The beauty of handmade jewelery is that you see exceptional attention to detail as well as fine workmanship. In other words, it is not a mass produced that you will see on every 10Th person.
Many jewelers have their own signature style that they incorporate into each individual piece they create and if it is a well known jeweler his/her design is recognized by his/her followers. Some jewelers could be using a combination of metals, textures, shapes, cut-out figures, symbols, etc.
One of the key factors to first consider is to seek out a jeweler whose work you admire. You want to establish a good relationship with the jeweler, especially if you are going to be involved in the creative process. You also want to make sure that the jeweler does quality work.
You can save a lot of money on material, if you have have unused pieces of jewelry that you no longer wear. With the current high price of gold, you may wish to consider this an an option. The jeweler would melt down the pieces and may have to supplement a little extra gold, depending on the weight of the piece you are having made. You would only pay the difference for the extra materials used. As well, you may have existing gemstones that can be "recycled" and "reused" in your new piece. This can apply to all metals--gold, silver, platinum.
Taking the above into consideration, before your jeweler begins, make sure you have an estimate. Remember, it is not only material costs, but his/her workmanship to make the piece. A jeweler can spend many hours from start to finish in creating your signature piece of jewelry.
If you have a strict budget, your jeweler would be able to tell you if your budget is realistic for what you wish to have created. This is why I suggest that if you have do not have any sentimental attachments to some of your jewelry, that they can be melted down and stones can be reset.
You may also consider designing your own piece. While you may not be an artist, try to execute a sketch to show your jeweler what you have in mind. Look through magazines or on the internet for pictures. You may incorporate the design from 3-4 different pieces of jewelry into the piece you desire. Your jeweler will advise you if your ideas are practical and functional.
All things considered, the final outcome will be your signature jewelry piece.