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Cosmetic surgery is increasingly visible among Nigerian adolescents and youths, yet its mental health implications remain insufficiently understood. This systematic review synthesized evidence on cosmetic surgery trends, determinants, and associated mental health and psychosocial outcomes among adolescents and youths in Nigeria, while identifying gaps in the existing evidence base. A systematic search of PubMed, Scopus, African Journals Online, ScienceDirect, SpringerLink, and Google Scholar was conducted for peer-reviewed primary studies published between 2016 and 2025. Methodological quality was assessed using Joanna Briggs Institute critical appraisal checklists alongside a complementary risk-of-bias assessment. Findings were synthesized thematically because of substantial heterogeneity in study designs, populations, exposures, and outcomes. Twelve studies met the inclusion criteria. Liposuction, Brazilian butt lift, and body contouring were among the most frequently reported procedures, particularly among young women. Reported drivers included social media exposure, celebrity and influencer culture, body dissatisfaction, peer and sociocultural pressures, and economic aspirations. Mental health and psychosocial outcomes included body dysmorphic disorder, anxiety, depression, body-image dissatisfaction, reduced self-esteem, and post-surgical regret. Psychological screening before cosmetic surgery was rarely reported. Cosmetic surgery among Nigerian youths appears to be shaped by interacting sociocultural, media, and psychological factors. Evidence-informed priorities include strengthening psychological assessment, public mental health education, appropriate regulation of cosmetic surgery practice, and longitudinal, culturally validated, mixed-gender research.