38 - What treatment would help the lines and drooping? (Photos)

Great question! It sounds like you are someone who is very dedicated to their journey in aesthetic medicine, so finding the right treatment for your concerns will restore your hope!
It is true- dysport (botox) and fillers can really help to contour and volumize specific areas of concern. In addition to injectables, a combination treatment of Morpheus and Neogen would be extremely beneficial for jowling and skin tightening concerns.
Morpheus stamps ultra-thin needles that emit radiofrequency energy into your skin to create a controlled injury, which, in turn, prompts collagen and elastin to form. Neogen uses nitrogen plasma technology to actively rejuvenate and tighten the skin, generating collagen and elastin from within for outstanding results. Combining these treatments will deliver the results you're looking for.

At age 38, persistent facial lines and drooping despite thread lifting, HIFU, PRP with fat, and lasers suggest that volume loss and tissue descent are the main contributors. Dermal fillers can be highly effective in restoring lost volume, softening lines, and improving facial contours. The most impactful areas for filler placement typically include the midface (cheeks), nasolabial folds, marionette lines, and jawline. Restoring volume in the cheeks can provide a subtle lift and indirectly improve the appearance of nasolabial folds and jowls. Directly treating the nasolabial folds and marionette lines with fillers can further smooth these areas and rejuvenate the lower face. Jawline contouring with fillers can enhance definition and reduce the appearance of sagging.

Botox (or other neuromodulators) is best for dynamic wrinkles caused by muscle movement, such as frown lines, forehead lines, and crow’s feet. It does not address sagging or volume loss but can be combined with fillers for a more comprehensive rejuvenation.

Given your history of non-surgical treatments, combining hyaluronic acid fillers in the midface and lower face with Botox for dynamic lines is likely to yield the most natural and satisfying results. If skin laxity is significant and non-surgical options are no longer effective, a surgical consultation for a facelift or midface lift may be warranted.

In summary, fillers can help restore youthful contours and soften lines, while Botox addresses dynamic wrinkles. A tailored combination approach, possibly with adjunctive skin tightening treatments, will provide the best outcome for persistent lines and drooping at your age.

A fill face photo would have been extremely helpful, or at least a photo that showed more of the cheeks.
However, from what I can see, the smile lines, the marionette folds, and the fullness of the lower face and lack of definition along the jawline. A robust HA volumizing filler for the cheeks would help to not only lift them, but create a more desirable Ogee Curve and likely soften the smile lines. A robust HA contouring filler can help to better define and straighten a heavy lower face. And if still necessary, a robust HA lifting filler can help to further soften the smile lines and address the marionette lines. In the hands of an experienced, board certified cosmetic dermatologist filler expert can typically be accomplished in about forty-five minutes, with immediate "Wow!" results and typically engenders little to no significant post-treatment downtime.
Unfortunately, I am not surprised with the lack of success with "bells and whistles" light and energy-based device treatments, nor the PRP, or the threadlifting (which I gave up performing many years ago), since the hard science to support the use of these modalities lags well behind the heavy marketing hype and social media buzz to promote them. So, going forward, remember "buyer beware." Hope this helps and best of luck.

If you are only considering non surgical options you may want to explore FaceTite and Morpheus8. FaceTite is a minimally invasive procedure that uses RF technology to tighten skin. No general anesthesia is required. Morpheus8 is a treatment that improves overall skin tone and texture and pairs well with FaceTite. I've included a video that I hope you find helpful.