The aim of this interventional, pre-market, double- blinded, controlled, two stages study is to evaluate the performance and safety of Crosslinked Hyaluronic Acid (CLHA) Hydrogel (with and without Lidocaine) for the Treatment of Soft Tissue Deficits.

The performance of Crosslinked Hyaluronic Acid Hydrogel (with and without Lidocaine), for the correction of congenital and acquired deficits of soft tissue, will be evaluated using the change from baseline to V3 in the Wrinkle Severity Rating Scale (WSRS) for 26 mg/ml and 18mg/ml CLHA formulations and in the Lip Fullness Scale (LFS) for 20 mg/ml CLHA formulation.

The duration of the aesthetic effect of Crosslinked Hyaluronic Acid Hydrogel (with and without Lidocaine) for the correction of NLFs, perioral wrinkles and lips augmentation, will be assessed using the mean of the absolute change from baseline to each follow up visit in WSRS and LFS score. WSRS and LFS will be assessed by the evaluating investigator who will be different by the treating investigator.

The aesthetic appearance of the Crosslinked Hyaluronic Acid Hydrogel (with and without Lidocaine) will be assessed using the Global Aesthetic Improvement Scale (GAIS) at each visit. The GAIS will be completed by both the subjects and the evaluating investigators; The volume of material required to achieve an optimal correction result will be assessed at baseline and at optional touch up; The pain intensity after injection of Crosslinked Hyaluronic Acid Hydrogel (with and without Lidocaine) will be assessed using a Numerical Rating Scale (NRS) 2 hours after the injection; The patient satisfaction and the usability of Crosslinked Hyaluronic Acid Hydrogel (with and without Lidocaine) will be evaluated with a specific questionnaire, completed by the Principal Investigator.

The Safety of Crosslinked Hyaluronic Acid Hydrogel (with and without Lidocaine) will be assessed by facial examination and vital signs over the duration of the study. Adverse events and serious adverse events will be collected at each planned visit into a diary dispensed to patients.

Inclusion Criteria:

• Patient Informed consent form (ICF) signed
• Female and male subjects aged 18-65 years and in good general health;
• Subjects with Soft Tissue Deficits of the face requiring midface volume restoration;
• Willingness to follow all study procedures, including attending all site visits, tests, and examinations;
• Agreeing to present at each study visit without makeup;
• Accepting to not change their habits regarding food, physical activity, make-up use, facial cosmetics, and cleansing products;
• Willingness to not undergo other procedures involving permanent and nonpermanent aesthetic correction (e.g. chemical peel, dermabrasion, ablative laser resurfacing), non-invasive skin-tightening, botulinum toxin injections, dermal filler injections, mesotherapy, or fat injections during the study period of 12 months;
• Willing to follow indications to not be exposed to make-up, excessive heat (sun, UV tanning sessions, or laser), and extreme temperatures (intense cold, sauna, hammam, etc.) after the treatment and until the complete absorption of swelling and reddening.

Exclusion Criteria:

• Presence of recurrent facial/labial herpes;
• Presence of tendon, bone, or muscular implants near the area of intervention;
• Subjects previously treated with fillers anywhere in the face or neck;
• Subjects who have undergone invasive face or neck surgery;
• Ongoing cutaneous allergies and history of hyper- or hypo-pigmentation in the mouth area, keloid formation, or hypertrophic scarring;
• Subjects with a known allergy or sensitivity to any component of the investigation products;
• Subjects with a known allergy or sensitivity to any component of the anesthetic cream;
• Subjects with active autoimmune disease and subjects immunocompromised or immunosuppressed;
• Diabetes mellitus or uncontrolled systemic diseases (endocrine, hepatic renal, cardiac, pulmonary, neurological disorder);
• Problems with coagulation or anti-coagulating therapies in progress;
• Subjects with acute inflammatory process or infection, active herpes infection, or history of chronic or recurrent infections;
• Current treatment with substances which act on blood fluidity (eg. Aspirin, NSAIDs, Vitamin E), anti-inflammatory drugs, anti-histaminic, topic and systemic corticosteroids, narcotic, antidepressant, immunosuppressive drugs (with the except of contraceptive or hormonal treatment starting more than 1 year ago), drugs able to influence the test results in the investigator opinion;
• Known drug and/or alcohol abuse;
• Mental incapacity that precludes adequate understanding or cooperation;
• Any previous permanent and nonpermanent cutaneous treatment for aesthetic correction e.g. chemical peel, dermabrasion, ablative laser resurfacing, non-invasive skin-tightening, botulinum toxin injections, mesotherapy, or fat injections within 6 months prior to study inclusion;
• Pregnancy or breastfeeding;
• COVID-19 vaccination within one month prior to study inclusion;
• Participation in another investigational study within 1 month prior to study inclusion.

The study will be double-blinded: patients and the treating investigator will not know which variant of each product (with and without lidocaine) will be injected in the left/right side of the face (or in the upper/lower lip for CLHA Hydrogel 20 mg/ml) and the evaluating investigator will be different from the treating investigator.