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The series focuses upon the relationship between Sean and Christian, friends since college and partners in a successful plastic surgery medical practice. Sadly, their lives are far from happy: Sean's marriage to Julia, who dropped out of medical school after becoming pregnant (with Christian's child, due to a one-night stand) is strained at best. Their "oldest" son Matt (an 18-year-old played by an [[Dawson Casting|actor in his late twenties]]) is a complete screw-up of epic proportions. Matt's crazy "antics" include trying to cut off his penis's foreskin by himself, seducing his girlfriend's lesbian lover, running over a young girl and disfiguring her as a result, sleeping with a 30+ year old woman who turns out to be transsexual, beating up another transsexual (who later has her friends beat Matt up and piss on him afterwords), doing crystal meth and becoming a Scientologist while being married to his real dad Christian's ex-fiancée, porn star Kimber Henry, and fathering a daughter with her, almost starring in gay porn because he can't afford baby food, burning himself while "cooking up" drugs, dating a horribly disfigured woman and then cruelly dumping her when she won't marry him, and becoming an armed robber while dressed like a mime.
On the other end of the show there is Christian Troy, the self-absorbed serial womanizer with a tragic past (his father raped his mother, who gave him up for adoption, where he was sexually abused by his foster father). Christian has multiple relationships over the course of the series, most notably being his relationship with ex-actress/porn star Kimber, who Christian once literally traded to a rival plastic surgeon for his car.
Rounding out the cast is Liz Cruz, the lesbian anesthesiologist who is the sarcastic foil to Christian and generally the voice of reason within the show.
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* [[All Just a Dream]]: {{spoiler|Christian's "funeral" in Season 3.}}
* [[And I Must Scream]]: Rhea Reynolds, a pathetic woman who cuts up her face a la the victims of the Carver in order to get attention. During surgery to fix her scars, the anesthesia is tampered with so that she is awake and can feel the doctor operate on her.
* [[Anyone Can Die]]: Supporting cast members have been offed with regularity on the show.
* [[Armchair Psychology]]: The Scientologist in season five, as they feel dishonesty is a way to repress their feelings.
** So they adjust their speech in order to hide them, instead, you mean? Honestly!
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** Or {{spoiler|Teddy Rowe}}.
** Or the convict that Matt strangled to death in his cell.
* [[Back-Alley Doctor]]: Dr. Merrill Bobolit loses his medical license after botching a cosmetic surgery on a dog, and winds up performing cheap liposuctions in the back of a Korean nail salon.
* [[Back for the Dead]]: {{spoiler|Gina}} in Season 5.
* [[Back From the Dead]]: Julia's mother dies in a plane crash. When looking through the bodies, Julia finally finds the unidentifiably charred, but still human-shaped, remains of her mother. Suddenly, the body takes a huge gasp. Terrified, and knowing the woman will not have much a chance at survival anyway, Julia smothers her with a pillow. Later, she enters her apartment, where her mother has been sitting safe and sound all along, as she decided not to take the plane today.
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* [[Break the Cutie]]: Quite a few, but most notably Cara Fitzgerald. She gets run over by Matt while he was driving and getting high and is forced to receive plastic surgery so her face can be repaired. Then she asks Matt out to the school dance, only to be rejected since Matt's friend was the one who wanted to date her. And to break her even more, Matt's friend beats ''and rapes'' her in Season 2.
* [[Break the Haughty]]: Here's a challenge: watch the entire show and then make a list of the haughties who ''don't'' get broken at least once.
* [[Broken Pedestal]]: Sean's old teacher, Dr. Grayson, shows up as a pathetic alcoholic performing underground surgery on transsexuals in a filthy apartment.
* [[Bullet Holes and Revelations]]: In the season 2 finale, {{spoiler|Adrian and Ava}} are close together and we hear a stabbing noise, {{spoiler|Ava}}'s shocked look and bloody hands, but the reveal shows that {{spoiler|Adrian stabbed himself so that Ava would never leave him again}}.
