I know that testosterone use in women changes fat distribution over time (in spite of all the pooners you see with thunder thighs lol). Test induced rougher skin, facial fat loss, as well as stress on the body in general surely contributes to her absolutely haggard look. (Nevermind a crazy emotional/mental state)
Some think she got a jaw implant, but Ellen has always had the big sharp Teagan & Sarah shaped face. It's just been less apparent in some pics, and especially when she was younger. I agree with those who think maybe she had buccal fat removal. It would help make her face look less soft and round, but like most women who get it, would also make her look sick and old. And she does.
Botox would indeed be dumb for her. (Nicole Kidman- love her, but it's true- can't make any expression other than a smile, a blank face, and a weird little pout.) Not that Ellen is some great actress in high demand, but still. She's no Brad Pitt (and never will be), so you'd think she'd at least want to be able to keep making facial expressions and at least try to act