Textile design has transformed significantly, from traditional weaving and dyeing techniques to incorporating advanced technologies such as CAD, 3D printing, and innovative fabrics. CAD/CAM tools have transformed the industry by offering efficiency in production, customization, and cost-effectiveness. Indeed, Iris van Herpen’s pioneering 3D-printed haute couture and Nike’s Flyprint footwear exemplify the true potential of personalization and performance optimization. The industry is increasingly embracing practices such as biodegradable materials, natural dyeing, zero-waste strategy, and closed-loop recycling systems in conjunction with these technological advancements. Innovations include bacterial dyeing and bioengineered spider silk, new frontiers in eco-friendly textiles. Intelligent textiles can integrate functionality into fashion, from health-monitoring apparel to adaptive athletic wear. Nevertheless, there are still significant challenges. Ethical issues emerge in the design process as AI may improve efficiency and personalization at the cost of human designers’ cultural and emotional value. High barriers to finance for advanced technologies are another hurdle, mainly for smaller companies. Against all these challenges, however, the synergy of creativity, technology, and ecological responsibility continues to open new doors in textile design towards innovation and addressing critical concerns globally. This chapter explores the challenges and potentialities in the design of modern textiles and stresses how creativity, technological advancement, and sustainability converge.