Sass is a CSS pre-processor that adds advanced features like nesting, variables, mixins, inheritance and extends. It has two syntaxes: SCSS, which is similar to CSS, and the indented syntax which does not use brackets or semicolons. To use Sass, Ruby must be installed along with the Sass gem. Compass is an optional framework that adds features like a watch system and custom mixins. Sass allows nesting rules, using variables, creating reusable styles with mixins, importing partial files, extending styles for DRY code, and performing operations.