Sleep lines. Commentary

BACKGROUND. This is a tribute to Dr. Samuel J. Stegman who in 1987 described Sleep Creases. His awareness of these lines has helped us understand the anatomy of the underlying superficial musculoaponeurotic system (SMAS). OBJECTIVE. To expand upon the clinical description and the anatomical basis of sleep lines. METHOD. A pillow or hand test is used to accentuate sleep lines. Their development is linked to the underlying attachments of the SMAS. RESULTS. There is a correlation between the location of the underlying SMAS or aberrant scar tissue and sleep lines. To effectively treat these lines, the sleeping position must be altered or subcision of the underlying SMAS attachments and skin resurfacing may improve the situation. CONCLUSION. We have confirmed Dr. Stegman's hallmark work on sleep wrinkles. They are accentuated by pillow contact and the underlying SMAS.