San Jose Morgan Hill San Jose & Palo Alto
Most facelifts fall into one of two camps. A traditional SMAS facelift tightens the surface layer of the face but leaves the deeper anchors in place. A deep plane facelift goes underneath but often stops short of doing more than repositioning.
The Deep-ER Facelift is my answer to what I felt was missing in both.
The "ER" stands for Extended Release. It starts with a SMAS facelift, then goes further. I release every retaining ligament in the midface, because that is the only way to actually reach the sag underneath. Once the flap is free, I use it as a working tool, not just tissue to be pulled tight. I redirect it to strengthen the neck lift. I fold it over the cheekbone when a patient needs more width, projection, or a stronger upper face.
One incision. One flap. Three jobs.
The letters stand for Extended Release, and every part of the procedure is built around that idea.
of the retaining ligaments, so the SMAS flap moves freely instead of fighting its own anchors.
of the cheek, using the SMAS flap folded over the zygomatic bone when width or projection is needed.
in the neck, because the freed flap adds real lifting power to the neck component instead of leaving it as an afterthought.
One name, one operation, and a clear reason for every letter in it.
The face does not age in isolated sections. The brow, temple, cheek, jawline, and neck are connected through layers of tissue that influence one another. The Deep-ER approach is designed around that continuity.
In the midface, releasing the retaining ligaments allows the SMAS and descended cheek tissues to move upward and back toward the malar bone and ear. In the neck, a dedicated SMAS flap supports the platysma in a posterior direction behind the ear.
Here is the part most patients are never told. In my experience, and consistent with the anatomic work of Mendelson and others, the retaining ligaments of the face function as anchor points that hold their position while the tissue around them descends. The lateral face falls toward those anchors, which is what creates the jowl. The malar fat pads drop against them, which is what deepens the nasolabial fold.
You can't reach that fallen tissue surgically without releasing the anchors first. If the ligaments aren't released, a facelift can only pull on what is in front of them. That is why so many facelifts leave the midface and the nasolabial fold looking largely unchanged. The surgeon never got past the tether. Extending the release lets me reposition the tissue that actually dropped, not just tighten what's on the surface.
Most facelifts treat the neck as a separate problem. In the Deep-ER Facelift, the freed SMAS flap becomes part of the neck lift itself. The pull is stronger and comes from a deeper, more stable layer. That means better definition along the jawline and under the chin, especially for patients whose neck is the reason they came in.
For patients who have lost cheek volume or who want more structure in the upper face, I fold the SMAS flap over the zygomatic bone. This adds width and projection using the patient's own tissue rather than an implant or filler. The tissue is repositioned in a single operation and moves the way the surrounding face moves.
Cheek implants, neck lift, midface lift, filler, fat transfer. These are often stacked to try to get the result the Deep-ER Facelift produces in one operation. Fewer variables. One recovery. A more cohesive result.
The Deep-ER Facelift is designed for patients who:
It is not a mini lift and it is not a substitute for skin-only tightening. It is a full surgical lift for patients who want the deeper work done right the first time.
Every face is different, and the exact plan depends on your anatomy, your goals, and how much of the technique you actually need. During your consultation I will walk you through what a Deep-ER Facelift would look like for you specifically: how much ligament release, whether the cheek fold is part of the plan, and what the neck component adds.
Recovery is comparable to a standard deep plane facelift. Most patients are comfortable in public around two to three weeks, with continued refinement over several months as swelling resolves and the tissues settle.
I have spent years doing SMAS facelifts and studying the deep plane literature. What I kept seeing was that the SMAS flap, once fully freed, is one of the most useful pieces of tissue in facial surgery, and most techniques use only a fraction of what it can do. The Deep-ER Facelift is my way of getting every bit of value out of that flap in a single, well-planned operation.
A facelift can reposition descended tissue, but it does not automatically correct every sign of facial aging. Eyelid skin, volume loss, lip position, fine lines, and sun damage often need a different kind of treatment. The Deep-ER Facelift+ is a personalized plan that combines the structural lift with selected procedures for the eyes, mouth, and skin.
The plus sign does not mean that every patient receives every procedure. It means we look at the face as a whole and add only the components that fit your anatomy, priorities, skin type, and recovery goals.
The periorbital plan may include:
The perioral plan may include:
For patients with broader sun damage, uneven texture, or fine lines, full-face laser resurfacing may be considered as part of the surgical plan. The laser treatment is customized to the patient's skin type, medical history, and tolerance for recovery.
