After abruptly quitting art classes, she moved to New York at the end of the 60's. Here she became involved with the underground art scene, writing for music magazines acting and collaborating with among others the playwriter Sam Shepard. She met photographer Robert Mapplethorpe and they moved together. She began writing lyrics for other band such as the Blue Oyster Cult and read her own poetry as a warm-up act for the pioneer punk group New York Dolls. Her first book of poetry, Seventh Heaven, was published in 1972, followed by among others kodak (1972) and WITT (1973).

With her readings of poetry, usually backed by guitarist Lenny Kaye and keyboardist Richard Sohl, she became part of the emerging punk scene in New York. They teamed up with guitarist Tom Verlaine from Television and recorded the single "Hey Joe", with "Piss Factory" on the b-side. Shortly thereafter they formed the Patti Smith Group and had a lengthy stay at CGBG (originally "CGBG and OMFUG", "Country, Bluegrass and Blues and Other Music For Urban Gourmets"). Their concerts were instrumental in making this place the major punk and new wave club in New York, were groups like the Ramones, Television and Talking Heads would play regularly. Patti Smith Group were among the first punk/new wave groups signed to a major label. Their first album, Horses, was produced by the Velvet Underground's John Cale and was very well received both by the music press and the public and are regarded today as a classic. The cover, a black and white photo of Patti smith taken by Robert Mapplethorpe, created much debate. It shows Patti Smith in an androgynious pose, dressed in black trousers, white shirt and a tie around her neck — "my Rimbaudian pose" as she describes it — avoiding all the stereotypes attributed to female rock artists at that time. In poetry and song in her early period she often challenges gender stereotypes, exploring male and female sexuality and gender ambiguity.

Their next recording, Radio Ethiopia (1976), did not get so good reviews and sold poorly. It was during the tour that followed that she fell down from stage and had to withdraw for a while. In 1978 she published her most extensive book of poetry, Babel, and the same year came Easter. The song "because the night", co-written with Bruce Springsteen, hit the charts both in the US and UK, which meant a commercial breakthrough for the Patti Smith Group. They made one more record, Wave (1979) before Patti Smith withdrew from the public. She married guitarist Fred "Sonic" Smith of the legendary pre punk group MC5, and they raised two children. She stepped into the public again for a short time with Dreams of Life (1988), produced by Fred Smith.

Robert Mapplethorpe died of AIDS in 1989, and the poems in The Coral Sea (1994) are written in honor of him. Duing 1994-5 several of her closest friends passed away, among them her husband Fred Smith and brother Todd, and her comeback album, Gone Again (1996) centers around the theme of life and death. Since then she has released two albums, Peace and Noise (1997) and Gung Ho (2000). Since the middle of the 90's she has appeared in public again, both with poetry readings, concerts and tours.