Is Botox, filler or Hifu better for me at 42 for wrinkles and sagging? (Photo)

There are lots of options for you. HIFU is certainly a great at home option that will help tone your skin while you use it, but does not last long term. For a more long lasting effect you would probably enjoy a snatched jawline using hyaluronic acid and/ or solid fillers with PDO threads. A PDO thread lift will give you a lifted appearance and definition to your cheeks and jawline, as well as promote natural collagen production in the areas where the threads are placed. A hyaluronic acid jaw defining procedure would be achieved using HA filler directly at the jawline to define your jaw and give you that snatched jawline that is so desirable. Just know that you have options that would make you very happy, with very little downtime.

you need a combination of treatments. fillers for volume iwth sculptra, lasers and microneedling RF in the office.

at home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules weekly, see linkt) should be started now to prevent further aging.

For facial rejuvenation, I would suggest a combination approach of
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.