Decide the size of the flowers. One you know what size you want your flowers to be, but the tissue paper. Keep in mind that the flowers will shrink about 25% when you fold them and twist them, so you want to cut the sheet bigger than your desired final product.
Cut the tissue paper into squares or rectangles depending on how large you want the flower bud. For a larger flower bud, make a wider sheet of paper. For a smaller flower bud, make the sheet of paper thinner and less wide.
Roll the tissue paper in a tube. The roll should be long and thin, or vertical, when you roll it. Keep the tube loose for a larger flower bud or a tighter tube for a smaller flower bud. The looser rolls will make flower buds will have more defined petals while the tighter tubes will make flower buds that have petals closer together.
Twist the bottom of the tissue paper. Start at the very end and twist tightly moving upwards towards what will become the flower bud. If you want a larger stem, twist firmly but also loosely. Continue to twist until the flower bud is the desired size. If you want a firmer stem, wrap green pipe cleaners around the stem.
Optional- Cut the outer sides of the petals. Make small incisions around the rose if you desire the petals to be more separated from the flower. Gently pull the separated petals out until you achieve the desired look. If you prefer the rose looking flower, skip this step.