R.A.M 3 and L.V.E 2023 have a very deep terrain painting system.
You can paint whole terrains via areas, so splines lakes, rivers, etc., by predefined procedural rules. So you have the whole terrain painted in a few clicks; you can repaint and refresh it anytime. From Unity version 6.3, it also supports stamping via splines. So the whole terrain level design could be made via one of this 2 systems. Just like in the video.
Asset Store link: https://assetstore.unity.com/packages/tools/terrain/r-a-m-3-river-auto-material-3-287456?aid=1011l7vcu