This photo popped up in another thread a while back. I think (and thought at the time) that the individual ovals and teardrops were piped on a flat surface with RI, left to harden, lustred, and then stuck to the cake. The round balls are pearl dragees stuck on around the ovals.
Looks like a mold since the symmetry looks so precised. Tried to look for similar mold and saw that Caljava Online has some molds for sale. Fondant Mold 224 has kind of the same look with the teardrop pattern and it's on sale. Hope this helps : )