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If I wanted to, for example, have all my sims in a world be elves, how would I do that? Would I need a blank map or could I just go through and edit all the ones in a save game?
Yeah, just going through and editing them is the best way. probably. If you mean you want all NEWLY generated Sims to be...for example, elves, then you could try looking for CC that has made elven-like defaults for ears, or whatever you wish to replace.