An Experimental Eye-Color-Changing Surgery Is Gaining Popularity—Here’s What We Know about It
Some people who have always wanted a different eye color, like this vibrant green shade above, are considering a new surgery called cosmetic keratopigmentation to permanently change them.
Carol Miranda paid a surgeon in Los Angeles thousands of dollars last year to permanently change her eye color from dark brown to hazel.
Miranda, a now 49-year-old sales associate, had dreamed since childhood of having hazel or green eyes. For decades she’d worn colored contacts and admired how the lenses “softened” her facial features. She sometimes wore them to bed or the beach despite doctors’ warnings. Then, in 2022, she learned of an experimental procedure called cosmetic keratopigmentation—which claimed to offer the effect of colored contacts sans the fuss.
For the procedure, Miranda lay flat on an operating table opposite a large, machine-guided laser. Speculums bared her eyes wide as numbing drops desensitized the tissues. Her surgeon directed the laser to dig donut-shaped channels into each of her corneas, the clear outer coverings of the eyes. Using various handheld tools, the doctor then adjusted the edges of these channels and filled them with dye. In under 20 minutes and with minimal discomfort, the transformation was complete: Miranda’s honey-colored eyes looked “surprisingly natural,” she says.
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Clients’ motivations range as widely as custom eye color options, which span the natural spectrum from icy blue to hazel. Some, like Miranda, believe different colors better suit their appearance. Others, Boxer Wachler says, find solace in having an eye color that resembles a family member’s, living or deceased. After receiving their new eye color, “I’ve had patients be giddy with laughter or cry of happiness,” Boxer Wachler says.
In September 2024 surgeon Boxer Wachler transformed this client’s eye color from brown to a “medium-intensity evergreen.”
In the early 2000s, people interested in similar cosmetic transformations often turned to iris implantation, an invasive and dangerous off-label operation then available in a few countries outside of the U.S. But iris implantation routinely causes chronic inflammation, glaucoma, cataracts and vision loss. By contrast, proponents of cosmetic keratopigmentation liken the newer procedure to LASIK (laser-assisted in situ keratomileusis), a widely approved procedure for correcting visual problems. Both LASIK and keratopigmentation procedures are generally quick, painless and easy to recover from. (At around $6,000 per eye, however, cosmetic keratopigmentation costs more than twice that of LASIK.)
In December 2024 Boxer Wachler transformed another client’s eye color from brown to a “medium-intensity emerald green.”
“I tell my students, ‘You want to be on the cutting edge, not the bleeding edge,’” says Roberto Pineda, a corneal specialist at Massachusetts Eye and Ear. “Cosmetic keratopigmentation currently lacks scientific rigor.”
Boxer Wachler says few lasting adverse effects have been reported in the procedure’s medical literature. The largest study of outcomes to date, published in 2018, surveyed 204 people who’d undergone keratopigmentation in the past four months to 12-plus years. Of the 29 people who developed complications, 49 percent suffered light sensitivity that tended to resolve after six months; 19 percent saw their new eye color fade or change; and 4 and 2 percent, respectively, experienced slight visual field limitations or pain in magnetic resonance imaging (MRI) machines. A 2021 study conducted by some of the same co-authors, who surveyed 40 cosmetic keratopigmentation clients two and a half years after their operation, reported similar but less frequent complications. The authors of that study wrote in their paper that this shift reflected advancements in technique. More recent research documented five cosmetic keratopigmentation recipients who later developed ectasia, a corneal bulge that can distort vision without treatment.
Visual field changes may arise because the procedure can flatten the dome of the cornea, Boxer Wachler explains. And if a person later has an MRI, swelling and burning of the eye can occur if the machine’s powerful magnetic field interacts with trace colorant metals in the new pigment. The FDA does not regulate such pigments, raising the risk of contamination by bacteria or damaging materials, including certain colorant metals.
Boxer Wachler clarified he does not use pigments containing metals, though he declined to specify his dyes’ ingredients or sources. He and Movshovich say they’ve pioneered techniques to remove some of a client’s dye if needed, but the pigment generally persists in eyes. The removal techniques are mostly used to modify the intensity of a client’s new color or to swap it out for another hue.
Cosmetic keratopigmentation surgeons may be able to extrapolate from the 25-year history of the procedure’s therapeutic counterpart: medical keratopigmentation. This treatment, also performed off-label, is an option for people born without irises or missing parts of them, which causes serious visual glare that can make daytime activities such as driving difficult or painful; in medical keratopigmentation, surgeons inject dye over missing regions of the iris to help block excessive light. Pineda, who began performing the therapeutic procedure in the late 1990s, notes that reports of side effects are limited but can include pigment fading and, in rare circumstances, spreading.
Boxer Wachler says he declines to operate on people with a history of LASIK, eye inflammation, present or prior autoimmune conditions or other conditions that might raise the risk of complications. He treats clients at risk for glaucoma on a case-by-case basis. Steinemann advises anyone with a strong family history of eye disease to steer clear of the procedure, noting that it might obstruct surgeries needed to treat any future conditions. Boxer Wachler encourages prospective cosmetic keratopigmentation receivers to seek out experienced providers for the safest and most natural-looking results.
“I’d ask people to remember,” Steinemann says, “that with your eyes, you don’t get a second chance.”
Saima S. Iqbal is a former Scientific American news intern. She specializes in health and medicine and is based in New York City.
Source: www.scientificamerican.com