I draw constantly. When I have an idea, I will doodle it here and there for days until I get the shape worked out. Then I start making drawings on graph paper, with measurements and sometimes 3D projections and such. I don't feel this is necessary, but I received training in classical mechanical drawing (odd for young people these days), so I enjoy doing this. None of this really matters very much on a fixed-blade - it just cements the shape in my head. Then I do a rough sketch on barstock and let it evolve from there. I find that curves and subtleties of shape that are difficult to capture with a pencil come almost naturally from the grinding process, so I don't try to let my doodles get in the way of what I end up with.
Folders require a bit more precision (though I have made only a few). These usually get careful drawings and I will cut the drawings out and move them around to make sure my ideas of how it will fit open and closed work properly (I am disgusted when I see a knife whose lines don't "work" closed as well as open - this is important!) My final drawings are photocopied and and a copy is cut out and glued to the materials to make sure I follow the pattern closely. Even here, though, the final fitting always works better by eye, not sticking to some pattern. I sometimes leave areas of the pattern oversized, to be figured out as the knife is made.
Perhaps my prolific drawings are because I am a relative neophyte, or because I have trouble finding shop time. For whatever reason, I have hundreds of "paper knives" for every one that reaches steel. I do feel that while shape need not be worked out beforehand, every step in the construction should be carefully planned ahead of time. I build a knife in my head dozens of times before I start handling materials, and this helps avoid unexpected difficulties.
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-Drew Gleason
Little Bear Knives