You can flip, rotate, zoom and alter the colors, saturation and hue. It contains the basic tools you'd expect to find in a paint program, such as airbrushes, a paintbrush, watercolors, pencils and an eraser. PaintTool SAI is one of your options, and it's a good one in many respects.
If you've ever wished you could spice up some of your photography or digital artwork, you'll want to take a look at a to do it.