Aikens started his cooking career as a commis chef at the Mirabelle in Eastbourne. He continued his career as a commis chef at the Cavalier's with David Cavalier. Aikens moved to London’s Capital Hotel under Michelin-starred head chef Philip Britten as a commis chef. Aikens was working as chef de partie at Pierre Koffmann’s La Tante Claire in London when the restaurant won its third Michelin star before becoming sous chef at Pied à Terre in 1993 under Richard Neat. Aikens left London to work under Joël Robuchon in Paris and Gerard Boyer in Reims before returning to Pied à Terre as head chef in 1996, where he held onto the two Michelin stars earned by his predecessor, Richard Neat. In doing so, he became the youngest British chef to be awarded two Michelin stars.
Aikens spent a year as head chef at La Tante Claire before opening Tom Aikens in April 2003. The restaurant won a Michelin star in January 2004 and three stars in the Egon Ronay Guide for 2005. In 2005, it was named as the eighth best restaurant in the world in Restaurant's Top 50