I'm gonna say this is real. I'm a paramedic and have seen this happen quite a few times. He most likely was bearing down very(like he was taking shit) along with breathing out hard both of which put pressure on yor baroreceptors which stimulate your vagus nerve which drops your heart rate which in turn drops your blood pressure then you slowly drop out like that.
Also he smashed his grill hard! Any after pics? Hah.