Sean and Christian have relocated their practice from Miami to Los Angeles. Being new to the city they find themselves having to start from scratch business wise. What they thought would naturally fall into place turns out to require some foot work. So Christian and Sean hit the town and begin discovering a whole new world.
It's been two months since the duo moved to the new town and they yet to have a single consult. As the doctors shoot some hoops to kill the time, their anesthesiologist, Liz, enters telling them that the repo man is there, collecting their tropical fish. After convincing the repo man to give them another week, the three talk about their future. Liz thinks the guys are in over their heads but Christian still has hope. As a last ditch effort, the doctors decide to hit the club and go pick up some girls in order to get some business.
After getting all done up, the boys hit the town, talking to all the ladies they meet in the club. Unfortunately, they're not having any luck, as it seems that every girl they meet has already had work done and has a plastic surgeon they use. After spotting the one woman at the bar who doesn't appear to have any work, Christian and Sean decide to double up the older lady to convince her get some surgery. Even though they get shut down once again, they stumble on what may be an opportunity. Fiona McNeil, the lady they talk to, is publicist and explains that in order to become successful in L.A. they either need to work on a celebrity or become celebrities. She offers them her expensive services, which Christian pays for using his son's nanny money. She then offers them a gig as the surgical consultants for a new show about surgeons called "Hearts n' Scalpels."
The doctors watch the show, which is basically a parody of Nip/Tuck itself, and mock the surgical techniques and the unrealistic medical situations. After watching the show, they wonder if associating with the production will harm their careers. Before they reach their decision, however, they get their first surgical consult. The guy is a big-shot studio exec with a bad sadomasochism fetish which he blames on the high stakes of his profession. Since he has a family summer vacation coming up, he needs the doctors to get rid of all of the scars and cuts on his body inflicted by his dominatrix, played by Tia Carrere, and also wants to keep the surgery below the radar of any of his circles, which is why he went with the unheard of McNamara/Troy. The partners agree and patch the guy up, though they are not happy about it, claiming that dealing with clients of this kind is beneath them.
The next day they meet with the producer, Freddy Prune. Freddy asks what they think of the show and, though Christian tries sucking up, Sean is honest and tells him the show is terrible. At this point, the lead actor of the show, Aidan Stone, shows up and yells at Freddy for making a horrible show, threatening to leave. As Freddy breaks down and cries, Christian smells an opportunity.
When Freddy complains about not having any surgical ideas, Christian offers one of their old cases as the plot of the show, particular where the client burned her lips and needed tissue transplant from her unmentionables to do the procedure. Freddy loves this. Going for more, Christian says that they can give him their cases, but not if they are just consultants. He asks for production credit and lines in the show to which the producer agrees.
Next we are introduced to Carly Summers, the namesake of the episode. Carly is a client of Christian and Sean's publicist and is in for a consult at the publicist's request. She is up for a new role, and wants to make a statement that an older woman can compete for roles without plastic surgery. Her publicist disagrees, saying that this is the only way she'll get the part. Carly asks Christian if maybe she should just get some botox to start out, to which he states that she doesn't need any surgery, assuring her that she is beautiful.
Unfortunately, Christian's motives are not nearly as noble as we are led to believe. As he prepares for his date with Carly that night, Christian talks about how they will never get famous from a little botox, and is only going on the date to convince to get major surgery.
Later Sean is woken in the middle of the night from a call from Liz at the office. He arrives there to find Bob the exec getting all his wounds reopened as his personal dominatrix punishes him. Sean authoritatively tries to kick her out of the building which clearly interests her. Even while being yelled at by Sean, she continues to verbally berate her client.
Back at Carly's place, we learn that Christian's moves work on both coasts as the two lay in their bed. Christian then starts with his plan, continuously turning on lights while she tries to get dressed in order to focus on her shyness. After asking her repeatedly why she is so insecure with her body, he notices a large photo of her taken 14 years earlier. After, again, convincing her that she is still gorgeous, she asks for his honest opinion in what it take to make her look the same as she does in that old picture of her. Borrowing a stick of lipstick, he goes to town on the photo, marking up all the areas on her body where he would do work. She's visibly hurt as apparently this move works on both coasts as well.
The next day at the set, the doctors are meeting with the actors, doing a dress rehearsal of the scene with Jennifer Coolridge, who plays the woman receiving the lip transplant surgery. When Sean tries offering tips to Aidan, the show's lead, the actor throws a fit claiming to not want to learn the moves, despite that Sean claims it will make him seem more credible. When Christian tells him to wear the surgical cap, he gets even angrier claiming that his hair is the main draw of the show, going so far as to make fun Christian's receding hairline. He's interrupted when Sean, taking taking some points from the dominatrix he met earlier, takes control and yells at the actor. This quiets Aidan down, who agrees to listen to the two real doctors in the room.
The next day at the office, Christian, affected by the young actor's remarks, asks Sean to give him hair-plugs in order to look better on camera. At the same time, Carly comes in, after losing the role to Cameron Diaz, asking for Christian to give her the surgery. This leads in to the token musical surgery portion of the show, as Christian and Carly's surgeries are paralleled.
The next night as Sean reads a letter from his son, Matt, Christian comes in freaking out about his plugs. Apparently they have become infected and he is worried about how they will look on camera. When they show up the next day for their big scene, the producer and director are uncomfortable with his lines and appearance on camera and intentionally shoot Sean instead.
They return to the office as the dominatrix is again leaving Bob's room. Apparently he was promoted and needed to be punished even more. They go in and he looks terrible, claiming that it is only a matter of time before this town claims them too. Christian then goes in to check on Carly's room, who is complaining about the pain.
That night the partners, Liz and Wilbur all sit down to watch their big scene in the new show. Christian is infuriated when he discovers that his scene has been cut and, instead, the scene focuses on Sean. Things are made worse the next day when, getting lunch, Sean is bombarded by fans of the show, asking for his business card after discovering that he's an actual surgeon.
After Sean gets done going over a surgical procedure with the now overly eager lead actor, the dominatrix makes one last appearance, offering Sean her business card, claiming that he'll need her services sooner or later.
After that we see Christian, who is jealous of Sean's new celebrity status and success, anonymously calling a tabloid magazine to leak Carly's surgery in order to promote himself as a surgeon. Apparently in Hollywood, their roles have been reversed.