I may need to make this cake. Has anyone done one that can advise me? I like this pic and am going to PM the artist, but wanted a variety of suggestions and ideas.

http://www.cakecentral.com/cake-photo_1287516.html

My main question is regarding the area around the 'mouth'. It's very 3D and protrudes. How is this done? Is it carved, is it RKT? If it's RKT, how do you 'attach' that part to the cake so that you get a seamless fondant covering? Same for the other raised and sculpted facial features...

I've never really wrapped my head around how you can add RKT pieces and parts to a cake and make it look so smooth and seamless...

I wonder if you could put shaped modeling chocolate over the crumb coated cake and then cover it with fondant?