the single-worst of the entire series.

S04E12: Diana Lubey
A patient, who was the long-time mistress of a man, wants his ashes suspended in her saline breast implants. Sean sees therapist Faith Wolper who tells Sean of the content of her earlier sessions with Christian (breaching patient-doctor confidentiality), including Christian’s sexual identity crisis. Christian proposes marriage to Michelle, but she wants to live with him first. James is beaten by her pimp and is treated by Christian.

S04E13: Reefer
A depressed Sean begins drinking on the job and at home during the holiday season. Sean and Christian receive a special gift from Escobar. Christian regains custody of his son Wilber. Poppy (Alanis Morissette) and Liz play elves at a department store and convince Sean to play Santa. James must fill her holiday kidney quota.

S04E14: Willy Ward
Christian and Michelle begin legal proceedings to adopt Wilber, but not before Gina intervenes. Matt and Kimber try to spice up their love life, while Liz and Poppy’s (Alanis Morissette) falls apart. Kimber is haunted by her former self and her current position. Sean realizes that he is nothing more than Christian’s puppet, and has had enough. James and Michelle have their final confrontation.

S04E15: Gala Gallardo
Escobar asks Sean & Christian to perform surgery on his wife who suffered a brutal attack at the hands of his enemies. Michelle reveals her connection with Escobar to Christian. After being bought out by Christian & Michelle, Sean moves to Los Angeles to start a new life. Christian ends his relationship with Michelle and joins Sean in L.A.