I love this, its pretty good piece of graphic design. For criticism I'd suggest committing more fully to a direction and balancing the asymmetry more. When I mean direction, large parts of the image is smooth flat colours but others are more grungy and feel out of place but with more work would be more at home. For a 'sleeker' look take the spots around the eye and draw them similar to how you did the flower petals. Dark outlines and filled in with solid colours and overlap the spots, and switch the typeface one that looks more like a label gun's lettering (eg. http://www.fontsplace.com/images/chars/label_gun_tape_characters_502346.gif ) The opposite direction is to make it look more grungy over all, like stain the flower petals to give them shadows and add in subtle highlights on the piercing.

For balancing the asymmetry, I'd suggest adding in another one of the smaller flowers (Bringing the total to five) but skewering its position so its on the bottom opposing the small flower on the big one on the left. It makes the headband look less bare on that side, and makes the imbalance look more pleasing. I love the faces on the ear plugs, but I'd advise turning one the right way up and/or changing the expression on the other to create a duality. Like Sun and Moon tattoos, or like a thespian mask which does the comedy/tragedy expression thing.

I think you've done a lot with a mostly greyscale pallette and limited colour choices to keep a melancholic theme. Adding Daisies to the garland was pretty cleaver given the expression pushing up daisies.