Lateral oblique forehead lines: redefining sleeping lines and treatment with botulinum toxin A


Correspondence: Mohammed G Turkmani, Derma Clinic, PO Box 20632, Riyadh 11465, Saudi Arabia. E-mail:



Lateral oblique forehead lines had previously been defined as “sleeping lines.” We present arguments to support the premise that these lines are not caused by sleeping position, but arise instead from the repeated contraction of powerful frontalis and orbicularis oculi muscles and can therefore be successful treated with onabotulinum toxin A.


To understand the causes behind the development of lateral oblique forehead lines and to look at treatment outcomes using onabotulinum toxin A.


An examination of facial anatomy and physical laws that could influence the formation of lateral oblique forehead lines was performed. Case studies of two male subjects presenting with these lines and treated with onabotulinum toxin A are discussed.


Lateral oblique forehead lines were shown to be the result of muscular contraction rather than sleeping position. There were positive esthetic results in the appearance of these forehead lines in the two patients treated with onabotulinum toxin A.


This new definition of lateral oblique forehead lines is important because it allows for the possibility of treating overactive muscular activity with onabotulinum toxin A thereby diminishing the appearance of the lines.