I mean too if Picrews are allowed even though they're avatar generators, Gacha have a chibi art style but i think it's because standars and that stuff.
It's debatable whether there's enough visual information here to warrant tagging her, but from context that's almost certainly meant to be Tsukumo Sana's hand.
I tried to preserve the parallel structure between the speech bubbles in panels 2 and 4, but it didn't seem to fit properly while still being accurate to the text. So I decided to favor the joke over the translation.