How would you accomplish this look? I'm doing a three tier cake, the top tier will be polka dot, middle gold leaf and bottom ruffles. I know how to do the others, but I'm lost on this part. Thanks for the help!

I tried to post the actual picture but I'm having issues, this is the link

http://pinterest.com/pin/126523070756666183/

Those are just painted on with gold paint. It does look like there's some kind of outline around the dots, though, which is strange, it's like they're little flowers but it's really light. It looks like dots, though, so I'd just get the gold luster dust out and paint them on.

If you want, you can cut the dots out of fondant, paint them, then attach them when they dry  

If they are painted how did they make them all the exact same size and shape??

Use a decorating tip as a cutter that is the size you want the dots.  They work great for cutting out fondant.

Yes, or you could use the cutter/tip to imprint your fondant and paint inside the lines  

They're not all the exact same size and shape. It does look like there was something that they pushed into the fondant to mark them off, but they're not all exactly alike. If you look at the outline of the tiers that have them on the sides it's obvious that they were painted on, there's not an extra layer of fondant dot applied to the surface.

You could use a pencil (either the eraser end, or the flat unsharpened end), covered in plastic wrap, as a stamp to just stamp the dots onto the fondant.  That's the way I would go now that I think of it.