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They would get the skins by "Unknown Signals" that spawn in survival worlds
There is, however, a bug (that I am trying to track down) with this mod that doesn't allow you to change your tool skins in the medical station, but you can change them through the character select in the main menu. I have tested and confirmed that it works in both Singleplayer and Multiplayer. If this doesn't work for you can you post a screenshot or video to help me understand what is happening.
https://gtm.steamproxy.vip/sharedfiles/filedetails/?id=1804120419