Well I use existing templates that I get for free off the Internet, and then tweak them to how I want them to be. I use Notepad++, a free development software, as my editor, together with Mozilla Firefox for viewing my pages.
By the way, here's a great place for finding some kickass templates. They come with css and are ready and perfect to go:
I've always dreamt about using it ... Both Photoshop and Dreamweaver are on my MUST DO list. I probably shouldn't say it loud, but I'm using Expression Web 4. Dreamweaver probably runs like a Porche in comparison, whereas Expression Web is like taking a train.
Now and then I use Notepad++ with Mozilla Firefox. What I like about Expression Web 4, apart from the much cheaper price, is that one can view one's Website in multiple browsers. One can also use FTP spontaneously when one publishes in addition to editing Websites live, if FrontPage Extensions are enabled by the Host. The latter is great for when one wants to make quick changes, I like speed and Expression Web 4 provides me with that. Code can be messy however.