San Jose Morgan Hill San Jose & Palo Alto
The Deep-ER™ Facelift is an advanced deep plane face and neck lift developed by David Boudreault, MD, FACS. The procedure focuses on extended release of the midface retaining ligaments, allowing descended facial tissues to be repositioned rather than pulled. Deep-ER™ may improve the cheeks, jawline, jowls, and neck while maintaining a natural appearance. Patients should expect more lifting and tightening than traditional deep plane facelift surgery.
Facial aging is not simply loose skin. Over time, the deeper tissues of the cheeks and midface descend, jowls develop along the jawline, and the neck loses definition. A natural-looking facelift should address those structural changes without making the face look tight, pulled, or fundamentally different.
The Deep-ER™ Facelift is David Boudreault, MD, FACS's proprietary approach to extended deep plane facelift surgery. It was developed to address the midface, cheeks, jawline, and neck as connected parts of the same aging process.
The defining principle is Extended Release. Dr. Boudreault releases the retaining ligaments of the midface so that descended facial tissues can be mobilized and repositioned rather than simply pulled against their existing anchors. Once released, the SMAS flap becomes a versatile surgical tool: it can reposition the face, reinforce the neck lift, and, when appropriate, be folded over the cheekbone to add structure using the patient's own tissue.
One incision. One flap. Three jobs.
The Deep-ER™ Facelift is Dr. Boudreault's approach to an extended deep plane facelift and neck lift.
Traditional facelift techniques and modern deep plane facelifts differ in how surgeons access, release, and reposition the deeper tissues of the face. Dr. Boudreault developed Deep-ER™ around a specific principle: to reposition descended tissue effectively, it first has to be adequately released from the structures tethering it in place.
The procedure begins with mobilization of the SMAS, the strong supportive layer beneath the skin that is intimately related to the muscles and soft tissues of the face. Dr. Boudreault then performs an extended release of the retaining ligaments through the midface.
Once the SMAS flap has been sufficiently freed, it can move without fighting against the same anchors that held the descended tissue in place.
Extended Release of the retaining ligaments allows the SMAS and descended facial tissues to move more freely.
Enhanced Reshaping allows Dr. Boudreault to reposition the midface and, when indicated, fold a portion of the patient's own SMAS tissue over the zygomatic bone to enhance cheek width or projection.
Elevated Results through the lower face and neck are supported by redirecting the released SMAS flap to reinforce the neck-lift component.
Release. Reshape. Elevate.
That is the philosophy behind the Deep-ER™ Facelift.
To understand the Deep-ER™ Facelift, it helps to understand what happens beneath the skin as the face ages.
The retaining ligaments of the face act as attachment points between the soft tissues and deeper facial structures. As surrounding tissues descend with age, these relatively fixed points can contribute to characteristic patterns of facial aging.
In the lower face, descending tissue contributes to jowling and loss of a clean jawline. In the midface, descent of the cheek tissues can flatten the upper cheek and contribute to deeper nasolabial folds.
You cannot freely reposition tissue that is still tethered in place.
In Dr. Boudreault's approach, releasing the midface retaining ligaments allows him to mobilize the tissues that have actually descended rather than relying primarily on tension from the skin or more superficial tissues.
This is the central idea behind Extended Release: release first, reposition second.
The goal is not to pull the face tighter. It is to restore deeper facial tissues to a more youthful position and allow the skin to redrape over that underlying structure with less dependence on skin tension.
A deep plane facelift works beneath the SMAS and releases facial retaining ligaments so the deeper tissues of the face can be repositioned as a connected unit.
The Deep-ER™ Facelift builds on that deep plane foundation.
Dr. Boudreault extends the ligament release through the midface and then uses the mobilized SMAS flap for more than facial repositioning alone. Depending on the patient's anatomy, that same tissue can help support the neck lift and can be folded over the cheekbone to enhance cheek structure without a separate cheek implant.
The result is not a predetermined set of surgical maneuvers performed on every patient. Deep-ER™ gives Dr. Boudreault a broader set of options within one operation, which he uses selectively based on the patient's anatomy.
Traditional SMAS facelift: Works with the SMAS to improve facial laxity, but the extent of ligament release varies by technique.
Deep plane facelift: Works beneath the SMAS and releases key retaining ligaments to mobilize deeper facial tissues.
Deep-ER™ Facelift: Uses an extended midface ligament release and then strategically uses the mobilized SMAS flap to reposition facial tissues, reinforce the neck lift, and, when indicated, add cheek structure using the patient's own tissue.
