The producers obviously drive the majority of the action on the show. However, in Nikki’s case, I don’t think they need to do that because she is so fake inside and out. Her behavior seems as artificial as 99% of her body, but at the same time, it’s become who she is. So I think the answer is that it’s all fake but also natural for her.
100% no one has clocked her as a trans woman because they’re too busy marveling at the sheer madness of her face and body.
Why the actual fuck won’t she get new teeth? For a fraction of the cost of her procedures, decent teeth that haven’t been put through a couple cycles in the old dishwasher would make a HUGE difference in her appearance. But in a good way.