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Blepharopigmentation or permanent eyeliner is a popular cosmetic procedure currently performed by a variety of methods. All methods attempt to implant ferrous oxide pigment into the dermis. We performed histopathologic studies on a series of three eyelid specimens, including two by a previously undescribed multi-needle pigment delivery system. Light microscopy revealed the epidermis to be pigment-free and the dermis to contain pigment in clumps. Transmission electron microscopy (EM) demonstrated that the pigment was largely in macrophages. Energy-dispersive x-ray micro-analysis showed that in addition to iron and talc, titanium particles were also present. These findings suggest that the pigment is tolerated by the eyelid despite the fact that current pigments are contaminated.
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