Tsukamoto was a member of the jury at the Venice International Film Festival in 1997 and 2019.

Vital (2004) again features a love triangle, this time consisting of two women and one man. The story concerns a young man whose girlfriend is killed in a car crash whilst being driven by him. He is a medical student and is given her body to dissect in class (whether by coincidence or intentionally is not clear). Tsukamoto also acted in and directed the short film Haze in 2005. In 2006, Tsukamoto directed the horror thriller Nightmare Detective (2006). The film centers around a vagrant with the supernatural ability to enter the dreams of others and a police officer who pleads with him to help her solve a series of bizarre murders committed by a serial killer (Tsukamoto) with a similar ability.

He is also a successful voiceover artist for TV advertising in Japan. He also provided the Japanese voice of Vamp in the 2008 PlayStation 3 game Metal Gear Solid 4: Guns of the Patriots. Tsukamoto was originally set to play the character in Metal Gear Solid 2: Sons of Liberty (after Hideo Kojima’s first choice, Kaneto Shiozawa, died before casting began) but was unavailable due to scheduling conflicts, so Ryōtarō Okiayu was assigned the role instead.