The art director also provided a color Laser print of a patient with the dental device surgically implanted (Ouch!). No, that's not an earring. It's actually fastened to the jaw bone, and with subtle adjustments over a period of time, it will move the jaw down and forward.

The image is scanned in RGB, then after adjusting it with the Channel Mixer to get the best gray tones possible, it is converted to grayscale mode and placed on a new layer above the original layout. It is then sized, rotated, and positioned with the Free Transform tool.

Now the photo needs to work with the layout.