is it super expensive to get your clothes custom made rather than just buying a ready made outfit? or how do these things work?? and do you have to go to some top notch designer for these things or can u just get it made from a regular dukaan? or does it not happen at all?
and how expensive would it be? say in pak and here?
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You can buy some, get some made, get some half completed ones and get them stitched.
People go to designers, look at their designs and get a tailor, kaam walay people to make them. There are excellent craftsmen in Pakistan that can make dresses for half the price compared to designer labels and you wont be able to tell the difference. You just have to pick the right people.
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and what if you have a design of your own in mind, and you want something made exactly to that. can you do that also??
and who are those right peeps? 
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Absolutely. You'll be amazed how well tailors and craftsmen (most) work in Pakistan. Where are you going? Lahore or Karachi? I don't know exact places in Karachi, I'm originally from Lahore. In lahore you can go to Liberty market, anar kali, rung mehel, kinaari bazar, ichra.
I'm not exactly sure where these places are located but these are the apparent huge bazaars -- a mecca for shopping! So you could ask anyone there. They have samples of their work, references etc so it wont be hard for you to pick a shop based on their work.
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im from lahore and yea have heard and been to most of the places you mentioned so i'll see what i can find. thanks a bunches :)