Heavy metal contamination in water bodies poses significant environmental and health risks due to its toxicity and persistence, necessitating cost-effective and sustainable remediation methods. Coagulation-flocculation is a widely employed physicochemical process for the removal of heavy metals from wastewater. Emphasis is placed on the evolution of wastewater treatment practices, with a particular focus on advancements in coagulation-flocculation and its integration with modern technologies. The interaction mechanisms between metal ions and coagulant-flocculant complexes, including charge neutralization and adsorption, are discussed. The results indicate that optimal pH conditions aid in significant heavy metal removal and the integration of coagulation-flocculation with advanced treatment methods, such as biosorption, offers a promising approach to improving treatment efficiency. The case study of the Common Effluent Treatment Plant, Bantala, presents the efficacy of coagulation-flocculation in heavy metal amelioration from the composite tannery wastewater along with addressing the challenges such as sludge production and secondary pollution optimized on-site.