I think it's real. aferall most PS works replace the head at the neck but i don't see discrepancies in that area. Also the nipples are definitely hers, they match the rest of the set. I'm usually a good judge of photoshop works, but not always. I often can spot the subtleties of the better PS artists and the tools used. Other clues are the direction of the shadows. If the direction oppose, then you know something is wrong.
Note the shadow under her chin matches the shadow below the acrinalyn above the panty line.
I think the refection of the flash covered enough the screeners of the photoshoot allowed it to pass.