It's probably photoshop or a photo of someone who looks like her. Horrid stuff, sure, but don't let it make you lose sleep for it. "Hopefully not real" - it may well be. There's an unlimited supply of gore on the Internet. I found the hard way back in my teen years. Something died inside of me because of it (innocence? I dunno...), and then I decided that the best thing I could do is accept that people suck and to try to live my own life as best as I could, and help others as much as I could.