On a recent afternoon in Paris, a woman was having her eye colour changed from brown to green.
She was lying on the operating table, her left eye clamped open with an ophthalmic speculum while a doctor used a scalpel to slowly inject the pistachio green, mineral-based pigment into her cornea.
Observing the surgery was Dr Francis Ferrari, the French ophthalmologist at the New Eyes Paris clinic who invented the cosmetic process, called Femtosecond Laser-Assisted Annular Keratopigmentation, or Flaak, just over a decade ago.
He rolled his stool closer to the monitor, which projected an extreme close-up image of the eye. “Not too much in the left eye,” he told his colleague, Dr Jean-François Faure, who murmured in agreement, his own eyes focusing through the surgical microscope as he worked.
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Hours earlier, Ferrari had consulted with the patient, holding up a plastic model of an eyeball. “The colour of the eye is determined by the iris, and we won’t be changing the colour of the iris,” he said. “We will be hiding the colour of the iris by colouring the space in front of the cornea, similar to a contact lens, and with a laser, we will create a circular incision through which we will inject the colour. Do you understand?”
“Oui, docteur,” said 35-year-old Aysegul Kolvert, who had travelled to Paris the previous day from Grenoble in southeastern France. She’d always dreamed of having green eyes. And, she said, “I was tired of wearing contact lenses”.
Kolvert is one of more than 2,500 people who have come to New Eyes Paris seeking the surgery. Many of Ferrari’s patients learned about keratopigmentation through social media, and often message the doctor on Instagram to book initial appointments over Zoom calls. Most want to transition from dark to light shades, choosing among a range of pigments that include olive green, pistachio, “Riviera blue,” “honey gold” and “ocean”.
The procedure is performed every Wednesday in a clinic that was formerly a stained-glass factory, which is fitting for an establishment where two doctors, who in some sense regard themselves as artists, stain the proverbial windows of the soul. Recovery lasts a single day.
Ferrari and Kolvert studied the simulation on a laptop to see how the pistachio green would look in her eyes. “Are you sure it will look green enough?” Kolvert asked. Ferrari assured her it would.
Because a cornea never completely heals, a patient who is not pleased with the results of the keratopigmentation can remove about 80 per cent of the colour, though it’s not advisable.
Within the wider ophthalmology community, the procedure is controversial since manipulating the cornea comes with a host of potential complications – such as corneal scarring, infections, and serious vision problems.
“I think there’s a lot of fear among ophthalmologists, especially because there’s not really any long-term data on the procedure itself and the pigments that are used,” said Dr Amita Vadada, an ophthalmologist and a clinical spokesperson for the American Academy of Ophthalmology. “The eye is a very sensitive organ, immunologically.”
Vadada is especially concerned with foreign pigments being injected into the corneal layers, which can cause inflammation. “Unlike other parts of the body, even low-grade inflammation of the eye can lead to permanent scarring, light sensitivity and pain,” she said, adding that with keratopigmentation, “you’re potentially altering the function of the eye”.
Ferrari insists that Flaak is no more dangerous than Lasik surgery and carries even fewer risks than wearing contact lenses, which are prone to infection and corneal ulcers. He claims the process is safer than both laser depigmentation and iris implant surgery. The latter surgery is an alternative colour-changing technique often known by its brand name, BrightOcular. It is another controversial procedure, in which coloured silicone is inserted into the eye. It is now at the centre of several lawsuits.
At 67, Ferrari is tall and soft-spoken with watery, greenish-blue eyes. He was raised in Luxembourg by a father who worked as an interpreter, from French to Italian, for the European Parliament, and a mother who was a homemaker. Trained in ophthalmology at Eberhard Karls University of Tübingen in Germany, he is the first person in his family to pursue medicine. Ferrari prides himself on being able to conduct his consultations in English, German and Italian, in addition to French.
Ferrari has worked with Faure – who also has greenish-blue eyes – since 2019, when Ferrari decided to open his keratopigmentation practice in Paris. Ferrari was looking for a pre-existing clinic with all the necessary equipment already available. And so he approached Faure, who was already running a clinic that offered regular ophthalmological services such as eye exams, cataract surgery and some laser surgery. Ferrari works only on Wednesdays. He is otherwise back at home in Strasbourg with his wife (who has brown eyes).
Ferrari does the consultations and oversees the Flaak procedure in the operating room. He hasn’t performed the surgery in two years; he declined to say why. Faure (70), a seasoned surgeon, does the procedure.
The idea for keratopigmentation came to Ferrari 15 years ago, when he was reading an online discussion among French ophthalmologists about the best way to colour eyes. Keratopigmentation was originally developed as a way to treat conditions like aniridia, in which an eye is lacking all or part of an iris and therefore becomes extra sensitive to light.
“I thought to myself that it would be good to find a technique that permits you to change the colour of your eyes in a safe way, and then I thought,” Ferrari said, widening his own eyes as if reliving the memory, “the cornea”.
That was in December 2011.
He began to experiment on rabbits. Ferrari tried the procedure on a human in December, 2013 – the world’s first.
He was motivated to work quickly, worried someone would beat him to it. And he wasn’t wrong to think so: Another ophthalmologist, Dr Jorge Alió, who is based in Alicante, Spain, was thinking about it, too. “I’d been researching keratopigmentation for therapeutic purposes,” Alió said. He had been looking for ways to address ocular trauma.
After learning of each other, Ferrari and Alió met in person at a conference in London. They have agreed to be named as “co-inventors.”
The operation is not for the squeamish. After the eyeballs are numbed, the femtosecond laser is beamed into each eye, cutting a circular tunnel within the cornea. After using an ordinary surgical hook to widen the incision, Faure carefully slides the full arch of the “Ferrari scalpel” into each cornea and, with a series of decisive strokes, nudges the pigment on to them. The dye slowly swirls in, like an ink droplet in water.
The surgery at Ferrari’s clinic costs €7,000.
Each client has a 20-minute consultation the morning before the procedure. Ferrari studies the cornea and makes an image of the retina to ensure the patient’s eyes are healthy enough to undergo the treatment. Then Ferrari and the patient finalise the eye colour, toggling among different simulations on a laptop.
There is now a growing web of doctors performing keratopigmentation worldwide. In Paris alone, there are six competing clinics offering the procedure.
Ferrari believes copycats are an inevitability and acknowledges that there’s something flattering about them. “There’s money to be made,” he said. But there’s little Ferrari can do to mitigate the uncredited use of his process. In medicine, while you can occasionally patent the technology, it is nearly impossible to patent a procedure. Even the scalpel, which he designed and patented, has been copied elsewhere, he said.
And he has managed to get some recognition. On the desk he shares with Faure is an octagonal glass trophy, which was presented to him by Alió, recognising Ferrari as Best Speaker at the second annual Kolor Congress in Dubai, United Arab Emirates, last year, a conference for ophthalmologists already practising keratopigmentation and others looking to do so. This year’s two-day Kolor Congress, which took place in Nice, drew an international crowd of 300 ophthalmologists.
There, they witnessed live demonstrations using the latest techniques and pored over swatches for new pigment shades. –
- This article originally appeared in The New York Times
