At first glance some might think Photoshop! But it is not so.
Jerry Uelsmann has been a master print maker since the early 1960s. He creates composite photographs with multiple negatives and extensive darkroom work. He uses up to a dozen enlargers at a time to produce his final surrealist images.
Many of my students struggle with the idea that manipulating images using Photoshop extensively somehow degrades the image or renders it fake. I remind them that photographers have been manipulating their photos since the beginning of the art and that it is one's intended vision that should dictate how much manipulation should be done. Photoshop is a tool just as printing with multiple negatives is for Uelsmann. However, like in any medium, expertise makes the difference between a classic image and a shoddy one.