Group IV nanodots (NDs) mainly including carbon (C), silicon (Si), germanium (Ge) have aroused much attention as one type of important nanomaterials that are widely studied in optoelectronics, semiconductors, sensors and biomedicine-related fields owing to the low cost of synthesis, good stability, excellent biocompatibility, and some attractive newly emerged properties. In this review, the synthesis, surface engineering and application in bioimaging and biotherapy of group IV NDs are summarized and discussed. The recent progress in the rational synthesis and functionalization, specific therapy-related properties, together with in vivo and in vitro bioimaging are highlighted. Their new applications in biotherapy such as photothermal therapy (PTT) and photodynamic therapy (PDT) are illustrated with respect to C, Si and Ge NDs. The current challenges and future applications of these emerging materials in bioimaging and biotherapy are presented. This review provides readers with a distinct perspective of the group IV NDs nanomaterials for synthesis and surface engineering, and newly emerging properties related to applications in biomedicine.