Body piercing and tattooing have surged in popularity among adolescents, particularly youth. However, secondary school students often possess limited knowledge of the associated health risks. This study assessed knowledge and perceptions of these risks among students in Egan, Lagos State. Specific objectives included evaluating knowledge of health risks, perceptions toward body modifications, and factors influencing their adoption. A descriptive cross-sectional design was employed in this quantitative study. A self-developed questionnaire gathered data from 270 Senior Secondary 1–3 students selected via simple random sampling. Analysis used SPSS version 23, with results presented in tables and charts. Findings indicated that 73% of respondents viewed tattooing as cutting skin and injecting dyes, while 18.5% described it as ink drawing. For body piercing, 68.9% accurately defined it as creating a hole for jewelry insertion. Awareness of health risks was high (92.6% for tattoos; 81.5% for piercings). Perceptions were predominantly negative, with 46.4% deeming tattoos unnecessary, 51.4% linking them to irresponsibility, and 46.4% to indecency. Key influences included media exposure (58%), personal expression/identity (72.2%), and peer pressure (55.6%). Gender showed a significant association with knowledge of health risks (p=0.01p=0.01), but no significant link existed between perceptions and influencing factors (p=0.314p=0.314). The results highlight the importance of culturally sensitive nursing interventions, targeted health education, and non-judgmental care for individuals with body modifications. Recommendations include government-mandated regulations and licensing for piercing and tattooing studios