In a brightly lit Manhattan clinic, CassieAnn peered into a mirror and saw blue eyes staring back at her. For years, she had worn colored contact lenses to achieve that look. But now, the change was permanent. “I always wanted to have a little bit of change when it comes to the eyes,” she told Salon. “I didn’t want to have to take my contacts out and then look different.”

Her transformation was made possible by a cosmetic procedure called keratopigmentation, a technique that uses lasers and dye to alter the visible color of the eye. It’s not contact lenses, nor Photoshop. It’s essentially tattooing the cornea: a procedure some hail as cutting-edge and others warn could go dangerously wrong.

A Permanent Change, A Growing Trend

Keratopigmentation is gaining popularity around the world as a new frontier in elective body modification. The procedure typically involves using a laser or micro-needle to create a ring-shaped channel in the clear cornea, then injecting a pigment to mask the underlying iris color. It’s performed only on the surface of the eye—unlike earlier methods like iris implants, which required entering the eye and carried a higher risk of vision loss.

Originally developed for medical purposes—such as restoring appearance or reducing glare in people with damaged irises—the technique has been repurposed for pure aesthetics. Dr. Kevin Niksarli, who performs the surgery at his New York clinic, says that while some patients report short-term side effects like blurry vision, light sensitivity, and irritation, these symptoms are usually brief. “We have had no one with long, lasting visual or other kinds of side effects,” he said.

Others echo the sentiment. Jack Titus, a Thai-born model who moved to Las Vegas to pursue his version of the American dream, underwent the procedure to make his brown eyes a striking blue-gray. “I love the result,” he told CNN Health. “Every day when I wake up, it’s much more easy for me.”

But not all share the sentiment. When Titus told his family, their reaction was swift: “They tell me it’s too risky, because you only have one set of eyes.”

An Art Form, a Science, and a Warning

Dr. Alexander Movshovich, one of the few U.S.-based ophthalmologists offering keratopigmentation, calls the procedure “basically art.” A trained photographer as well as a surgeon, he designs each pigment blend to suit the patient’s vision of themselves. Some patients tell him they were born with the wrong color. Others believe people with green or blue eyes are more successful or creative. Some just want to stand out.

Movshovich uses a specialized surgical instrument to create a precise channel in the cornea, then seals it after injecting a custom pigment blend. “The possibility of a general infection is tiny,” he said. The pigment stays trapped in a “secluded space,” reducing the risk of leakage—a problem sometimes seen with traditional tattoos.

Still, experts warn that keratopigmentation remains largely unregulated, particularly in the United States, where the Food and Drug Administration (FDA) has not approved it for cosmetic use. Most doctors perform it “off-label,” a term for medical practices that haven’t been officially sanctioned but are nonetheless legal.

The American Academy of Ophthalmology (AAO) issued a public warning earlier this year, citing risks like infection, inflammation, corneal clouding, light sensitivity, and vision loss. “While every surgery has inherent risks, those that are not carefully studied and regulated in the U.S. may carry even greater risks, especially when performed purely for cosmetic reasons on otherwise healthy eyes,” said Dr. Christopher Starr, an AAO spokesperson and professor at Weill Cornell.

In some cases, the risks become visible in magnetic resonance imaging (MRI) machines. A small number of patients experienced complications in MRIs due to metallic pigments used in early versions of the procedure. Although modern pigments have phased out iron, Europe’s Conformité Européenne certifies them, while no equivalent standard exists in the U.S.

Not Quite Blue Eyes, Not Quite Safe

For all the fascination around keratopigmentation, it’s easy to forget what exactly is being altered. The procedure doesn’t change the iris itself. Instead, it masks it by tinting the transparent cornea above. The result can look vivid—or, depending on whom you ask, unnatural. As The Guardian put it, “It makes you look like a replicant.”

It’s not reversible, though the color can be tweaked in follow-up sessions. And it’s not cheap. Prices for the procedure in the U.S. range between $10,000 and $12,000. Insurance doesn’t cover it.

Despite the cost and risk, demand is rising—fueled in part by social media. Platforms like TikTok and Instagram are awash with before-and-after videos showcasing dramatic eye color shifts. The trend mirrors a broader aesthetic turn, from face filters to embryo selection, in which vision of beauty is ever more customizable.

CassieAnn, Jack Titus, and Reva Stout—another patient who opted for a lighter shade of brown—each say they’re pleased with the results. “I’m really happy with this color now,” said Stout, a Navy veteran. “Now, with my new color, I just look like myself,” added Titus.

But none of them can know what their eyes will look—or feel—like in twenty years.

And that’s the question science hasn’t yet answered. Long-term studies on keratopigmentation in healthy eyes simply don’t exist.