This picture is not sufficient to allow an assessment and recommendation in this instance. I am copying my discussion of Neck Enhancement as a general discussionNeck EnhancementRichard O. Gregory, MDMany times the neck is the “forgotten component” of beauty and yet is one of the more common complaints of people who have had the unfortunate fate of seeing a photo taken at a wedding or elsewhere revealing that “component” problems. Surely we can wear a high necked shirt or lots of neck jewelry but that always raises suspicions.We spend a lot of time improving our faces and forget about the remainder (including neck, chest, arms and hands).It starts with the skin which of course starts with skin cleansing, moisturizing, sun screen, etc. But the need goes beyond those things and should include retinoid, a topical form of vitamin. We have retinyl palmitate in our skin when we are young but we lose it as we age along with the youthfulness it grants. Tretinoin will help restore that youthful beauty.Lumps, bumps, barnacles and brown spots including that parchment or leathery appearance can be addressed with laser which may also tighten the skin a small amount. There are many different kinds of lasers and many different kinds of laser practitioners (make certain you get the appropriate one of each in order to avoid making it worse.)Skin peels may help some, but again peels come in many different varieties.Hiding under the skin (but not hidden by it) may be rolls of excess ice cream and cookies = double chin, or that classic subject of ridicule the “turkey gobbler folds” (otherwise known as the dewlap or wattle).Some of this may be inherited, but you can “disinherit” it in some cases with judicious liposuction, if the skin is adequate to pick up the slack. Radio frequency treatment done internally or externally may tighten as well as melt the fat. I am somewhat skeptical of some external energy sources such as ultrasound or some microwave that have to penetrate several layers of tissue in order to reach the target which is the stretched, distorted collagen bundles which suspend the skin. Speaking of “inherited” we inherit much of our neck problem and the best way of improving that is surgery. Frequently this is part of the facelift.All of these approaches deserve a much more comprehensive discussion and a consultation with a plastic surgeon that is experienced in these various modalities of improving the appearance of the neck, “the forgotten component.”