I made this for myloveasdeep in a RHPS swap recently. I bought the bag since I can't sew to save my life, and used iron-on transfer paper for the lettering, and rhinestones for the lips. My wife wrote two pieces of software from scratch for this project - one to lay out 4mm circles over the entire design, and one to count them (so we'd know how many rhinestones to buy).
Then we marked each rhinestone hole through to the fabric, which ended up not being necessary since we only used the first four marks (and counted up/over the amount of spaces on the grid to place the next stone)
We used the single-stone applicator tip which ended up taking a long, long time (next time we'll use the flat tip so you can melt like 4 stones at a time)
There are 120 clear, 650 siam and 150 pink hot-fix glass rhinestones involved (give or take a few)
Several hours later we were done!
Then we iron-on transfered the lettering, and I then went over the lettering with diamond and ruby glitter paint (which you can't really see from the pictures)
and taa daa!