Sustainable innovation – the introduction of new products and processes that bring economic, social and environmental benefits – have a crucial role in the textile and fashion industry. However, current literature mainly focuses on new product development and the consequent environmental impacts. One of the main challenges for textile and fashion companies is how to be environmentally, socially and economically sustainable and innovative in the meantime. This paper is based on the Triple Bottom Line framework and attempts to address this gap by identifying some key success factors (KSFs) that could allow textile and fashion companies to develop product and process innovations, taking into account their social, environmental and economic outcomes. The research is based on a multiple-case study method and results show that textile and fashion companies can achieve a competitive advantage by being sustainable and innovative and when there are strong corporate values, cultural heritage and stable relationships with the territory. Besides extending the literature on sustainable, the paper highlights the main challenges and opportunities within this sector.