What can be done to address sagging in my mid face? (photo)

You may have the best result from a combination of treatments. FaceTite uses RF technology to tighten skin. It's a great option for those with mild to moderate laxity but who aren't quite ready for a facelift. Adding Morpheus8 treatments can enhance your results. See my website or a provider near you to learn more.

Hello and thank you for your question. Knowing more about your history, future plans and demographics would be helpful to provide you with a complete opinion. On brief view, it does appear as though you have deep nasolabial folds and marionette lines. These could be addressed appropriately with a fat transfer. I would recommend an in person consultation with a board certified facial plastic surgeon to best answer your questions and provide you with options tailored to your needs.

While I am not surprised by the lack of success with ultrasound treatment, since this gizmo, much like fraxel lasers and other supposedly "next big thing" gizmos are backed far more by marketing hype and social media buzz than hard science. I am likewise not surprised by the lack of success with liposuction, since the removal of volume is more likely to worsen smile folds, marionette lines and even jowls along the jawline. What's more I gave up threadlifting ages ago since the results were unimpressive and not long-lasting, at best, and the procedure carries a high complication rate.
I would strongly suspect that the lack of success with the fillers was because either an insufficiently robust filler was used for each area and/or the filler was not properly injected or injected in the wrong location to achieve the desired results.
To achieve a nonsurgical filler facelift (that would improve both cheek contour and diminish the smile folds), a robust HA volumizing filler should be used in the appropriate location of the cheeks in order to lift the cheeks. If mistakenly injected directly into the smile folds, it can actually worsen them and make the cheek more jowly looking.
An appropriately robust HA lifting filler, injected properly can also lift and straighten the marionette folds on the sides of the mouth. Once again, if not injected properly, the folds may actually become more pronounced. When proper HA fillers are properly injected in the appropriate locations, the results are typically immediate and gratifying, and there is usually little to no significant downtime.
You would be wise to make sure to consult with a board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

It sounds like you are a candidate for a Mini-Facelift since the various non-invasive treatments did not really work for you. Don’t feel badly that is fairly common.
My favorite technique is the MACS short scar Mini-Facelift. Developed in Europe, it is the ideal approach for the younger patient, not ready for a full facelift, or patients who desire a less invasive procedure with a shorter recovery time. It addresses both the mid face area (especially the jowls) as well as the neck, if needed. Come see me or another board-certified plastic surgeon in our area to explore the best options for you. Good luck

If you would like to get this part improved the best and definitive solution would be a mid-face lift.I also see some fat under your chin, so a double chin liposuction will also be appropriate. If you would like to get a sharper definition and okay with scars, then you can also get a full face and neck lift. Good luck.