* [[Bungled Suicide]]: {{spoiler|Sean}} in Season 6, even though he claims he just [[Blatant Lies|"swam out too far."]]
* [[The Casanova]]: Christian.
* [[Chained to a Bed]]: Kimber tricks Christian into letting her tie him to a bed; she used the opportunity to torture him and get revenge after a particularly nasty break-up.
* [[Character Blog]]: Serial killer The Carver had a [[Myspace]], in which he would post videos about his motives and philosophy of life, and finally, unmasking.
* [[Clear My Name]]: In the episode "Granville Trapp," Christian was hauled into jail on suspicion of being the Carver — a hypothesis which would have demanded truly frightening devotion on his part, as both he and his partner had been Carver victims. The frame-up was, of course, {{spoiler|1=perpetrated by the actual Carver team: Dr. Quentin Costa, aided by Det. Kit McGraw.}}
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* [[Circumcision Angst]]: [[Broken Aesop]] version, in the very first episode. But then again, the show ''is'' about plastic surgery...
* [[Coitus Uninterruptus]]: Escobar Gallardo uses this to intimidate Sean. He implies that the woman he's having sex with could instead be Sean's wife.
* [[Daddy DNA Test]]: Used to establish that {{spoiler|Christian}} is the father of {{spoiler|Matt}}.
* [[Dawson Casting]]: Really obvious on Matt.
** it gets a little creepy as the actor playing Matt was dating the actress playing his mom (like Matt didn't have enough issues).
* [[Death by Sex]]: In Season 5, {{spoiler|Gina is ''literally fucked to death'' by Christian}}.
* [[Detective Mole]]: serial killer The Carver turns out to be {{spoiler|Quentin Costa}} and {{spoiler|1=Detective Kit McGraw, who's investigating the case, is his sister and accomplice}}.
* [[Deus Angst Machina]]: Everything about this show. If it can go wrong, it will a million times over.
* [[Downer Ending]]: Most of the episodes don't end well. Were the creators [[Accidental Aesop|trying to tell us something?]]
* [[Driven to Suicide]]: Most notably Nanette Babcock and {{spoiler|Kimber Henry}}.
* [[Dysfunction Junction]]: Basically every cast member.
* [[Easy Sex Change]]: One episode featured a MTF transperson becoming male again after realizing she really felt more comfortable being a gay male. Christian Troy does the surgery ASAP, without any of the prerequisites.
* [[Evil Matriarch]]: Erica Noughton, Julia's mother: witty, intelligent, and a hell of a great person to have a drink with -- unless you happen to be her daughter. It's heavily implied that her criticism and emotional absence are responsible for Julia's [[Freudian Excuse|extreme insecurity]].
* [[Face Heel Turn]]: Christian, and painfully so through Season 6.
* [[Flash Forward]]: One to 2025 that was ultimately [[Retcon|retconned]] as being a drug-fueled dream.
* [[Force Feeding]]: In the season five episode "Kyle Ainge," a rival talent agent is knocked out, taped to a chair, and killed by having teddy bear stuffing pellets forced down his throat through a machine.
* [[Freaks of the Week]]: A lot of the clients of the week were part of strange subcultures.
* [[Good Adultery, Bad Adultery]]: Played with so much it's hard to find a consistent standard.
* [[Goodbye, Cruel World]]: Megan O'Hara (Sean's first love) does this with his help after her breast cancer returns as does The [[Donnie Darko]]-esque [[Emo Kid]] Enigma, and then Kimber after she discovers that Christian is still unable to truly love her.
* [[Good Girls Avoid Abortion]]: Averted twice. In season 2, Liz had one when she finds out that the baby she's carrying would be born with Down's Syndrome. In season 6, Kimber has one when [[Jerkass]] Christian tells her that she could either choose between keeping him as her boyfriend or receive child support checks but lose him completely as he already has 3 kids and does not want another. There are some complications during the procedure and afterwards Kimber is told that she can't have kids anymore.
