Joan Rivers explains to the surgeons that she wants to be made into what she was, to make it look like she never had plastic surgery so her grandson can see the real her. Also, so she can become more famous.
Ava and Matt lie in bed and Matt can clearly see that she is depressed. When asked she tells him that she is tired of all the threats from his family. He offers to go to Paris with her and never return so they can be happy, even offering to steal medicine from his father so they can go.
In the operation room, Sean is about to start an operation on one of the Carver's victims when one of the assistants materialize into Escobar Gallardo. Escobar talks to Sean about making war with the Carver and trying to get him to defend himself. Escobar eventually gets Sean to shoot him in the face and then Sean wakes up at home in his bed.
Matt is busy stealing all of the medicine on the list that Ava gave him when Christian walks in and discovers what he's doing. Christian finally threatens to have him thrown in jail before Matt tells him why he was taking the pills.
Christian approaches Ava and threatens her, but Ava won't budge. Ava begins slapping, pushing, and berating him until he stops her. They begin to make out and when they begin to have sex, he pulls out and leaves in a hurry.
In his office Sean and a detective are discussing what they will do to catch the Carver when Christian walks in and tells Sean the truth about Ava. The two later meet with Julia at his house and plan on what they will do. During the planning, the detective and a security man walk out of another room telling Sean that the camera's covering the house are operational. Sean simply tells them that he upgraded the security.
A transgender meeting is going on when the doctors enter and ask to talk to Carol, the doctor who's heading the meeting. After everybody leaves Christian convinces her that Ava is in need of an operation and that they need her records. She directs them to a retired doctor.
They arrive at the mansion of Dr. Barett Moore and they learn of Ava's past. He was a gay man named Avery Tanner, who brought rich women to his conferences to raise money for him. Barett operated on him and turned him into Ava. But this was not enough to get him to love him. So they artificially inseminated Barett's assistant to produce Adrian. Again it didn't work and Ava took Adrian and left. Sean eventually gets the file from him.
Sean visits Julia and gives her the file so she can approach Ava. Sean also gives her a can of mace and tells her that he still cares for her.
Ava has lunch with Julia while Matt has lunch with Christian and Sean. Julia informs Ava that they know the truth and that she wants her to leave. Ava agrees on one condition, that she wants the final surgery to make her a woman, which Dr. Moore does himself.
Later Matt visits Ava announcing that he has the tickets to France. Ava blows up at him and breaks it off, breaking Matt's heart.
Christian and Sean call Joan into discuss the operation. Joan thinks nothing of it so they show her a computer image of what she will look like afterwards. She decides not to go through with it and announces that she might as well get another lift while she's down there.
The McNamara family has dinner with Christian and looks like their back to being a happy family. Adrian returns to Ava's house and confronts her with her not knowing that he has a knife behind his back. She tells him that they are going to Paris together and she kisses him. While they are hugging, he says he wishes he could trust her and then stabs himself.
As everybody is leaving Sean is telling everyone that he loves them and gives Julia and Christian a hug. Sean makes sure the door is unlocked and heads into his bathroom where he gets his gun. While Sean is in his bed awaiting the Carver, he or she enters a building inching his way toward his, yet unknown to us, target. Sean hears a bump, looks, but nothing. Christian suddenly wakes up to be stabbed with the Carver's needle, paralyzing him. As the Carver is above him, Christian stares upward with a tear rolling down his cheek. The Carver slashes once as Sean is still in his bed with the gun awaiting the Carver.