Introduction: Skin ageing is a multifactorial biological process with a documented impact on quality of life and psychological well-being. Demand for non-invasive treatments has grown steadily, and cosmetic facial acupuncture has emerged as an alternative based on the principles of Traditional Chinese Medicine and with biologically plausible mechanisms of action. Objective: To systematically review and critically analyse the available scientific evidence on cosmetic facial acupuncture as an approach to skin ageing, identifying its mechanisms, clinical outcomes, safety profile, and limitations in the literature. Methodology: A literature search was conducted in the PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science, CNKI and Wanfang databases, with no restrictions on date or language. Randomised clinical trials, prospective pilot studies, systematic reviews, and narrative review articles were included. Methodological quality was assessed using the Jadad scale and the GRADE system. Results: The studies identified report measurable improvements in skin elasticity, hydration, muscle tone, and wrinkle reduction, with a favourable safety profile. The proposed mechanisms of action include stimulation of dermal fibroblasts leading to collagen synthesis, improved microcirculation, lymphatic modulation, and neuroendocrine activation. The available evidence is still predominantly preliminary, with a limited number of large-scale randomised clinical trials. Conclusion: Cosmetic facial acupuncture is a promising approach with a biological basis, but the existing evidence does not yet permit formal clinical recommendations. Larger-scale controlled trials with standardised methodologies and long-term follow-up are required.