* [[Gorn]]: During the surgery scenes, and in plenty of other instances as well.
* [[Grand Finale]]: A somewhat subdued one that gives a fairly definitive conclusion to the series {{spoiler|with Christian forcing Sean out of the practice for good because he knows its what Sean really wants}} while still being somewhat open ended and not overly dramatic about the whole ordeal.
* [[Happily-Failed Suicide]]: Joel Seabrook.
* [[Has Two Mommies|Has Two Daddies]]: {{spoiler|1=Matt McNamara}} after [[The Reveal]] refers to {{spoiler|Sean and Christian}} as his Dads to acquaintances.
* [[Heterosexual Life Partners]]: Sean and Christian
* [[Homoerotic Dream]]: See [[Ho Yay]] in the YMMV tab.
* [[Idiosyncratic Episode Naming]]: Each episode is named after the patient(s) served by McNamara/Troy.
* [[If It's You It's Okay]]: Season five features an interesting variation on this trope. Liz Cruz, who up to this point has been a committed lesbian, discovers she's sexually attracted to her male boss Christian (but not any other guys).
* [[Incest Is Relative]]: {{spoiler|The Carver and the female police officer investigating the case}} are siblings. Who are sleeping together.
* [[Infant Immortality]]: Compared to what rest of her family goes through, the [[Mc Namaras]]' young daughter Annie gets off awfully light. The show rarely even acknowledges that her immediate family going through hell might have some kind of adverse effects on her.
* [[Insecure Love Interest]]: Christian breaks up with Natasha because he thinks she deserves better than a [[Casanova]] like him.
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** Season 6 provides the greatest example with {{spoiler|Teddy Rowe. She intended to kill Sean ''and his children'' via carbon monoxide poisoning so she could get his insurance money. After she leaves them to die, she stumbles upon a camper who just so happened to be a serial killer...}}
* [[Karma Houdini]]: In Season 3 {{spoiler|the Carver and his sister Kit}} have successfully executed their escape plan and eager to continue their crimes.
** In Season 5 {{spoiler|Eden}} was slowly poisoning {{spoiler|Julia}}, when exposed, shot her and told everyone that it was suicide attempt, asked {{spoiler|Olivia}} to preserve this secret which resulted in her death. And since {{spoiler|Julia}}'s memories about those events never returned, {{spoiler|Eden}} remains unpunished.
** In Season 6, Virginia Hayes doesn't get punished for suffocating Marcy Hamill.
** Matt seems to ''adore'' this trope. He doesn't get in trouble for running over and almost killing Cara Fitzgerald in Season 1. Or for being an accessory {{spoiler|to the murder of Ariel's father}} in Season 3. Or for burning down his apartment because he was cooking meth in Season 5. This was finally subverted in Season 6 when {{spoiler|he was turned into the police for all the stores he robbed--not to mention he got shot in a botched robbery.}} But then it was played straight ''again''; Matt didn't get a further prison sentence for {{spoiler|strangling his cellmate to death}}.
* [[Licensed Sexist]]: Arguably, Christian Troy. Pathologically oversexed, determinedly shallow, given to anything from sexual harassment on up to psychological warfare as seduction tactics (see, for example, the scene in the "pilot" where he strips his latest conquest naked, stands her in front of a full-length mirror, and uses a red lipstick to indicate flaws he finds surgically improvable), and an overwhelming fan favorite. Possibly because of the hotness, possibly because of the tragic backstory, possibly because he's the only major character who isn't an insufferable hypocrite.
* [[Lonely Funeral]]: Recurring patient/plastic surgery addict Mrs. Grubman blackmailed Christian into giving her more treatments, beyond the point of reason. Eventually, he was asked to give a eulogy at her funeral and was the only one there: she had alienated her whole family.
* [[Mad Love]]: Christian and Kimber. in the "very first episode", shortly after they've slept together, he strips her naked and covers her in red lipstick to mark the places where he thinks she could use a little surgical tweaking. She comes back. Enough said.
