Photoshop :: Lighting Effect Used In Image

It is clear air brushing and skin toning was used to create the somewhat surreal skin surface.  But I cannot figure out if the lighting is from the Render / Lighting Effect tool, or air brushed to emulate lighting, or something else? 

When I use the PS lighting effect tool, everything turns dark in the photo outside the lit target area.  Notice the shadowing on the arm and breast.  It appears the light source is coming from two opposite directions.  Like if this is a multi-layer process, etc.  Not asking for a hand-holding tutorial.