There are many valid approaches to facelift surgery. The Deep-ER™ Facelift is not a universal medical category or the right operation for every patient. It is Dr. Boudreault's proprietary approach to extended deep plane face and neck rejuvenation.
One of the principles that shaped Dr. Boudreault's technique is simple: tissue that remains tethered cannot move freely.
The retaining ligaments function as facial anchor points. As surrounding tissue descends with age, those attachments remain relatively fixed.
Dr. Boudreault's extended release is intended to free the descended midface tissues so they can be repositioned directly. Once the deeper tissues have been mobilized and supported in their new position, the skin can be redraped without asking the skin itself to provide the lift.
This distinction is central to Dr. Boudreault's goal: a face that looks repositioned rather than pulled.
Patients rarely age in isolated zones. Midface descent, jowling, loss of jawline definition, and neck laxity frequently occur together.
Rather than viewing the neck as completely separate from the facial lift, Dr. Boudreault uses the released SMAS flap as part of the structural support for the lower face and neck.
The specific neck-lift technique depends on each patient's anatomy. Some patients require more extensive neck work than others.
The goal is continuity: cheek to jawline to neck, rather than treating each area as an unrelated problem.
Not every flattened or aging cheek is simply 'missing volume.' In many patients, tissue that once created upper-cheek fullness has descended lower on the face.
When additional cheek width or projection would improve facial balance, Dr. Boudreault can fold a portion of the released SMAS flap over the zygomatic, or cheek, bone.
This creates additional structure using the patient's own living tissue rather than automatically adding a cheek implant or relying on repeated dermal filler.
Not every patient needs this step. For some faces, repositioning alone creates the desired cheek shape. For others, SMAS-fold cheek augmentation provides an additional option within the same operation.
Facial aging may involve the midface, cheeks, jowls, jawline, and neck simultaneously. Depending on the patient, addressing these concerns can require multiple surgical or nonsurgical treatments.
The Deep-ER™ approach allows Dr. Boudreault to evaluate these areas as a connected anatomical system and determine which components can appropriately be addressed during one surgical plan and one recovery.
It does not replace every facial procedure. Upper or lower eyelid surgery may still be appropriate for aging around the eyes. Brow surgery may be needed when brow position is contributing to the patient's concerns. Laser resurfacing or other skin treatments address pigmentation, fine lines, and skin quality that a facelift cannot correct.
The goal is not to perform more surgery. It is to perform the surgery that the patient's anatomy actually requires.
The Deep-ER™ Facelift is designed for patients who need meaningful structural facial rejuvenation rather than limited skin tightening.
There is no single best age for a deep plane facelift. Some patients develop meaningful facial and neck laxity earlier than others. Skin quality, genetics, facial structure, weight changes, previous procedures, and the position of the deeper tissues matter more than the number on a driver's license.
If your facial aging is still limited, Dr. Boudreault may recommend a smaller procedure or no surgery at all.
A Deep-ER™ Facelift may improve midface descent, flattened or descended cheeks, jowls, loss of jawline definition, facial and neck laxity, selected changes around the nasolabial folds, and loss of cheek structure in appropriately selected patients.
A facelift does not directly correct every sign of facial aging. It does not replace eyelid surgery for significant upper- or lower-eyelid aging, resurfacing treatments for sun damage and fine surface lines, or brow surgery when brow descent is the primary concern.
During consultation, Dr. Boudreault evaluates the face as a whole and recommends additional procedures only when they address something the facelift itself cannot.
Every operation begins with a detailed assessment of facial anatomy. Dr. Boudreault evaluates where the midface and lower-face tissues have descended, where tissues remain tethered, the shape and projection of the cheeks, the jawline, skin quality, and the anatomical causes of neck laxity.
The incisions generally follow established facelift patterns and are carefully placed around the hairline and ear and behind the ear into the scalp.
Through these incisions, Dr. Boudreault mobilizes the SMAS and performs the planned ligament release. The deeper facial tissues are repositioned to restore facial contour, and the released SMAS flap can be redirected to support the lower face and neck.
If the patient's anatomy would benefit from additional cheek structure, a portion of the SMAS can be folded over the cheekbone before closure.
The skin is then redraped over the repositioned deeper tissues, excess skin is removed as appropriate, and the incisions are carefully closed.
The objective is for the deeper tissues to create the lift, not excessive tension on the skin.
Deep-ER™ Facelift procedures are performed in an accredited surgical facility, with anesthesia administered by a board-certified anesthesiologist.
Dr. David Boudreault personally develops each patient's surgical plan and performs the operation.
