That pic a) could very well have been rendered in Poser, it's well within Poser's capabilities since it's pretty much just a photo projected onto the mesh and almost all the lighting effect is coming from the photograph; and b) is not particularly realistic anyway, note how the mouth wrinkles obtrude into the neck straight over the jaw bone, and the shadows of the photo texture do not match shadows cast on the mesh from 3D lights.

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