Background: The unpredicted growth on the use of cosmetics among young adults including medical students is accompanied by increasing concerns over inappropriate usage and consequent adverse effects. Cosmetovigilance is a systematic monitoring, reporting and analysis of undesired events associated with cosmetic products remains insufficiently addressed within in undergraduate medical training in India. Hence, this study was aimed to assess the knowledge, attitude and practices regarding cosmetic usage and cosmetovigilance among second year MBBS students at a tertiary care institute in Tamil Nadu. Methodology: This cross-sectional, questionnaire-based survey was conducted among second year MBBS students from February to April 2024 at tertiary care teaching hospital in Chengalpattu district. A total of 130 students were participated in this study. Data were collected using a pretested, semi-structured questionnaire pertain to knowledge about Drugs and Cosmetics Act, awareness of cosmetovigilance, attitudes towards cosmetic safety, and practices in product selection, testing, and reporting adverse reactions. Data were entered into Microsoft excel and analysis was performed using SPSS Version 22, and results were presented as frequencies and percentages. Results: Among the 130 participants, 60% of the participants are female with the mean age 20.6 ± 0.95 years. Only 21.1% aware about the Drugs and Cosmetic Act and 33.8% recognized the concept of cosmetovigilance. Knowledge of reporting of side effects were low (28.5%) and merely 41.5% understood the primary purpose of cosmetovigilance. Majority of the participants (68.5%) had poor practice about cosmetic sharing with others. One-third considered product certification (24.6%), tested products before use (22.3%), or checked expiry/manufacture dates (26.9%). Adverse event reporting was notably deficient (23.1%). Conclusion: Suboptimal knowledge and practices regarding cosmetic safety and cosmetovigilance were observed among second year MBBS students. This study highlights the imperative for integrating consumer safety and cosmetovigilance modules into the medical education to foster responsible cosmetic use and adverse event reporting among future healthcare professionals.