Initial ugly color rough:
Blocking in colors and form. I took reference images around this stage too.
Rendering and fixing anatomical issues with a spackled brush, starting with the face.
I was wishy-washy about what she'd be holding... at first I thought a mask, but then I decided on a skull. I have it on a separate layer so I could position it correctly in relation to her hand and face. Thankfully it worked out.
Adding in some palette colors into the skull to integrate it. The blood and cording are also on a separate layer so I can fiddle with them after I'm satisfied with the anatomy.
