<p>Per- and polyfluoroalkyl substances (PFAS) are synthetic compounds characterized by strong C–F bonds and unique physicochemical properties, which confer extreme persistence in the environment and resistance to conventional treatment. Their widespread occurrence in water, soil and biota, combined with adverse health effects, has raised major public, scientific and regulatory concern. Remediation strategies are broadly categorized into separation and destructive technologies. Separation approaches, such as adsorption with activated carbon or ion exchange resins and membrane processes like nanofiltration and reverse osmosis, show promising removal efficiency but face challenges related to energy demand, fouling, limited performance for short-chain PFAS and the generation of concentrated waste. Destructive technologies, including electrochemical oxidation, advanced oxidation and biological degradation, aim to mineralize PFAS into less harmful byproducts. While offering potential for permanent remediation, these methods remain limited by high costs, slow kinetics and material instability. Most studies are confined to laboratory-scale experiments under idealized conditions that do not reflect the complexity of contaminated matrices, limiting scalability. Field-scale demonstrations and integrated treatment are increasingly recognized as necessary to bridge this gap. Future research should prioritize hybrid system optimization, cost–benefit analyses and the development of energy-efficient, sustainable approaches targeting both short- and long-chain PFAS. This review critically examines current advances, limitations and perspectives in PFAS remediation, outlining pathways toward scalable solutions for mitigating their environmental and health risks.</p>