* [[Mall Santa]]: A drunken Sean dons the Santa outfit. He even gets a blow job from one of the helper elves. Ho ho ho!
* [[The Masochism Tango]]: Sean and Julia McNamara. The are so ungodly ill-suited for each other from the moment they appear onscreen that any other two people in the universe would have come to their senses and cut ties ''years'' ago: they tend to split up and recombine a minimum of once per season, swearing every time they do either one that ''this'' time, it's going to stick. It never does, and one wonders if even the ''writers'' can put up with their whining for much longer.
** At the end of the series, {{spoiler|they do split up for good, with Julia moving overseas with Annie and Conor.}}
* [[Morality Pet]]: Wilbur for Christian.
* [[Mother-Daughter Threesome]]: In "Cindy Plumb", Dr Christian Troy has a mother/daughter threesome with nurse Riley and her mother Jill White. When he asks the daughter if they do this often together, she reveals that the first time was when her mother walked in on her ''[[Parental Incest|making out with her stepfather]]''. He throws them out of his apartment not long after that because "this is [[Squick|too screwed up]], [[Even Evil Has Standards|even for me]]".
** On another occasion another women offers the same by essentially trying to pimp out her 17-year-old daughter along with herself in exchange for plastic surgery. Suitably disgusted, Christian declines and walks away.
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* [[No Pregger Sex]]: Christian gets physically violent with a store clerk who has sex with the woman carrying his child (even though Christian and the woman no longer have a sexual or emotional relationship). Even though Christian has sex with her later on to help reduce her tension. The implication is that Christian freaks out because the clerk has a pregnancy fetish, which makes Christian "sick" for having sex with women to whom he's attracted. Considering that Christian is the show's Casanova, this helps solidify his position as being a giant hypocrite.
* [[Once Per Episode]]: "Tell me what you don't like about yourself."
* [[Out with a Bang]]: In the [[Grand Finale]], an elderly porn star dies with a smile on his face while filming a sex scene in his latest movie.
* [[Parental Incest]]: The girl was really male, but with a rare physical deformity.
* [[Patient of the Week]]: Or "Client of the Week", depending on how you look at it.
* [[Potty Failure]]: Kate Tinsley shits herself in a hot tub after swallowing three laxatives. [[Squick|With Sean sitting beside her]].
* [[Prison Rape]]: The show managed to take the jackpot without even showing anything. All it took was one word - "anal retread". That's the type of operation a former inmate blackmails a surgeon into performing on him for free. The patient claims what happened to him wasn't gay - it was about surrendering. During the operation, the surgeon doesn't forget to turn on "How Deep Is Your Love" and mention how loose his patient's anus is.
* [[Promotion to Opening Titles]]: Several. Liz gets one in Season 2 (along with a new last name), and Kimber, Gina and Dr. Costa all get one in Season 3, although Gina was only credited for her appearances. {{spoiler|Liz and Kimber remain so until the end of the show, Gina and Dr. Costa are both dropped after Season 3, although Gina begins appearing as a guest star again.}}
* [[Rape as Redemption]]: This could be the point of the Carver arc. [[Serial Killer|The Carver]] selects beautiful models (both female and male), brutally rapes them and disfigures their faces. In one memorable case, the Carver rapes a ''male'' victim, hinted to be a [[Jerkass]] prior to the rape, making him pathetic, broken and emasculated.
* [["The Reason You Suck" Speech]]: Handed out to Christian and Sean (as well as several others) at least once per season.
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* [[Sex Is Interesting]]: Those who thought the [[High Concept]] of "a TV show about plastic surgeons" is interesting enough to hold the viewers' interest by itself will have to get used to the constant influx of sex-related plots, most of which surprisingly enough don't even involve [[The Casanova|Christian]], the one character you'd expect it of.
