Realism in sex dolls is achieved through detailed external and internal features that mimic human anatomy and sensations. External features include lifelike skin textures, facial features, hair, and body proportions, all crafted to resemble real humans closely. High-quality external realism involves realistic eye movement, natural-looking makeup, and skin with subtle imperfections to enhance authenticity. The external appearance sets the initial impression and greatly influences the overall experience.

Internal features contribute significantly to the realism and satisfaction of use. These include anatomically accurate orifices with textured interiors designed to simulate human tissues. Some dolls feature complex internal structures with ribbed or veined textures, mimicking the sensation of real skin and tissue. Additionally, the internal skeletal framework allows for natural positioning and movement, making poses more realistic. Advanced dolls may also include sound or vibration features within internal cavities to augment sensory stimulation.

When comparing internal and external realism, external features tend to be more immediately noticeable, but internal features greatly enhance long-term satisfaction. The most realistic dolls combine both aspects seamlessly, with external appearances that mirror human features and internal textures that provide authentic sensations. The level of realism varies across models, with some prioritizing visual fidelity while others focus on tactile realism. Overall, a balanced combination of both external and internal features creates the most convincing and satisfying experience.