The beads and cabochons are sewn onto a dyed woolen cloth.
Tibetan women traditionally wore in their headdress a round silver ornament inlaid with turquoise and coral and decorated with an embossed pattern (or several). It is unusual for this object to be decorated with skulls.
The curator of the museum tells us that such oval amulet boxes are known as kerima, which means kidney, due to their shape.
The shape of the amulet box on this necklace is unusual.
Kirtimukha may hold a serpent between his hands, as above, or sprouting vegetation, as often seen on the front panel of crowns, or raining jewels.