Fillers not enough for mid-face sagging? 50 years old (Photo)

To some degree fillers can make improvements, but the mid-portion of the face is often best treated with something more permanent such as a short incision facelift. Gravity is bringing this portion of the face downward and the short incision facelift can reverse this effect. The incision is well hidden in front of the ear and hairline. Good luck

Its hard to say, but likely you can have a nice, natural improvement with much less downtime, pain, and risk of surgery by starting out with properly placed fillers, especially in the cheeks, and likely a bit in the laugh & marionette lines as well. Best to speak with a highly trained cosmetic expert such as a dermatologist to ensure optimal results & safety.

Based on the photo, you are a good candidate for treatment with dermal filler. I think what your plastic surgeon meant was that it would be best to start by injecting filler into the midface/cheeks which would help lift the face. After this has been done, a small amount of filler could be placed into the laugh lines directly to soften them further. The aging process, mainly volume loss, begins in the midface and most experienced injectors address this first in their treatment plans. 

Thank you for your question. 
By your photograph, you do have some lines and wrinkles, but you also have volume loss. Combination treatments with laser and filler may obtain the most satisfying results. 
It is important to treat the mid face and cheek area first to give a lift. This will soften the structures of the lower third of the face.  
There are many great products for creating a beautiful result for marionette lines, nasolabial folds, pre jowl sulcus  and cheek volume loss.  Juvederm Voluma or Vollure, Restylane Lyft would all give nice results. 
Active FX laser resurfacing or microneedling would help to tighten and brighten aging skin and improve tone, texture and would be a great choice for under eye wrinkles.  Laser resurfacing requires one treatment whereas, micro needling would require multiple treatments. We use platelet rich plasma with both procedures. 
Please consult a local board certified facial plastic surgeon for more information and a comprehensive consultation 

Your surgeon is correct. The nasolabial folds and the marionette lines under your lips are caused by the loss of fat and bone in your upper face. The most natural and effective way to treat them is to add volume to the cheeks and lift the tissue back up. You can still add filler to the folds directly but it will take less filler and look better if you start in the cheeks! You don't necessarily need Botox, as it doesn't provide much of a lift to the lower face, but it does look nice, and will also make you look younger. I hope you love your filler. They can make you look younger and prettier. Enjoy! -Dr. Jenny

Combination therapy always better.
There are many areas we like to examine before start treatment
1. Bone: osteoporosis and lack of tooth cause loss of bone
2. Fat Loss
3. Muscle loss
4. Lax skin
After looking at everything, I would recommend Ultherapy to tighten skin  and muscles and fillers from top to bottom or facelift with everything