Drawn by hand, using a Wacom tablet into Photoshop.

Paper tea-stained and distressed, then photographed and added as a texture. Flat colours added in Photoshop. Drawing removed.

Additional paper and metal textures photographed and added. Cogs and watch parts photographed and added to chest cavity, hand, and heart. Shading added. 

Cogs, other watch parts, lace, keys, and cabochon photographed and added. Printing blocks used to stamp paper and words added into the cabochon. Bordering effects added and photo grain effect added.