What do people use to make their fake perks/modified perks

Friendly_Blendette

I always see images of perk idea or perks with some modification to them and they look so real that I want to know how people make them. Is it as simple as photoshop or is there some actual like app people use. If its just photoshop like what font do you have to use etc. Thanks this is just for making a ######### meme.