Unlike programs like 3D Studio Max or Maya, Zbrush modeling is based on a totally different principle. It’s obvious that it is a tool created for designers. Modeling an object is simply a body sculpting using brushes.
The main attraction of the program, in my opinion, it’s how easy is the modelling anything alive when you master the software. However, it’s pretty hard to use for noob users, the interface is less intuitive than other programs. Too much focused on shortcuts, ideal for experts, but tedious for those who started.
More information in: [Pixologic - Zbrush]
About the image about, the puppet is modeled in zbrush while texturing, shading, lighting and objects in 3D Max.