Soap operas and “Nip/Tuck” are like Silly Putty, or, for that matter, the cosmetic filler Restylane. No matter how far and distortedly the characters are stretched, they always return to their original form. The two boyhood friends who share a plastic surgery practice in the South Beach section of Miami have endured all kinds of baroque twists — infidelity, abducted girlfriends, illegitimate children and a maniacal slasher — but their personalities remain fixed, unmarked and buoyant.

Most shows reach a point where they sag and suddenly strain in outrageous directions; it has happened on “Boston Legal,” “Desperate Housewives” and many others. But “Nip/Tuck” started up where most other shows leave off: willfully absurd and over the top. The third season tried to outdo the first and second, and exhausted itself. The fourth season is trying to restore the show's balance of farce and melodrama.

For one thing the writers have recognized anew that the particular procedures clients seek are integral to the series: they chart the full range of human vanities and along that spectrum produce humor and pathos in equal measure, and not merely a freak show.

Of course the love of the grotesque is hidden in plain sight in the casting. “Nip/Tuck” takes the current obsession with giving choice cameo parts to actors past their prime and runs wild with it: Larry Hagman , Brooke Shields and Kathleen Turner all have star turns in the debut episode. Richard Chamberlain and Jacqueline Bisset are featured in the second. The future holds Rosie O'Donnell and Catherine Deneuve .

One would think any show that packs in everything from breast reduction (a lap dancer seeking respect) to vocal cord lifts and testicle implants would find sufficient dramatic fodder under the knife to leave home life alone. And yet, among other things, in the second season, Sean discovered that the son he thought was his was actually Christian's. The new season is crammed with a whole new set of lurid plot lines, including lesbian blackmail, a sex-starved nanny and a sudden and alarming conversion to Scientology. (It's not Ms. Shields's, though she has told the world that Tom Cruise apologized to her in person.) There is even an unborn baby with a rare genetic malformation.

“Nip/Tuck” has always strained on paradox, and now the plastic surgeon's baby is going to be born deformed. He may require prenatal surgery, but so does the show: an ironoplasty.

The last line of the theme song fastens on the lyric “a perfect lie,” and that is what “Nip/Tuck” is nominally about: the deceptions, physical, psychological and emotional, that fill out people's lives along with their wrinkles. But what on one hand sounds like an elegant metaphor also sounds very much like a description of any daytime soap opera. “Nip/Tuck” too often turns into “General Hospital” with liposuction instead of life support, and breast implants in lieu of amnesia and evil twins.

Dylan Walsh (Dr. Sean McNamara), Julian McMahon (Dr. Christian Troy), Joely Richardson (Julia McNamara), John Hensley (Matt NcNamara), Roma Maffia (Liz Cruz), Bruno Campos (Dr. Quentin Costa), Jessalyn Gilsig (Gina Russo), Vanessa Redgrave (Erica Noughton), Kelly Carlson (Kimber Henry), Kelsey Lynn Batelaan (Annie McNamara).

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