you know that's injected with a small saline bag. a local lfs owner I've known for years always goes to Thailand or Maylaysia every couple of months and told me he's seen some breeders actually injecting some of the very nice colored flowerhorns that had small koks. very sad.
just like any other aspect of nature (and humanity); natural (even if smaller) is beautiful and desireable, artificially enhanced is weird and freaky looking.
Answering a question someone asked. There is no bone in the nuchal hump. It is typically just fat and water.
This guy is crazy though! Could be an implant, but it's not beyond the realm of "natural" possibility. I'm reminded of the pic of a midas in "The Complete Lexicon of Cichlids" by Axelrod. Not quite as large as in this flowerhorn, but close. The "bloody marks" on it's head are likely from rubbing on the glass.