I'm absolutely sure it's touched up and photoshopped at the very least, plus the makeup is way better than our average troons, his surgeon is from Beverly Hills, costs a ton and apparently offends lots of troons by being totally blunt to them. But this kind of thing in regular ol plastic surgery is semi-possible, and the guy's probably an extreme outlier anyway, plus it's like 30+ hours of surgery or some shit. I'll lean "optimistic" as it's not like he was a hulking brute in those before pictures.
In any case I hope he continues his fine work so that all the other 35+ year old balding linebacker troons think this kind of near bankrupting magic will work for them through a quick outpatient procedure in Mexico.
edit: Look at his hand on the phone in the first comparison.