Surgical Techniques for Cosmetic Eye Color Change: A Narrative Review

The desire for permanent cosmetic change of eye color has driven the development of various surgical techniques aimed at achieving this transformation, pursuing more enduring solutions. This demand has led to the emergence of three primary surgical approaches: cosmetic iris implants, laser iris depigmentation, and cosmetic keratopigmentation (KTP). Each technique presents distinct advantages, yet also entails specific limitations and potential risks. Cosmetic iris implants, originally designed for congenital or traumatic iris defects, have been repurposed for aesthetic use. However, they come with severe risks, including glaucoma, corneal endothelial cell loss, and even permanent vision impairment. As a result of these complications, they are not approved by major regulatory bodies and are widely considered unsafe. Laser iris depigmentation offers a less invasive approach, using a Q-switched Nd:YAG laser to remove melanin from the anterior iris stroma. While it provides a natural-looking result, it lacks customization and has potential complications like patchy pigmentation, photophobia, and temporary intraocular pressure spikes. Additionally, there is limited long-term data on its safety. Cosmetic KTP, an advanced version of corneal tattooing, has emerged as the safest and most effective option. It involves embedding micronized mineral pigments into the cornea, allowing for precise, customizable, and long-lasting results. Studies show high patient satisfaction and minimal risks when properly performed. Among these techniques, KTP appears to be the best choice owing to its safety and aesthetic flexibility, while cosmetic iris implants should be avoided because of their high risk of complications, and laser iris depigmentation deals with limitations in color selection and long-term reliability. While KTP currently seems the safest option for cosmetic eye color change, this is largely based on limited single-center data and should be confirmed by larger studies in the future.