Thanks for your question and for including the photo as well. I always recommend that you have a consultation with a board-certified dermatologist or plastic surgeon who understands the cosmetic options for skin tightening. You have numerous options, and while surgery may be one of them, there are plenty of non-invasive alternatives that will help tighten and rejuvenate your skin. One of the first things that one may consider is Ultherapy, which is a fractional ultrasound procedure that can definitely tighten and treat lax skin in the face and neck. It is a one-time procedure in most everyone and results are seen usually at the 3-month time period. In addition, there are a variety of radiofrequency (RF) skin tightening devices that work after a series of treatments to give some very nice results here – these include the Venus Legacy, the EndyMed 3Deep, and the Alma Accent and VShape. Again, an office which has multiple treatment options can examine you, work with you on what may be the best for you, and take care it the tightening and sagging that is bothering you.