Anyone here interested in cosmetic surgery will find that most providers in the state will advise you to get facial fillers before a facelift even if you have seriously obvious sagging of the facial skin and muscles. So that's what I did, I got like 10k worth of fillers. But any artist/sculpture worth their claim knows that filling in space doesn't always equal taught lines.
So now my face is sagging but full. When I turn my head down, my face and all the fillers lean toward the ground even more than prior to getting them. Now I've found one provider who is going to do a midface lift. It will cost the same amount of money I spent on fillers, nearly 12k worth, but will finally address the sagging skin and muscle.
Do not get fillers or a threadlift, don't waste your money.
And yes, cosmetic surgery can be medically necessary to address issues of gender identity and needing to appear more feminine. Fillers won't do it, not when your over 30.