Perkins's first acting role was in 1983's "Psycho II", in which he briefly appeared as the twelve-year-old version of the Norman Bates character his father had created. Since then, he has appeared in the 1993 film adaptation of the play "Six Degrees of Separation", the 2001 film "Legally Blonde" as, Dorky David, and he also appeared in "Not Another Teen Movie" and "Secretary", and on episodes of "Alias" and other television shows. He also has a brief role in the 2009 film "Star Trek" as a Starfleet Academy trainee. In the award winning indie film "La Cucina" he plays Chris, opposite Leisha Hailey. He also had a brief role in the 2022 film "Nope" as Fynn Bachman.

He wrote and directed the horror films "The Blackcoat's Daughter" (2015), "I Am the Pretty Thing That Lives in the House" (2016), "Gretel & Hansel" (2020) and "Longlegs" (2024). His next film, "The Monkey", is due for release in 2025. He also wrote and directed an episode of "The Twilight Zone" (2019).