What I mean is to edit the actual items in the frame so that I can move/copy the ponytail style to make multiple strands of "hair" to pass as snakes.

Not sure if I understand your problem correctly, but I hope this helps: You need to leftclick on a layer (left window called "items") before using cursor and Copypaste. You could also use rightclick on the layer and choose the option duplicate.

This is very interesting. I'm playing the creator at the moment and I'm attempting to make a Medusa creature much like the paizo one, but in pixel form. do you have any tips on how to edit and duplicate items within the tiles? The main issue I have is it claims I havn't selected any items :p

I have been messing around with the long white pony tail and attempting to duplicate it so that instead of a simple ponytail on the character it would look like many different long strands that are too thick to be hair and maybe add little eyes or something. I might just leave it as large green strands to leave it as a suggestion of snakes considering being pixel art.

Medusa PFS: http://vignette1.wikia.nocookie.net/pathfinder/images/e/eb/Medusa.jpg/revision/latest?cb=20090629133320