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It's actually a photo with a lot of post processing. I also used a skull overlay to alter the features. I changed the color to sepia then duplicated the layer and changed it to black and white. I changed the levels to enhance the contrast giving the image a stark appearance. then i blacked out the background to isolate the image. check the link for the model for the original photo. The work was done in photoshop. Thank you for taking the time to view my work and comment about it!