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Hilton began modeling as a child, initially at charity events. When she was 19, she signed with Donald Trump's modeling agency, T Management. Hilton has also worked with Ford Models in New York, Models 1 Agency in London, Nous Model Management in Los Angeles, and Premier Model Management in London. She has appeared in numerous advertising campaigns, including Iceberg Vodka, GUESS, Tommy Hilfiger, Christian Dior, and Marciano. In 2001, Hilton began to develop a reputation as a socialite, being identified as "New York's leading It Girl" whose fame was beginning to "extend beyond the New York tabloids". She has appeared in several magazines, including the April 2004 issue of Maxim.

Hilton has made cameo appearances in several films, notably Zoolander, Wonderland, and The Cat In The Hat. She landed minor and supporting roles in the feature films Nine Lives, Raising Helen, The Hillz, and House of Wax. Her role as Paige Edwards in House of Wax won the Teen Choice Award for "Best Scream" and earned her a nomination for "Choice Breakout Performance – Female". (It also won her the 2005 Razzie for "Worst Supporting Actress" at the 2005 Golden Raspberry Awards.) She also earned a nomination for "Best Frightened Performance" at the 2006 MTV Movie Awards. She landed her first lead roles in 2006 with the straight-to-DVD releases National Lampoon's Pledge This! and Bottoms Up. She plays the Hottie in the box office bomb romantic comedy The Hottie and the Nottie, released in 2008. She had a minor cameo appearance as herself in An American Carol. Hilton plays Amber Sweet, the surgery- and painkiller-addicted daughter of a biotech magnate in the goth/rock musical Repo! The Genetic Opera. Critics have responded well to her performance in the film, in which she sings and acts. However, in an interview Repo! director Darren Lynn Bousman revealed that he had originally refused to audition Paris for the role of Amber Sweet. "I broke down," says Bousman, "and I met with her, and immediately she charmed everyone in the room." In the same interview, Bousman also revealed that Hilton was so keen to get the part that she had the script smuggled in to her during her much publicized stint in a Los Angeles jail, and used her time inside to work on her role. After numerous unfavourable reviews from critics regarding her acting talents, Hilton announced she was retiring from acting in films on May 25, 2009, but said she would reconsider if given the chance to work with Quentin Tarantino.

Paris Hilton has been quoted as saying that she is the "iconic blonde of the decade"' and compared herself to Princess Diana and Marilyn Monroe (a claim she denied in the May 2007 issue of Harper's Bazaar). She appeared in the 2007 Guinness World Records as the world's "Most Overrated Celebrity". In a poll conducted by the Associated Press and AOL, Hilton was voted the second "Worst Celebrity Role Model of 2006", behind Britney Spears. Critics suggest that Hilton epitomizes the title of famous for being famous; echoing that sentiment, the Associated Press conducted what they called an experiment in February 2007, trying not to report on Hilton for a whole week.

Hilton recently posed nude, covered in gold paint, to promote "Rich Prosecco", a canned version of an Italian sparkling wine.