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Astaxanthin is a high-value carotenoid currently being produced by chemical synthesis and by extraction from the biomass of the microalga Haematococcus pluvialis. Other microalgae, such as Chlorella zofingiensis, have the potential for being used as sources of astaxanthin. The differences between the synthetic and the microalgae derived astaxanthin are notorious: not only their production and price but also their uses and bioactivity. Microalgae derived astaxanthin is being used as a pigment in food and feed or aquafeed production and also in cosmetic and pharmaceutical products. Several health-promoting properties have been attributed to astaxanthin, and these were summarized in the current review paper. Most of these properties are attributed to the high antioxidant capacity of this molecule, much higher than that of other known natural compounds. The aim of this review is to consider the main challenges and opportunities of microalgae derived products, such as astaxanthin as food. Moreover, the current study includes a bibliometric analysis that summarizes the current research trends related to astaxanthin. Moreover, the potential utilization of microalgae other than H. pluvialis as sources of astaxanthin as well as the health-promoting properties of this valuable compound will be discussed.