Thank you for your inquiry. I would suggest that you stop using fillers because you are already beginning to obscure your natural anatomical landmarks, and you don't want to end up looking "puffy" or unnatural. The fact that you have focused on your upkeep is excellent, because if a patient waits until they are older without any upkeep, it's more difficult to achieve profound results with facelifting. In your case, it's difficult to judge if you're a good candidate for facelifting from your one photo, and I wouldn't want to misadvise you. I think it's essential to respect patients and their needs and not just toss out a judgement if the answer is not obvious. How the face looks in person is entirely different that how it looks in photographs, which is why I prefer in-person consultations. Because I can't pass judgement based on your one photo, I will speak in general terms. When patients are in the 40s-50s, they begin to notice that fillers aren't having the same effect as when they were younger. The amount of filler needed to disguise folds can become voluminous, can look unnatural, and can obscure the lymphatics, causing its own problems. Threadlifting can be effective to some degree, yet it is short-lived and not as powerful as surgery. Any kind of tightening device, which might be effective in the 30s and perhaps into the mid-40s, no longer has the same impact as a patient ages. This is when surgery enters the picture. Think of the face in three parts: the upper face (from the eyes to the forehead), the middle face (from the eyes to the bottom of the ear), and the lower face (from the bottom of the ear to the jawline. I have found that a hybrid facelift is the best approach for a natural-looking result, because the different areas need to be addressed in different depths. Most often, the upper face is fine, and I always caution patients against brow lifts, which are only needed in rare cases; otherwise, patients can look perennially frightened! The midface I will often approach with a subcutaneous lift and sometimes a SMAS lift, the jowl area with a deep-plane approach, and the neck area with a SMAS lift. I have found that this hybrid approach produces the most natural results, but every surgeon is different, and possesses a different aesthetic and skill set. I would suggest that you schedule some consultations with board-certified plastic surgeons, bring a lot of questions, and don't hesitate to explore these topics in depth with experts who can help.