I believe he is real and serious... Mental illness like this exists. He shows all the hallmarks of his condition. Even his constant posting is part of the condition as he would try to either seek whatever positive validation he can (which is never enough), or even if people insult his looks it confirms the delusion. It sounds absurd but people in a delusion do not want to believe it is just a delusion, they believe in the delusion as their reality. I have seen more ridiculous things than this...A super persistant and consistent troll? Had this been some guy popping up out of nowhere I would be more inclined to agree. He's been going on and on across several forums, google the username picollo30. That's the username he used to upload the pictures, he's got forum profiles under the same username with the same story. There's also a twitter account with that username, which shows what probably is his real name.
I offered him a place to go where they would offer him better psychological support. But I doubt he will take it because he is not looking for that, and he likely has either given up or has become entrenched in the delusion. He likely is also in therapy, but judging by him going for cosmetic surgery and his posts I doubt the therapist was successful at all... Which is typical because there is no real cure for insanity.
But either way, he should not be here... These kinds of threads he makes are not going to help him and will only drag him down deeper into his delusion. Not to mention that this kind of stuff is not suitable for SoSuave.