The eyes are one of the biggest markers of facial attractiveness, and everyone has taken notice. The beauty industry is more than happy to aid consumers in enhancing their eyes. Salon and at-home eyelash augmentation procedures are projected to continue expanding and growing in popularity in the market, and false eyelashes alone are expected to bring in almost two billion dollars by the end of 2024. The quest for longer, thicker and darker eyelashes and eyes that appear larger, however, does not come without risk. This is a risk many patients don’t mind taking, as they are often unwilling to give up their beauty regimen. In a study of 1,292 women, 44% of participants reported experiencing negative feelings when they weren’t able to wear make-up. Even knowing the risks might not be enough for patients to discontinue eye-enhancing procedures. Educating patients about healthier practices and alternatives could be the next best option.
Fig. 1. Magnetic lashes with added mascara. Click image to enlarge.
False Eyelashes: Types, Risks, and Alternatives
False lashes are categorized as strip lashes, individual flare lashes and single individual lashes, and are made from real hair or synthetic material. These lashes are applied at the lid margin above the existing lashes with glue, which often contains harsh ingredients with allergenic properties, including formaldehyde and latex. False lashes are associated with allergic contact dermatitis, blepharoconjunctivitis and abrasions secondary to application, removal and lash-fall. A newer false eyelash alternative created to avoid glues is the magnetic false eyelash. These lashes can be applied in two ways-either small magnets sandwich a patient’s real lashes between a set of upper and lower false lashes or the magnetic false lashes attach above the lash line to a thick line of metallic-based eyeliner. Risks include application abrasion, lash-fall due to the weight of the magnets and metal allergies in the case of the eyeliner version. If patients choose to use false eyelashes, recommend that they use glues that do not contain formaldehyde, choose lashes of a natural length-1/3 the eye width to facilitate the best ocular health by maintaining proper aerodynamic flow and avoiding funneling air and debris into the ocular surface-and use partial strips instead of ones that extend the full lash line to avoid using more material than necessary. Patients should take breaks in false lash wear or reserve them for special occasions. Placing a small amount of glue or metallic eyeliner on the inside of the wrist for a “patch test” could alert patients to potential allergies before contact dermatitis occurs on their eyelid.
Lash and lid procedures were created to enhance and rarely replace make-up. Mascara is often used in conjunction with false eyelashes to help “blend” them with the real ones. The addition of ocular cosmetics further increases the risk of irritation, allergic reaction and infection. Eye cosmetics themselves can contain allergenic and toxic additives. The non-profit Environmental Working Group has a free online database that rates more than 70,000 cosmetics and ingredients in terms of safety for doctors and patients alike to learn more about different products.
Fig. 2. During (left) and after (right) an eyelash extension procedure. Note this patient’s ocular irritation post-application. Click image to enlarge.
Eyelash Extensions: Application, Care, and Risks
This approach differs from false eyelashes in their application. Extensions are applied by gluing a single hair or synthetic lash to an existing anatomic eyelash. This is a long process and takes a trained esthetician between one and three hours to apply 50 to 200 lash extensions individually with forceps. The glues involved with application contain the same allergenic ingredients as false lashes, sometimes in even stronger concentrations. Post-application ocular irritation is common. Most professional estheticians recommend re-doing or “filling” extensions every two to four weeks to replace lashes that have fallen as part of the natural lifecycle of an eyelash. Four to 11 months depending on ocular health-and achieve the best look. In order to “fill” extensions, old extensions must first be removed. Removal is often achieved by using ocular-irritating glue solvents combined with fragrances. Even in the best case scenario, some of the remover will make its way to the ocular surface, as it would with traditional eye makeup remover. A closed eye is not an air- or water-tight seal. Hygiene may become an issue, as these lashes are meant to be worn for weeks at a time. Extensions have the same potential complications as false eyelashes, with added infective risks of chalazia/hordeola and blepharitis. Safer practices for eyelash extensions include using glues that do not contain formaldehyde and removers that are oil-based. Patients need to practice lid hygiene and understand that extensions are not like jeans that you don’t wash in an effort to protect the look. Over-the-counter (OTC) hypochlorous acid is a cleaning option that will not dissolve the glues. More natural lash lengths are also preferable.
Fig. 3. Eyelash perming procedure. Click image to enlarge.
