Abstract Smart adhesives with engineered mechanical structures have emerged as a transformative technology with broad applications in fields such as wearable healthcare devices, bioengineering, and soft robotics. By integrating advanced mechanical architectures like kirigami, tessellations, and multilayered designs, these adhesives exhibit enhanced surface and mechanical properties that lead to superior interfacial adhesion. Such designs offer critical advantages—improved stretchability, substrate conformability, and increased adhesion strength—over conventional adhesives. This review explores the range of engineered structures used in smart adhesives and demonstrates how these innovations address the limitations of traditional adhesives. Additionally, we discuss their applications in wearable healthcare devices, flexible electronics, and robotics.