Various modification treatments have been carried out to improve the physicochemical and functional properties of various types of starch and flour. Modification by acetylation has been widely used to improve the quality and stability of starch. This review describes the effects of acetylation modification and its dual modifications on the physicochemical properties of starch/flour and their applications. Acetylation can increase swelling power, swelling volume, water/oil absorption capacity, and retrogradation stability. The dual modification of acetylation with cross-linking or hydrothermal treatment can improve the thermal stability of starch/flour. However, the results of the modifications may vary depending on the type of starch, reagents, and processing methods. Acetylated starch can be used as an encapsulant for nanoparticles, biofilms, adhesives, fat replacers, and other products with better paste stability and clarity. A comparison of various characteristics of acetylated starches and their dual modifications is expected to be a reference for developing and applying acetylated starches/flours in various fields and products.