Score the design into the skin by poking small holes through the paper with a nail or other sturdy tool, like a knitting needle, skewer, or old ballpoint pen. The holes should be about 1/8 of an inch apart, although more precise details will need a finer touch. If reaching over the table to punch the holes is tiring, hold the pumpkin in your lap.
After you have created your guide holes, remove the pattern. If the holes are hard to see, rub a little flour, baking powder or unscented baby powder into the holes to make them more visible.