Then I make sure the edges reconcile with the neighbouring tile. This is a manual and time consuming process.

This is while I was working on the edges.
After the edges are reconciled, then I start sculpting the terrain, trying to keep normal features terrain has in mind, as well as the general flow of the area I'm going for. The next picture shows this in progress.

And then I put trees on (sorry for the strange rotation) and water and other landscaping on. As well as neighbour connections (roads, rail, highway, power and the like).

And then I add any city. This one is pretty boring as it's supposed to be a dam (and not only are dams cool, but they're also a good way to change the rivers level between different city tiles) that's really far away from the center of town. So there isn't much going on here.