Not a photoshop. The "horn" is really an out of control mole; since this picture was taken, apparently, the mole on the right side of her head has started sprouting as well.
But fret not - since this nice old lady (over 100) lives in a place in China not yet corrupted by the evils of Christianity, the villagers still respect and honor this elder, rather than... hmm. Burning her? Among other Christian kindnesses...
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