Start by opening an image of a man with an open mouth.
Duplicate the layer and change the layer mode to "linear burn".
Select and merge both the layers. From Filter menu select"liquify". Select "Forward Warp tool and distort the hair as shown in the image below.
Duplicate the layer. From Filter menu select "Blur>>Gaussian Blur". Apply settings as shown in the image below.
Switch to "Channel" palette. Ctrl+Select the "green" channel to get the selection.
Click add layer mask button from the bottom of the layer palette.
Duplicate the layer again. Press Ctrl+U to open hue/saturation window. Apply settings as shown.
Using pen tool create tongue shape as shown in the image.
Double click the layer to open layer style window. Apply settings as shown.
Create a new layer. Press Q to enable quick mask. From "Filter" menu select "Render>>Difference Clouds". Apply settings as shown.
Press Q again to disable quick mask.
Fill the selection with white color.
Select eraser too and erase the portions leaving behind the steam coming out from the ear.
Duplicate the layer a couple of times to enhance the effect.
Duplicate the layers. Press Ctrl+T. Right click and select Flip Horizontal and place on the other side, also crete steam coming out from the mouth using same technique.
Click to enlarge