I think there’s some touching up or photoshop going on, her hair doesn’t look real.
- Smudged hair
- Weirdness of the lower neck
- Ear artificially stretched
- Lip merges with the teeth
- Doubling of the eye lids and merging into the eyeballs
- Double-wide tooth
- Blackness behind the neck and black eyeglass frame disappearing into pitch black next to the face
Most of the females do look real, so I think it was likely an actual scene that was photographed. However, I think this and maybe a couple more in it were likely 'AI'-generated add-ins to the photo to artificially bloat the scene to have more in it. It could also just be as you noted of photoshop adjustments by a person.
The image was potato quality. For the zoomed in, I used AI to increase the pixels and it is supposed to "enhance" facial features as best it can I suppose.