I look really awful

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I’m nearly 50. I have always been reasonably attractive with a olive complexion that looked ok. I was regularly complimented on how young I looked which stopped maybe three years ago.

I now look really bad. I have sagging cheeks, big heavy eyelids, very pronounced forehead lines, a large gap between my nose and lips and my lips are very thin. I look MUCH worse than my friends quite frankly. I am being objective rather drama queen.

What if anything can I do? I can Botox my forehead but not idea what else works.

Start with a good workout regime. Get a smart scale and increase your hydration.
Next comes a no fuss easy haircut and a facial.
Once that routine is in place consider some light makeup then if no joy consult a plastic surgeon if that’s what you want.

I’m sure you don’t look awful at all, but I know how it feels when you’re not happy with how you’re looking. As a practical suggestion, I would recommend some filler done subtly as it really helps sagging cheeks. I have a naturally gaunt face and they really do help. My doc puts them high up near the cheekbone and this fills out and also seems to lift my whole face. Get them done v gradually so it’s almost imperceptible. Lasts for about a year and definitely worth it! Good luck.

I think lots of water intake with a good diet and skincare routine will really help.

However if you’re comfortable with it, it may be helpful to have a full consultation with a clinician about Botox/Filler options to see what may help you achieve a younger look. For example you mentioned that your lips have started to thin out and you have a large gap between you lip and nose, so a small amount of lip filler may help - obviously you can be conservative, just show them an old photo of you to ensure it looks very natural and like how you remember yourself.

Hydration will help (drinking water/herbal tea, a product with hyaluronic acid and a good hydrating toner - Hada Labo is supposed to be very good but I haven’t tried them yet).
Start a retinoid or go the next strength up if you already use them.
A little bit more sleep if you can manage it and in a slightly elevated position on your back not on your side (not as easy as it sounds, I know).
It might not be the case with you, but the way teeth are set when bone mass diminishes on the face (natural process - it happens to everyone) affects the way skin sits on the face.
A great haircut helps frame the face and conceal forehead lines.
Thin eyebrows are ageing after a certain age (strange but sadly true).
There are lots of YouTube videos on makeup for over 40s and it’s amazing how transformative it looks in those videos especially for eyes.

Botox, threads and fillers are viable options for what you describe as loss of volume which creates some saggy areas . You’d have to find a specialist who offers a variety of treatments as a combination of different interventions might give a more balanced result as opposed to just one treatment (for example, Botox addresses the forehead area and helps lift the eyelids but the lower part of the face which you feel needs addressing will need a different approach). And of course you’d need to repeat the treatments every so often. Perhaps some form of laser treatment might be a place to start. Also, it sounds simple but it is surprising how a good facial can ‘re-arrange’ the face as well as plump up the skin and make it look rested and fresher.

You are viewing your face close up with critical scrutiny out of context from the rest of your body and without the facial expressions which help create your personal charm and beauty. I’m absolutely convinced you don’t look awful. This is a new stage of your own beauty, attractiveness, new decade of your life, different hormones etc and you don’t simply stop being attractive.