LOLwhat? "Photoshop with photo references"! Or is it too hot for shop?
Oh pardon me 
I thought you believed it was two photo's merged together, which I would have found understandable since this is so damn realistic x.x...
I thought you believed it was two photo's merged together, which I would have found understandable since this is so damn realistic x.x...Oh wait. Now I'm entirely baffled. Is it DRAWN ART? I thought it was photomanip. ZOMG.