you have SIGNIFICANT sagging and facial volume loss. to improve this you need an early face/neck lift and if you do not want that then facetite + plastysmaplasty for the neck and threads for the mid face and lower face. YOU NEED volume -- fat, Sculptra, or fillers as most of your mid face is bone and has no facial volume. long term morpheus every 2-3 months, thermage and Ultherapy twice yearly and needed for sagging prevention or maintenance of the surgery. if you want a dramatic change necklift/facelift, Implants and fillers will give you that. noninvasive will improve the area and facetite, threads, morpheus, and fillers can be used. start at home dermarolling to tighten you skin, see emeragecismetics.com where we do free skincare consults daily and recommend MTS roller with anteageMD ampules daily (see dermarolling package). With significant neck sagging you would need a neck/face lift with muscle tightening (platysmaplasty). at the same time lasers (fraxel, co2 or erbium( or microneedling RF (fractora, intensif) can be . performed to improve the crepe skin or wrinkles. You need a formal consultation, as the neck can be treated with a combination approach: 1. micro needling and lasers for texture 2. botox, disport or xeomin to help platysmal bands 3. intensif or fractora RF microneedling for crepe skin and lifting 4. fillers like belotero, restylane silk, juvederm volbella to improve lines and folds 5. neck/face lifting if sagging is prominent or early starting +/- platysmaplasty (muscle tightening) 6. J plasma/Renuvion, thermiRF, inmode facetite for internal tightening 7. ultherapy and thermage for external tightening 8. regular Venus legacy, exilis ultra, or inmode forma treatments with facials to maintain tightness 9. PDO novathreads or silhouette instalift cone threads for lifting and long-term collagen production see an expert for a full evaluation and treatment plan based on your individual situation and goals. Best, Dr. Emer