On a new layer, using pen tool and hard brush, I drew lines and dots for joints. Applied bevel and emboss.
step 6 of 9
Selected, copied and pasted hand.
step 7 of 9
New layer: with pen tool drew the sticks, applying bevel and emboss. Erased unwanted parts on hand.
step 8 of 9
Duplicated and flipped hand; using puppet warp, I bent the forefinger. As it got a bit thin, I smudged it a little; then I copied, pasted and flipped a nail and put it over the image, adjusting the color and merging layers. Also made sticks for these hands.
step 9 of 9
Duplicated hand again, flipping and putting behind dummy. Added background and details (open mouth, shadows, coloring).