the picture is definetely real, its a riding friend of mine's friend. He told me when it happened and sent me pictures, since then its been floating around everywhere. But yes the picture is completely real
thats probably a while after the incident, they wouldn't take the photo while hes in risk of his brain falling out , and plus , that looks more like a cringe from the pain !
technically speaking when i was in the army one of our mn got gash but a ennemy knife and end up with the same type of injury and blood wa gushing all over the place and the scalp was much more rigid than this pic shows,so yes its special effect i would say