Are you referring to the "stars" at the intersections of the quilting? Use a ball tool to make an indention at each intersection of the quilting lines. You will have a big X coming out that are the quilting lines. Imagine a clock face (the old-fashioned ones, not digital 
) and make marks at 12, 3, 6, and 9 with a tool that has a rounded kinda knife-like edge (huh? you want to indent the lines, not cut through the fondant - make sense?). You now have the big long X mark that is part of the quilting and four new lines. Now mark shorter lines between all of those lines and place a pearl or button in the very center. Make your markings and indention in proportion to the center filler that you wish to use 
you know what I think is SOOOO cool about this cake??/ That the big time people that make cakes for OPRAH use the shelf liner from the $ store just like ME lol!!
Just thinking that too 
The indents have "buttons" in the middle - makes it look like a giant quilted pillow! Wonder if there's a tool to make those stars, rather than doing each by hand. Hmmm.
Ok, so it the fondant just rolled quite a bit thicker to make such an indent, or is the butter cream thicker so the fondant can be pushed into it?
I want to know what size it is! It looks huge... maybe 14" or 16"? And so TALL too! It's go to be a least 8" tall right? 
I'm sure the flowers are gumpaste... amazing gumpaste, but still. I can't see any cake artist making a cake THAT big/impressive, just to top it with fresh flowers. No way. They look a little too perfect to me also. 
looking at those stars ...
I wonder if they didn't just use one of these?
old fashioned wooden lemon juicer
http://www.saltandpepper.co.uk/cms_images/product/large_LemonJuicer.jpg
Oprah does have her own personal chef, maybe he made the cake? Doug, can you still buy those juice extractors? I have an old fashioned plastic one that would probably work, but I will be on the lookout now for one of those. I would love to see a picture of that cake on it's own. It is lovely.
Those juice extractors can also be found in Wal-Mart and in some dollar stores.
Theresa 
I wonder if a scoop of cake was "removed" at even intervals on the cake underneath to get those perfect beautiful indentations from the fondant. Covering thickly with fondant is an idea, but when I first saw this cake a few months ago that's what came to mind before covering the cake with fondant. Anyone?
I would do a standard fondant thickness, then mark out where the dimples and 'buttons will go. I would then use a regular balling tool to make the general dimple then add in the radiating lines either with a scribing tool or flower-centre tool (large).
After placing the lines of the quilting in (I'd use a metal ruler for those I think), I'd lastly glue in the small buttons into the dimples.
Thats what I'd do...now I want to make one!!
I LOVE this cake too! I may just have to make one. Mine will probably be a little smaller though.
Quote by @%username% on %date%
%body%