The hydrothermal synthesis of zinc oxide (ZnO) particles from zinc acetylacetonate monohydrate in "pure" aqueous solution and in aqueous NaOH solution at 90 °C is reported. The structural and morphological properties of ZnO particles were investigated by powder X-ray diffraction, X-ray absorption spectroscopy (XAS), field emission scanning electron microscopy, and transmission electron microscopy. The effect of NaOH on the growth mechanism and photocatalytic performance of hierarchical ZnO structures was investigated. The experimental findings, supported by results of quantum chemical calculations at the level of density functional theory, were used to propose the mechanism of nucleation and preferential growth of finely tuned hollow and nonhollow ZnO structures and their effects on the photocatalytic activity. The calculations indicate that the process of ZnO nucleation in "pure" aqueous solution mainly proceeds by the reaction of small monomers, while tetramers play a crucial role in aqueous NaOH solution. Both the preferred ZnO nanostructure and microstructure growth processes are driven by O-H···O hydrogen bonds as controlling elements. The calculated values of the EO···H interaction indicate a stronger interaction via O-H···O hydrogen bonds in "pure" aqueous media (EO···H = -11.73 kcal mol-1) compared to those obtained in aqueous NaOH solution (EO···H = -8.41 kcal mol-1). The specific structural motif of the (ZnO-H2O)12 dodecamers with calculated negative ΔG*INT free release energy indicates that the formation of anisotropic nanocrystalline ZnO with the c-axis as the primary growth direction is spontaneous and accelerated exclusively in "pure" aqueous solution, whereas it is an unfavorable endergonic process in aqueous NaOH solution (ΔG*INT > 0). Efforts have been made to determine the photocatalytic efficiency of the ZnO samples based on the XAS measurements. ZnO particles obtained in "pure" aqueous solution show the highest photocatalytic activity due to the presence of a larger amount of oxygen vacancies.