Impacts of skiing on alpine and subalpine vegetation are expressed by multiple disturbances: snow is being compacted by skiers and heavy machinery, new ski pistes are constructed by means of machine-grading and, increasingly, artificial snow is being produced by snow-making facilities. This review compiles studies on ski piste vegetation from more than three centuries and skiing destinations across the world and distinguishes between different types of disturbances and elevations. Skiing in general can exert disturbances in the vegetation because of the changed snow conditions. The compaction of the snow can induce hard soil frost and mechanically damage plants. Machine-grading in summer to create smooth surfaces represents the most drastic disturbance on ski pistes especially at elevations around and above treeline. Artificial snow production has the potential to change vegetation through an input of water and ions and through postponing the time of melt-out. Restoration measures to re-establish local vegetation after machine-grading have improved considerably in the last decades, however, still the vegetation and soil rarely fully recovers after major disturbance. If constructions are unavoidable, it is vitally important that restoration measures follow restoration guidelines that represent today’s state of the art.