The photos on the left are untouched. The photos on the right have the new cell phone towers in place. We create these by driving around the city and snapping off photos from different locations. Then photoshop in the cell tower to the cities specs.
Photo Sims is taking an existing image and importing new elements of landscaping, change of paint color to a house, new cell towers in your local neighborhood to skyscrapers into the background. Here are a few examples.