For some patients, the most balanced plan combines structural lifting with treatment of the eyes, perioral region, and skin. Deep-ER Facelift+ Complete is not a preset package. It is a coordinated plan built around the areas that meaningfully contribute to facial aging in that individual.
Incision placement depends on the procedures selected and the patient's anatomy. The Deep-ER incision follows the hairline and natural contours around the ear. A temporal browlift uses short incisions within the hair-bearing scalp. Upper blepharoplasty uses the natural upper-eyelid crease. Lower blepharoplasty may use a subciliary incision just beneath the lashes or a transconjunctival incision hidden inside the lower eyelid. A lip lift uses a subnasal bullhorn incision at the base of the nose. Laser resurfacing does not require an incision.
A deep plane facelift works underneath the SMAS layer, which is a meaningful step beyond a traditional facelift. The Deep-ER Facelift builds on that same deep plane foundation and extends it in two directions. First, the release of the retaining ligaments is more complete, which gives the SMAS flap more freedom to move. Second, that freed flap is then used to do more than reposition tissue. It supports the neck lift and can be folded over the cheekbone to add width or projection when the anatomy calls for it. Whether the additional steps are appropriate for a given patient depends on their anatomy and goals, which is what a consultation is for.
That pulled look tends to come from tension on tissue that has not been fully released. Releasing the retaining ligaments allows the tissue to sit in a new position rather than being held under tension. My aim with every facelift is a natural appearance, not an operated one, though individual results vary based on anatomy, healing, and lifestyle factors.
The underlying repositioning is designed to be long-lasting. You will continue to age normally after the procedure, from a new starting point. Longevity varies from patient to patient depending on skin quality, genetics, sun exposure, weight fluctuations, and other factors we will discuss in your consultation.
Age alone is not the deciding factor. Anatomy is. If your midface has descended, your jowls are forming, and your neck is showing laxity, you may be a candidate regardless of the number on your driver's license. In your consultation I will tell you honestly if a less involved procedure would serve you better right now.
Recovery is generally comparable to a standard deep plane facelift, though the exact timeline varies from patient to patient. In my practice, most patients feel ready to return to public activities in the two-to-three-week range, with continued refinement over the following months as swelling resolves and tissues settle. Your consultation will include a realistic recovery plan for your situation.
No. The SMAS-fold cheek augmentation is only used when a patient's anatomy would benefit from added width or projection in the upper face. Not everyone needs it. The technique gives me the option to include it in the same operation, without a separate implant or filler procedure, when it is the right call.
Often not, because the cheek volume in the Deep-ER Facelift is built with your own tissue rather than added from outside. Some patients choose light filler in specific areas over time. What is right for you depends on your anatomy, how you heal, and how your face changes with age.
Yes. Every surgical incision produces a scar. The Deep-ER incisions are planned within hair-bearing areas and natural contours around the ear when anatomy allows. Browlift, eyelid, and lip-lift incisions are placed according to the procedure selected. Scar visibility and maturation vary by patient.
Deep-ER Facelift procedures are performed at an accredited surgical facility, with anesthesia administered by a board-certified anesthesiologist. The surgery is performed by David Boudreault, MD.
The honest answer is that this is a conversation, not a checklist. In a consultation I will examine your anatomy, listen to what is bothering you and what you actually want, and tell you what I think would give you the best result, even if that means a different procedure or waiting.
Deep-ER Facelift+ means that the structural facelift is combined with selected procedures for the brow, eyelids, perioral region, or skin. It is a planning framework, not a requirement to have every available treatment.
No. The plan may include one additional area or several. Combining procedures depends on the patient's anatomy, health, skin type, priorities, and the amount of surgery and recovery that is reasonable in one setting.
Every patient is different. Anatomy, skin quality, healing biology, medical history, and lifestyle factors all influence what a facelift can achieve for an individual and how long the result lasts. Photographs, descriptions, and discussions of the Deep-ER Facelift on this page reflect the technique and its intended goals. They are not a guarantee of any specific outcome. The same before-and-after results may not occur for all patients. Your consultation is where we discuss what is realistic for you specifically.
If you are considering a facelift and want to understand whether the Deep-ER Facelift is the right approach for you, I would be glad to meet with you. Consultations are private, unhurried, and honest, including telling you when a less involved procedure would serve you better.
The Deep-ER™ Facelift is a proprietary surgical approach developed and performed by David Boudreault, MD, at Illuminate Plastic Surgery.
