It’s the face of effort. Dude probably doesn’t get off of the computer chair very much, and lifting his arms above the ‘loose hang, elbows bent, wrists resting on desk’ takes a lot of effort, and thus the grimace from struggling.
Nah, it’s just drugs. I mean, I think Elon Musk strikes me as a person who’d love to have the… for the lack of a better word, “courage” to perform the Nazi salute under such circumstances when actually totally sober, but a guy that had to fake Path of Exile 2 success is simply not gonna throw a Nazi salute on stage, even in front of people he sees as supports and loyalists.
I wonder if that absolutely bizarre specimen has been truly sober in last years. Or ever, if we count being high up your own ass as an altered state.