* [[Soap Within a Show]]: the show Sean co-starred in during season five, named "Hearts 'n Scalpels."
* [[So Beautiful It's a Curse]]: In the episode "Willow Banks", a woman wants to look ordinary because she feels her beauty is a curse.
* [[Something Completely Different]]: Season 5 and 6 of the show take place in Hollywood, not Miami.
* [[Split Personality]]: In the episode Montana/Sassy/Justice, the client has a split personality, where one personality wants her ankles fixed and another wants her breasts reduced because she is 5.
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* [[Stepford Smiler]]: Julia McNamara is half [[Stepford Smiler]] and half [[Defrosting Ice Queen]]. You have to have a little sympathy for the woman, as she ''has'' been keeping her son's paternity secret from both his natural father and assumed father. Unfortunately, her eternal struggle over "Sean or Christian?" just annoys most people.
* [[Surprise Incest]]: In season 5, Christian finds out that he fathered a daughter when he was in college. She just happens to be {{spoiler|Matt's}} new girlfriend. The [[Squick]] comes in when once {{spoiler|Matt}} realizes that he's slept with his sister, ''he wants to marry her and even goes to a website to show that any children they might have would be normal!''
* [[Swiss Cheese Security]]: Season 5 is a major offender with character Colleen Rose.
* [[Tattooed Crook]]: Escobar Gallardo.
* [[Took a Level In Badass]]: Sean in the Season 1 finale, when he found the balls to {{spoiler|point a gun at (and almost kill) Escobar Gallardo}}.
* [[Took a Level in Jerkass]]: Sean in the second half of Season 2.
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** [[Played for Laughs]] in Season 5 when Raj discovers the blowjob he received was really from a man.
* [[Victim Falls For Rapist]]: {{spoiler|Liz for Christian}}
* [[Villainous Rescue]]: In the last episode of Season 3 {{spoiler|Kit}} saves Christian and Sean from the Carver by shooting him in the back. Sounds good, huh? Not really, since {{spoiler|she is Carver's sister, they were working together all along and this is just a part of Carver's escape plan.}}
* [[Wham! Line]]: {{spoiler|"Ava's a man."}}
* [[What Happened to the Mouse?]]: Quite a few minor characters that impacted the story are cast aside with little explanation why. What happened to Cara Fitzgerald after she was raped by Matt's friend? What became of the transsexual Sofia Lopez? What happened to the neo-nazi Ariel {{spoiler|after her father was murdered by Cherry?}} Speaking of which, where did Cherry run off to? What became of Aidan Stone after he broke his neck trying to suck his own penis? What happened to Mike Hamoui after {{spoiler|Kimber killed herself by jumping off his yacht?}} The list goes on and on...
** This also seems to happen when a character is promoted to series regular. Grace Santiago was dropped with no explanation toward the end of the first season, and when Gina was added to the main cast of Season 3, she appeared a grand total of... four times. And was promptly removed and began appearing regularly as a guest star again.
* [[White Mask of Doom]]: The Carver.
* [[Who's Your Daddy?]]: has this with {{spoiler|Julia}} and the paternity of {{spoiler|Matt}}. After finding out that {{spoiler|Christian}} is his father, due to a one night stand before {{spoiler|Julia's}} wedding to {{spoiler|Sean}}, she hides it from {{spoiler|Sean}}. She reveals it to {{spoiler|Christian, Matt}}, and {{spoiler|Sean}} (in that order) causing {{spoiler|Sean}} to kick her out. {{spoiler|Sean}} doesn't treat {{spoiler|Matt}} any differently and eventually forgives both {{spoiler|Julia}} and {{spoiler|Christian}} for the affair.
* [[You're Not My Father]]: Matt says this to Christian right after the latter bails him out of jail. {{spoiler|the twist is that Christian really ''is'' Matt's father and had only found this out in the same episode. Unusually for this trope, Matt's pronouncement is actually quite accurate-- Christian isn't much of a father figure to him at all}}.
* [[Yo
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