Thank you for your question and for sharing your photos. The changes you are noticing appear to involve a combination of jowling, deepening nasolabial folds and marionette lines, lower facial laxity, loose neck skin and muscle, and loss of jawline definition.
Surgery is not your only option, but the more important question is which treatment can realistically address the changes that are bothering you. Nonsurgical treatments can improve certain aspects of facial aging, but they generally cannot reposition significantly descended facial tissues.
For the sagging jowls, lower face, jawline, and neck, a facelift combined with a neck lift would provide the most comprehensive and predictable improvement. A facelift repositions the deeper tissues of the lower face and improves jowling and jawline definition, while a neck lift addresses loose neck skin, the platysma muscle, and other deeper structures contributing to neck laxity.
The deep lines around the mouth (nasolabial folds and marionette lines) are related to a combination of tissue descent, skin quality changes, and volume changes. A facelift can significantly soften these lines by restoring more youthful tissue position. The goal is not to completely eliminate every line, but rather to restore a natural youthful configuration. Depending on your anatomy on exam, complementary treatments such as facial fat grafting or skin resurfacing may also be considered.
Fillers and other nonsurgical treatments can be useful for selected concerns, but attempting to correct significant jowling or facial descent simply by adding volume can actually make the lower face appear heavier without addressing the underlying cause.
Based on your photographs and concerns, I would recommend an in-person consultation with a plastic surgeon experienced in facelift and neck lift surgery. This would allow assessment of your skin, facial volume, jowls, platysma, deep neck anatomy, and jawline to determine which combination of treatments would give you the most natural and meaningful improvement.
