Often I get asked how it's done, so I've put together a tutorial.
Usually I layout the key elements of a page and then think about embellishments.
Here, I wanted to use embellishments to add energy and help the layout flow from left to right. To do this, I first sketched out some flourishes. Normally I would sketch in pencil, pierce the holes, then erase the pencil lines.
While I did these flourishes freehand, I will often use stencils or trace chipboard. Another idea is to print your image, position it on the page, pierce your holes, then remove the printout.
Once I have pierced the holes, I thread a needle with a large eye with embroidery floss, tape the end to the back of the layout, and begin stitching.
Click here for a video tutorial.