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It could be done in a few ways, but in the quick example below I built it up from :
a. A Color Fill layer for the background
b. 3 separate layers using the Filter Gallery Photocopy Filter applied to a smart object containing a copy of the image and a curve layer.
2 of these were set to a black forground colour before applying the filter and one to a grey foreground. I then I used "Blend If" to show parts of each layer depending on its content and the content of the layer below.
I also applied a bit of masking to hide some of the "noise" in parts of the image.
c. Finally a color copy of the original layer masked to show the lips and dog's eyes (in my quick example I did not swap the dogs eyes as the original appears to have done)
I hope that gives you some ideas to get you started
Thank you for your detailed feedback Dave! Much appreciated