Depending on the extent of the facial plastic surgery, the process generally takes four hours. The surgeon begins the incision in the area of the temple hair, just above and in front of the ear. The route then courses around and through portions of the ear, a strategy that helps hide much of the incision.

For men, the incision is plotted to accommodate the natural lines of the beard. In all cases, the incision is strategically placed, so that with normal movement of the head or with aging, observers see what looks to be a completely natural crease along the side of the ear and neck.

During the bi-vector facelift, the skin of the face is raised outward so that the surgeon can reposition and tighten underlying muscle and connective tissue (using non-absorbable, or permanent, sutures) in a vertical direction. Depending on the patient, the surgeon may remove excess skin and fat. When the tissue removal and tightening is complete, the skin is redraped naturally to avoid the “pulled” appearance associated with the skin-based and deep-plane facelifts. The incisions are closed using fine sutures that eliminate the need for shaving hair from the incision sites. Sterile dressings may be applied to the incision sites to protect the sutures and help promote healing.

Some patients, for instance chronic smokers, may not be candidates for the bi-vector facelift.