FX’s Nip/Tuck can’t control its own impulses.

The docs have issues, but wait till you meet the  patients

Vanity may be among the themes of Nip/Tuck, the new drama on FX about plastic surgery. Conformity, virility, and disguise also make an appearance. But Nip/Tuck is also plainly about nipping and tucking. Two episodes in, it’s clear that someone on the production team (someone high up) gets a powerful kick out of seeing almost anything—from hedges to vegetables to fatty flesh—cut open, and it’s this very personal and compulsive aesthetic that makes Nip/Tuck twisted, enraged, amusing. It’s a sick, passionate show, one that seems to lack impulse control. This fundamental conceptual anarchy makes it more frightening than other macabre shows that have been more tightly auteuristic: Twin Peaks, say, or Six Feet Under.

This is pitch-black comedy, and I like it. At the center of Nip/Tuck is a pair of plastic surgeons who share a practice in Miami; their contemptuous relationship superficially recalls the lethal dynamic between the twin physicians in David Cronenberg’s Dead Ringers. Tanned and bright-toothed, Nip/Tuck’s Christian Troy (onetime soap star Julian McMahon) has an oleaginous charm while Sean McNamara (Everwood’s Dylan Walsh), his partner, hesitates and frets. At first glance, Christian is the show’s villain while twinkly Sean, a family man who believes in pro bono skin grafts, is the hero. But eventually neither man is so simple—and the cross-graining of these characters has been done with particular ruthlessness.

Sean contrives to thwart and use his bitchy wife, sexually and professionally; then he sulks and leaves her. He also pushes his mediocre moral agendas without conviction, unable to make a call on anything. And Christian, a quintessential shark with designs on Sean’s wife, does small favors for his partner—keeping him from suffocating in high-minded despair, reminding him that self-satisfaction, and überman fun, is still possible.

Around both men revolve Sean’s family: the wife, Julia (Joely Richardson, of the London Redgrave-Richardsons); son, Matt (John Hensley); and daughter, Annie (Kelsey Batelaan). Floundering in the role of head-of-household, Sean is abdicating as the series opens; with mixed motives, Christian steps in to take Sean’s role—ministering to Julia, who looks exhausted and starved, and counseling Matt, who wants a circumcision.

Who controls the men’s shared medical practice also quickly becomes an open question. Christian, who sees plastic surgery as a racket, is content to take cash and run a chop shop that preys on the disfiguring self-doubt of its patrons. For Sean, however, something is missing—a thick intuition (Cosmetic surgery has no conscience?!) that the show unexpectedly, and savagely, satirizes. It seems Sean, try as he might, can be no better than his pathetic patients, who are willing to get carved up to be perfect. And this is where Nip/Tuck gets especially dark. Sean’s paltry efforts to do charity work come off as nothing more than an ineffectual form of self-aggrandizement—a botched soul-job.

Sean’s moral thrashing is also an effort to keep pace with Christian, who’s Olympian when it comes to keeping his ego efficiently stoked. When, on Tuesday night’s episode, Christian suffers erectile dysfunction, he broods for barely a half an hour. Advised to take a strong stand (for good or evil) to regain his potency, he quickly takes such a stand—for evil, as it happens—and he’s cured.

But these are the doctors. The patients are, so far, still more flatly vicious and pitiful. There’s a child-molesting fugitive who wants a new look so he can pull in more little girls. There’s a man who has quintupled the length of his penis and now wants breadth. And, tonight, a pair of underage Doublemint twins who no longer want to look like one another—and then suddenly, tearfully, miss their sexual gimmick and want their resemblance back.

Unlike Six Feet Under,the new show’s aesthetic is thoroughly tawdry, as are its ambitions. No character, thus far, seeks anything more than sex, riches, and grubby survival. The soundtrack includes desperate, lost-weekend music like meth-head techno and the Rolling Stones’ “Paint It Black.” Heroism and tenderness plainly have no place here. The would-be whistleblower (Liz, the anesthesiologist) sticks with Christian and Sean as long as the money’s good. And Matt, who seems gentle, wants nothing more than to tear off his foreskin so he can have sex with his carping girlfriend. Nor do Christian and Sean have discussions of breast- or calf-sculpting to match Rico’s disquisitions on the art of embalming on Six Feet Under.

And then there’s the cutting. While music generally plays over the gruesome surgery sequences, the sound mix at other times is filled with the cracking of glass, the grinding of coffee beans, the scraping of zipper teeth. Julia shreds a carrot as if flaying herself; a rabid psychologist violently castrates a cucumber; and—most vividly—the McNamaras’ gardener slashes deep gashes into the family’s hedges. Everyone wants to cut. And in this remorseless punk show, it seems, they will all get their chance.