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The lack of heart symbolises pain and so does the lack of colour. The aesthetic is imitating the image of Ayano's brokenness that is in the game's intro.
The hands that are offering the love, represent the real fans that still love and support. ❤
When looking at the face, you can see that the person's eyes are watery. That obviously shows crying, which is a strong emotion that can symbolise a lot.
YandereDev has mentioned before that he does not plan to keep using the same uniform for the characters, so the outfit is based off an example, of what the uniform could be that was shown in one of his videos a while ago. ---