Patients can meet with Dr. Boudreault for consultation through Illuminate Plastic Surgery in San Jose and Palo Alto, California, serving patients throughout Silicon Valley, the San Francisco Bay Area, and those traveling from outside Northern California for facial rejuvenation surgery.
Recovery is generally comparable to recovery after other comprehensive deep plane facelift procedures, although every patient's timeline is different.
Swelling, bruising, tightness, and temporary numbness are expected during the early stages of healing. Many patients find swelling and bruising more noticeable than discomfort.
Most patients feel comfortable returning to public activities in approximately two to three weeks. That does not mean healing is complete at three weeks.
Residual swelling can continue to improve for several months as the facial tissues settle and the result becomes increasingly refined. Dr. Boudreault provides individualized guidance regarding exercise, work, social activities, incision care, and other postoperative restrictions.
A Deep-ER™ Facelift is intended to create long-lasting structural improvement, but no facelift stops the aging process.
After surgery, your face continues to age naturally from its new starting point. How a facelift changes over time depends on factors including genetics, skin quality, sun exposure, weight fluctuations, smoking or nicotine exposure, lifestyle, and the patient's individual anatomy.
For that reason, Dr. Boudreault does not promise a specific number of years for every patient.
A Deep-ER™ Facelift is a significant surgical procedure and carries potential risks.
Depending on the individual procedure and patient, risks of facelift surgery may include bleeding or hematoma, infection, fluid accumulation, delayed wound healing, unfavorable scarring, temporary or permanent changes in sensation, hairline or hair-growth changes near incisions, asymmetry, skin-healing complications, injury to facial nerve branches, anesthesia-related complications, and the possibility of revision surgery.
Nicotine use can significantly interfere with blood flow and healing and must be discussed honestly before surgery.
Dr. Boudreault reviews the risks, benefits, alternatives, and patient-specific considerations during the surgical consultation so that patients can make an informed decision.
“I have spent years performing SMAS facelifts and studying deep plane techniques and facial anatomy. What I kept seeing was that the SMAS flap, once fully freed, is one of the most useful pieces of tissue available to us in facial surgery and many techniques use only part of what it can do.
The question became: if I have already released this strong, vascularized tissue, how can I use it more intelligently?
That thinking led to the Deep-ER™ Facelift.
The extended release gives me mobility. That mobility lets me reposition the tissues that have descended. The same flap can then contribute to the neck and, in the right patient, give me another option for rebuilding cheek structure with the patient's own tissue.
I don't perform every component on every patient. The operation has to fit the face in front of me.
The goal isn't to make someone look like they had a facelift. The goal is to understand what changed anatomically with age and restore those relationships in a way that still looks like that person.”
— David Boudreault, MD, FACS
David Boudreault, MD, FACS, is a board-certified plastic surgeon and founder of Illuminate Plastic Surgery. He completed general surgery training at UCSF East Bay and plastic and reconstructive surgery training at UC Davis Medical Center. His years of experience with SMAS facelift surgery, deep plane techniques, and facial anatomy ultimately led him to develop the Deep-ER™ Facelift.
Deep plane facelift surgery requires detailed knowledge of facial anatomy because the dissection and ligament release occur near important facial nerve branches and other structures.
For Dr. Boudreault, technical execution is only part of facelift surgery. His approach begins with identifying why an individual face looks older: which tissues have descended, where the face is tethered, whether the cheek has flattened because of true volume loss or tissue descent, what is creating the jowl, what is contributing to the neck, and which changes should (or should not) be corrected.
There is no standardized Deep-ER™ operation performed identically on every patient. Dr. Boudreault adjusts the extent of release, direction of repositioning, neck work, and cheek reshaping according to the patient's anatomy. And if a less extensive procedure (or no surgery yet) is the better choice, he will say so.
The Deep-ER™ Facelift is Dr. David Boudreault's proprietary extended deep plane face and neck lift. It combines extended release of the midface retaining ligaments with strategic use of the released SMAS flap to reposition facial tissues, support the neck, and, when appropriate, enhance cheek structure using the patient's own tissue.
The primary meaning is Extended Release, referring to Dr. Boudreault's extended release of the midface retaining ligaments. The technique also reflects three principles: Extended Release, Enhanced Reshaping, and Elevated Results - or, more simply, Release, Reshape, Elevate.
Both techniques work with deeper facial tissues and involve ligament release. Deep-ER™ extends that concept by using an extended midface release and then using the mobilized SMAS flap for additional purposes when appropriate, including support of the neck lift and optional SMAS-fold cheek augmentation. Deep-ER™ is Dr. Boudreault's proprietary surgical approach rather than a universally recognized category of facelift.
