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I almost think it looks worse with the head attached... well, with how the head was originally drawn anyway.
It's not a photoshop , is it?

Looks like it was originally being made detached.
That's why it feels awkward now.
Considering the source for this image is moe-ren and the artist doesn't have this on their pixiv profile, I'm pretty confident that this is a photoshop.
yes, this is edit using photoshop CS 4, i download from and chec the image properties ,program name was Adobe photoshop CS4. meanwhile nakajou made the real picture using SAI and photosho 7 . So this picture not made by nakajou
plus that moe-ran board is for shop pic.