Hyaluronic acid (HA) is widely used in topical formulations to manage photoageing, due to its viscoelasticity, biocompatibility, biodegradability, and non-immunogenicity. Given the variety of HA-containing products available, identifying the most effective formulations is important. This systematic review evaluates the effectiveness of different topical HA formulations in improving signs of photoaging in facial skin. The conduct of this review followed Preferred Reporting in Systematic Review and Meta-analysis (PRISMA) guidelines. We searched the databases of PubMed, Scopus, Cochrane Centre Register of Controlled Trials, Web of Science, and CINAHL from inception to July 2025. Randomised controlled clinical trials (RCTs) and quasi-experimental studies assessing topical HA in adults were included. The review included six studies: three RCTs and three uncontrolled quasi-experimental studies. Due to significant clinical and methodological heterogeneity across the included trials, a meta-analysis was not feasible, and a qualitative synthesis was performed. Overall, our findings show that HA improves skin wrinkles, skin hydration, and skin elasticity. Of the various HA formulations, microneedle patches appear more effective than conventional formulations. Evidence suggests that topical HA, especially via microneedle patches, may benefit photoaged facial skin. Further head-to-head trials with standardised outcome measures are needed to assess the relative effectiveness of different HA formulations.