I believe he took two sets of pictures with each person and had them change their clothes for the second. You would think, if he thought to chance the clothes, he would've thought to change the hair too, and put some makeup over the blemishes.

Anywho, while these pictures are fake, the procedure is real and has been done many times before.

http://wiki.bmezine.com/index.php/Ear_Pointing
http://sp6.fotologs.net/photo/54/34/11/kaziglu_bey2/1213187230615_f.jpg