First cut out the old man's head with "quick selection"
step 2 of 7
With the "selections tools" and the "clone tool" I took out the child's head
step 3 of 7
With the liquify tool (CTRL + SHIFT + X) I pulled the skin up, and to get this color result I used the color balance (CTRL + B) and Shadow / Highlight
step 4 of 7
Here I used Levels (CTRL + L) and color balance and shadow / highlight to clear the man's head, and inner glow to give a sense that the background is invading the head
step 5 of 7
I made a simple cut on his cane, and applied motion blur
step 6 of 7
I joined all the layers, and started to clean up the imperfections
step 7 of 7
The smoke was simple, I created this brush from the brush basics of Photoshop, I applied blur, and then Warp. When I got a result that pleased me I put a layer SCREEN