Depends on the item. Poses can only ever be purely from within the program. Many people buy Pose sets because it's easier and quicker than doing the work themselves. It's a timesaver, it saves them having to spend up to an hour getting a character into position. Character textures are always unique and usually made with photo references from a real person, or sometimes handpainted for the fantasy-type ones. Character morphs come either as custom-created morphs - where the merchant has taken the model into a modelling application and changed the mesh. Or some sets simply use the existing morphs available. Some folks feel that unless the morph is custom, they're paying for something they could do themselves. On the other hand, with a custom body morph, fitting clothing can be a pain. Swings and roundabouts...

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"you are terrifying
and strange and beautiful
something not everyone knows how to love." - Warsan Shire