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.

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.