I hate a ton of random icons on the desktop. A nice wallpaper with a nice neutral color to the taskbar, a few icons, and a couple useful gadgets (ask me a month ago and gadgets would have been unheard of, lol). If I were to ever get enough icons to make another column, it's time to delete a few. Three 24" screens are amazing BTW. My HTPC and laptop look the same basically, change around the desktop pictures and the fact that they only have one screen.
Oh I don't make them but I know a bunch of guys that do and there experts (most of there work is free), the themes are full (not just a skin) color, text, highlights, backgrounds, the full OS etc are changed.