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. They learn that Ava's surgeon was a retired doctor by the name of Barrett Moore. Avery was a homosexual admirer of his, but Barrett could not love him the way Avery wanted him to. He perfected his plan for surgery, and made Avery a woman. They married, but their marriage was not perfect. Since they could not conceive, Barrett used a surrogate, and Adrian was born. Ava could not live with the pain, so she left with Adrian when Barrett was not home. Julia confronts Ava, and tells her that she knows her secret - and that she will reveal it to Matt if she does not break up with him by the end of the week. Ava needs one more surgery before she's complete, and Sean and Christian call Barrett in to help. Barrett asks Ava if he could meet Adrian, and she agrees to let him do so.
When Matt comes home with the plane tickets, Ava gets upset by his constant mess making, and breaks up with him. In tears, Adrian comes home with a knife hidden behind his back. He once again tries to get his problems spoken. She tells him that Matt is out of the picture, and that they're going to go away to Paris together to start over. Adrian still knows something is missing, and we hear the noise of a stabbing. Adrian killed himself. He never got to meet his father. Upset, Ava decides to leave for Paris alone.
The entire family - Sean, Julia, Annie, Matt, and Christian - have dinner together, very similar to the previous season finale.
Sean repairs another victim of the Carver. Escobar lives in Sean's head as his conscious and tells him how to face the demon down. Sean decides he needs to lure the Carver to his house, and face him man to man. He has security cameras set up for protection, and brings a gun to bed with him. As the Carver creeps through the dark hallways, the Carver strikes. Sean is alone in his bedroom, and Christian has been slashed by the Carver.
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