Custom designed jewelry (also known as artisan jewelry) provides an alternative to shoppers to have jewelry made specifically for them. If you are looking for a unique piece of art that only you can war then you need to look into having something created for you by a jewelry designer. when you're looking for a gift you can almost ensure the piece is unique if you have is custom designed.
Most local jewelry stores have the tools and expertise to provide custom design services. Some outsource the actual manufacturing to an outside shop but will work with consumer to design the piece. Most stores will also be able to create what you want from a drawing if you have one.
You can also hire (commission) a jewelery designer that only creates jewelry for others but does not necessarily have a retail location. In this case you should see some samples of their work, and get some references. If they have a studio locally you can also visit it personally. If the person is in a different city you have to take additional precautions to ensure you will get the piece you are looking within your cost and schedule requirements.
The level of expertise required varies according to the complexity of the item.
How much will it cost? The normal processes are either based on a flat fee or base on a percentage of the cost of the finished product. Make sure you have this straightened out before you begin working with a store or designer.
And of course, the best way to find a good custom designer is to get referrals from others so please make sure you rate and review the any store that you have had experience in the Search tool on EyeOnJewels.