What can be done to improve lower face sagging and skin tone? (Photos)

Fat transfer to widen the face -- particularly the upper 1/3 can be a great option. Without other photos it is difficult to tell if any type of lift would help, but often a good volumization in someone 45 obviates the need to lift. the inflation "lifts" the tissues adequately. An upper lip lift would also balance the long face. And yes, a CO2 is great for the skin but doesn't lift tissue. Just improves it.

Thank you for the question and providing the photo.
I actually do not appreciate a significant amount of tissue descent of the lower face (ie things like jowls or deepened melolabial folds). I do think you have some fat loss of the midface which makes it appear that the whole face has a "sagging" appearance and some dark circles under the eyes which may be related to stress and poor sleep. Here are my thoughts:
- I would not recommend a facelift as I don't appreciate a significant amount of tissue descent in the lower face (where facelift has the biggest effect)- Fat transfer and/or a lower eyelid blepharoplasty with fat transposition may restore some fat loss under the eyes and of the cheeks - Laser resurfacing is also a great option for some of the finer lines on the face and sometimes with some of the broken blood vessels
I think your best option would be to schedule a consultation with a plastic surgeon well versed in the nuances of facial rejuvenation to further discuss these options and which would fit your goals best.
I hope this helps,Kyle Kimura, MD