Ti-bearing blast furnace slag (TBS), a byproduct of vanadium–titanium magnetite smelting, serves as an important secondary resource for titanium recovery. However, the complex mineralogical composition and finely dispersed nature of titanium in TBS present significant challenges for efficient extraction. This review systematically examines four major titanium extraction routes: hydrometallurgical leaching, pyrometallurgical smelting, molten salt electrolysis, and selective precipitation, focusing on their limitations and recent improvements. For instance, conventional acid leaching suffers from acid mist release, a colloidal formation that hinders titanium recovery, and waste acid pollution. The adoption of concentrated sulfuric acid roasting activation effectively suppresses acid mist emission and prevents colloidal generation. Pyrometallurgical approaches are hampered by high energy consumption and substantial carbon emissions, which can be alleviated through the use of gaseous reductants to enhance reaction efficiency and reduce environmental impact. Molten electrolysis faces issues such as polarization and undesirable dendritic deposition; these are mitigated by employing liquid metal cathodes integrated with vacuum distillation to achieve high-purity titanium products. Selective precipitation struggles with strict crystallization conditions and low separation efficiency, though advanced techniques like supergravity separation show improved extraction performance. We propose an integrated technical strategy termed “Online conditioning driven by waste heat-mineral phase reconstruction-directional crystallization-optimized liberation.” This approach utilizes the inherent waste heat of slag combined with electromagnetic stirring to enhance homogeneity and promote efficient titanium recovery, offering a sustainable and scalable solution for industrial TBS treatment.