This is a piece I made a little while ago as a wedding gift for my two friends. It was my first attempt at making anything like this, and it kicked off a whole new direction in my sewing. I used a sewing machine to attach the fabric pieces to the background material and hand embroidery (I think all back stitching) for the features and details. I used regular thread though, not embroidery floss, for fine detail. And a frame from the salvation army.
I don't know if you can see it well in this photo, but they are sewing themselves together with real needles that I left stuck in their hands, and they are bleeding where the thread pulls through them.