There is no single facelift technique that is best for every patient. SMAS and deep plane techniques can both produce excellent results in appropriately selected patients. Dr. Boudreault chooses the surgical approach based on the patient's anatomy, degree and location of facial aging, previous procedures, and goals rather than choosing an operation based on its name alone.
Dr. Boudreault’s Deep-ER™ Plane Facelift combines the foundational principles of deep plane surgery with a more extensive release and repositioning of the deeper facial tissues, addressing the cheeks, jawline, jowls, and neck as a cohesive unit. Each procedure is tailored to the patient’s unique anatomy and goals, with an emphasis on restoring youthful structure and contour without creating a tight or operated appearance. The difference is ultimately in the philosophy: a deeper, more comprehensive correction designed to look like you, only refreshed, restored, and naturally younger.
The Deep-ER™ Facelift is designed as a comprehensive face-and-neck rejuvenation approach when the patient's anatomy requires treatment of both areas. The exact neck component varies because different anatomical problems can contribute to neck aging.
Repositioning descended deeper facial tissues can improve jowling and restore greater definition along the jawline. The degree of improvement depends on the patient's anatomy, skin quality, tissue laxity, and surgical plan.
Midface descent can contribute to deepening of the nasolabial folds. Releasing and repositioning descended midface tissue may soften this area, although a facelift does not erase every line or fold and individual results vary.
That is specifically what Dr. Boudreault aims to avoid. The Deep-ER™ approach is designed to reposition deeper tissues rather than depend primarily on skin tension for the lift. The objective is a refreshed facial structure with natural expression and movement, not an intentionally tight or operated appearance.
No. The SMAS-fold cheek component is used only when additional cheek width or projection would improve facial balance. Many patients do not need it.
Not necessarily. In appropriately selected patients, the SMAS-fold technique can create additional cheek structure using the patient's own tissue. Other patients may still benefit from small amounts of filler, fat grafting, an implant, or no additional volume treatment at all. These treatments solve different anatomical problems.
There is no universally correct age. Anatomy matters more than a specific birthday. Patients are generally better candidates when there is enough facial and neck descent to justify a comprehensive surgical lift. Dr. Boudreault will recommend a less extensive option when the degree of aging does not warrant Deep-ER™ surgery.
Many patients feel comfortable being seen socially at approximately two to three weeks, although swelling continues to improve beyond that point. Your individual recovery depends on the extent of surgery and your healing response.
Exercise restrictions depend on the procedure and the stage of healing. Dr. Boudreault provides a postoperative schedule for gradually returning to physical activity. Patients should not resume strenuous exercise until cleared.
Incisions generally follow the hairline and natural contours around the ear and continue behind the ear into the scalp. These locations are selected to make mature scars as inconspicuous as possible. Scar quality varies with genetics, surgical plan, healing, incision care, and nicotine exposure.
Often, yes, but previous procedures can change the surgical anatomy and treatment plan. Tell Dr. Boudreault about previous facelifts, threads, fillers, fat grafting, energy-based treatments, implants, and other facial procedures during consultation.
Deep-ER™ Facelift pricing varies according to the extent of facial and neck surgery, whether cheek reshaping is indicated, additional procedures, anesthesia, and facility fees. After examining your anatomy and developing a surgical plan, Illuminate Plastic Surgery will provide individualized pricing and available financing information.
If you are researching a deep plane facelift in San Jose, Palo Alto, Silicon Valley, or the San Francisco Bay Area and want to understand whether the Deep-ER™ approach is appropriate for you, the next step is a consultation with Dr. David Boudreault.
The consultation is intended to answer a more important question than simply “Am I a candidate for Deep-ER™?” It is: What is actually causing the changes I see in my face, and what is the most appropriate way to address them?
Dr. Boudreault will evaluate your facial anatomy, listen to what bothers you and what you want to preserve, and explain the options he believes make sense including when a smaller procedure or waiting would be the better decision.
Illuminate Plastic Surgery | San Jose & Palo Alto, California
Every patient is different. Facial anatomy, skin quality, healing biology, medical history, previous procedures, lifestyle, and other factors influence what facelift surgery can achieve and how an individual result changes over time.
Photographs and descriptions of Deep-ER™ Facelift patients demonstrate individual outcomes and are not guarantees of a specific result. Your consultation with Dr. Boudreault is where the expected benefits, limitations, risks, alternatives, and realistic goals of surgery will be discussed based on your anatomy.
The Deep-ER™ Facelift is a proprietary surgical approach developed and performed by David Boudreault, MD, FACS, at Illuminate Plastic Surgery. Trademark pending.
