Having sourced the image of the smoking girl and a skull that was at a similar angle I overlaid them both until the facial features matched roughly. I then warped the skull over the face more precisely. I then masked out the eyes and nose areas making sure to give the skin edges a “burnt” look and some shadowing. To finish off I overlaid a cloud texture and darkened the photo a bit to make it all look smoky, unhealthy and dank. I added some unhealthy looking bruising to the skin also, some smoke rising as well as some custom smoky text at the top.