Eyelash Perming, Tinting, and Other Chemical Treatments
Eyelash Perming Sometimes known as a “lash-lift,” lash perming is a trend that may be a bit harder to detect, as there are no false lash materials involved. The goal with a lash-lift is for the natural eyelashes to curl up and outward. During this procedure, the eyelashes are wrapped around a rod and perming and neutralizer solutions containing highly ocular toxic active ingredients-hydrogen peroxide and thioglycolic acid-and other irritating additives are applied. The entire process takes 10 to 15 minutes. Patients should avoid lash lifting due to the potential risks, and only a highly trained professional esthetician should perform this procedure to mitigate the amount of perming and neutralizing solutions on the ocular surface. The main risk involved in lash lifting is toxic keratoconjunctivitis, and allergic reactions to perming solutions and adhesives are known to occur. Patients should see their eye doctor immediately if significant irritation ensues. Water deactivates perming solutions, so patients are typically told not to get their lashes wet for 24 hours. If a reaction occurs within 24 hours, flushing the ocular surface is advised.
Eyelash Tinting In this cosmetic procedure, permanent dyes are applied to darken the eyelashes. Similar to lash perming, the lashes are wrapped around a rod and permanent dye is applied and allowed to set. Ocular toxic and allergenic ingredients commonly found in lash tinting products include hydrogen peroxide, dyes and fragrances. The main risk is an allergic reaction, and these allergens persist for the lash lifecycle. Stripping the dye out comes with the risk of permanent damage to the follicle. Anti-inflammatory control with topical steroids is recommended until the lash lifecycle turns over. Lash tinting should be avoided, but if proceeding, it should be performed by a highly trained esthetician who conducts a patch test beforehand. Lash tinting is often combined with lash lifting, increasing risk.
Fig. 4. One of the most common synthetic prostaglandins is isopropyl cloprostenate. Click image to enlarge.
Eyelash Serums and Permanent Makeup
Eyelash Serums When Latisse (bimatoprost 0.03%) was FDA-approved in 2008, it changed the pharmaceutical and cosmetic industries. The prostaglandin analog can cause darker and thicker lashes but also side effects such as skin and iris pigmentation, conjunctival hyperemia, pruritus, lash-loss and lowered intraocular pressure. OTC lash serums may contain synthetic prostaglandins with identical side effects, yet cosmetics are not required to list all potential effects. Look for “prost” as an indicator of a potential prostaglandin ingredient. Some OTC serums avoid prostaglandins and use polypeptide or lipopeptide formulations, though these may still carry irritants. The healthiest practice is to choose non-prostaglandin options and monitor ocular health regularly, especially for patients with chronic dry eye.
Tattooed Eyeliner Often referred to as “permanent makeup,” tattooed eyeliner does not last forever and can fade or spread beyond the intended area. Inks vary between artists and may contain metallic ingredients that can trigger allergies. Tattooing can cause bruising, swelling, infections, scarring, granuloma formation and photo-toxicity. Studies link tattoos to meibomian gland dysfunction and reduced tear break-up time, suggesting potential ocular surface impact. Permanent makeup is not easily reversible and should be avoided when possible.
Fig. 5. Pigment fade (left) and spread (right), with the tattooed eyeliner extending upward further than the thin line originally applied, of permanent makeup. Both patients have dry eye with MGD. Click image to enlarge.
Trends and the Future of Eyelash Styling
The eyelash trends industry continues to evolve rapidly, driven by changing beauty standards, social media influence, and innovative lash techniques. Today’s clients seek personalized, fashion-forward looks that reflect their individuality. The “Clean Girl” lash trend focuses on a fresh, minimal, and polished appearance, typically using classic extensions or light volume with soft curls like B or C. The wispy and textured lash trend emphasizes a soft, airy, multi-dimensional look with a mix of classic and volume lashes. The wet look lash trend delivers a glossy, mascara-like finish often achieved with closed or narrow volume fans. The anime/doll eye trend aims for a wide, innocent appearance with balanced outer and middle lash density. The fox eye and cat eye lifting trend elongates and lifts the eye using longer outer lashes and curling choices such as C, CC, or D curls. Mega volume and Russian volume create dense, dramatic sets, sometimes 6D to 20D, popular with influencers and performers. Colored and creative lashes add color pops and artistic effects, especially in fashion shoots and campaigns. The lash lift and natural enhancement trend combines lifting with tinting to mimic mascara with less daily maintenance.
Future developments point toward greater personalization, innovation, and sustainability, with AI-assisted mapping and advanced design tools helping lash artists craft precise, customized results. Hybrid techniques combining wispy, wet look, and soft natural enhancements are likely to continue evolving, keeping eyelash trends flexible and expressive. Understanding these trends helps lash artists stay competitive and allows clients to choose styles that truly match their personality and lifestyle.
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Safety reminders and best practices
Always choose licensed professionals, review glue ingredients and patch-test due to potential allergies, and avoid prostaglandin-containing serums for patients with chronic ocular conditions. Maintain lid hygiene, perform regular eye checkups, and avoid self-removal of extensions if complications arise.