What Is Small Incision Lenticule Extraction (SMILE)?
Small Incision Lenticule Extraction, or SMILE, is an advanced type of laser eye surgery used to treat vision problems such as nearsightedness (myopia) and astigmatism. This minimally invasive procedure works by reshaping the cornea, which helps your eyes focus light more clearly and improves your overall vision.
Unlike LASIK, SMILE does not involve creating a large flap in the cornea. Instead, a small laser is used to create and remove a tiny piece of tissue (called a lenticule) through a tiny incision. This means less discomfort, fewer risks, and a faster recovery time for many patients.
It was approved by the U.S. Food and Drug Administration (FDA) in 2016. Since then, it has become a trusted vision correction method worldwide. As laser technology improves, more eye surgeons are turning to SMILE as a go-to procedure.
How SMILE Eye Surgery Works
Step-by-Step Process
- Preparation: Your eyes are numbed with special eye drops. This makes sure you feel no pain during the surgery.
- Laser Treatment: A femtosecond laser creates a small, lens-shaped piece of tissue (the lenticule) inside your cornea.
- Lenticule Removal: The surgeon removes the lenticule through a 2–4mm incision made on the surface of the cornea.
- Healing: The cornea reshapes itself after lenticule removal, correcting your vision. No stitches or flaps are needed.
The entire SMILE procedure usually takes about 10 to 15 minutes for each eye. The laser treatment itself is very quick and often lasts less than 30 seconds, making the process fast and efficient.
It is performed using the VisuMax femtosecond laser, a tool known for its high accuracy and safety. During the procedure, most patients feel little to no discomfort—usually just a mild sense of pressure in the eye.
Benefits of SMILE Over Traditional LASIK
SMILE eye surgery is well-known for offering several important advantages. Below are some of the key benefits you can expect from this modern vision correction procedure:
- Minimally invasive: No large flap is created, which lowers the risk of complications such as flap displacement or wrinkles.
- Quick recovery: Most people return to normal activities within 1–2 days, including going back to work or driving.
- Less dry eye: It affects fewer nerves in the cornea, reducing dry eye symptoms, which are common after LASIK.
- Strong results: Clinical studies show that most patients achieve 20/20 vision or better within weeks.
- Fewer complications: Since there is no flap, there’s a reduced risk of infection or other flap-related issues.
A 2020 study published in Nature found that it delivers vision results that are just as good as LASIK—and in some cases, even better. For certain patients, it may provide clearer vision with fewer side effects, making it a strong alternative to traditional laser eye surgery.
Other long-term studies show that patients who have SMILE surgery keep clear and stable vision for many years. The results tend to last, with little to no change in eyesight over time. This makes it a reliable option for people who want lasting vision correction.
Who Is a Good Candidate for SMILE Surgery?
You may be a good candidate for SMILE if:
- You are 22 years or older
- Your eye prescription has been stable for at least one year
- You have myopia (nearsightedness) between -1.00 and -10.00 diopters
- You have mild to moderate astigmatism (up to 3.00 diopters)
- Your corneas are thick and healthy
Who Should Avoid SMILE?
It may not be the best option for everyone. You should avoid this type of surgery if you:
- Are pregnant or nursing
- Have eye diseases like glaucoma, cataracts, or keratoconus
- Have an autoimmune condition that affects healing, such as lupus or rheumatoid arthritis
- Have thin or irregular corneas
- Are under 22 or your prescription is still changing
The best way to know if you are a good candidate for SMILE is to have a full eye exam with a qualified ophthalmologist. This exam will help determine if the procedure is safe and right for your vision needs.
What to Expect Before, During, and After SMILE
Before the Procedure
- Your eye doctor will run several tests to check your cornea shape, thickness, and prescription.
- You should stop wearing soft contact lenses 1–2 weeks before the exam and procedure (longer for hard lenses).
- Avoid makeup, creams, or lotions around the eyes the day before surgery.
- Arrange for someone to drive you home afterward.
During the Procedure
- The surgery takes less than 30 minutes for both eyes.
- You’ll lie on your back while the surgeon uses the laser.
- The process is quick and virtually painless.
- Most patients are surprised at how fast the experience is.
After the Procedure
- Vision may be blurry for the first few hours but improves quickly.
- You’ll be prescribed antibiotic and anti-inflammatory eye drops.
- Avoid rubbing your eyes for at least a week.
- Most patients return to normal life within 24–48 hours.
- Avoid swimming, dusty environments, and eye makeup for a few days.
Risks and Side Effects of SMILE Eye Surgery
While it is considered a very safe procedure, there are still a few risks you should be aware of before deciding on surgery:
- Temporary blurry or fluctuating vision
- Halos or glare at night, especially while driving
- Dry eyes, though these are usually milder and shorter in duration than with LASIK
- In rare cases, infection, inflammation, or under/overcorrection
- Enhancement surgery may be needed in less than 1% of patients
It’s important to talk with your eye surgeon about all the possible side effects before getting the SMILE procedure. Understanding the risks helps you make a safe, smart, and informed decision about your eye health.
To learn more about safety and side effects, visit the American Academy of Ophthalmology.
How Much Does SMILE Surgery Cost?
The cost of SMILE can vary based on your location and your surgeon’s level of experience. On average, most people can expect to pay between $2,000 and $3,000 per eye for the procedure.
While most insurance plans do not cover laser eye surgery, many clinics offer payment plans to help make it more affordable. Some clinics also work with health financing companies to give you more flexible payment options.
Be sure to ask what the total cost covers—some clinics provide all-inclusive packages that include pre-op exams, the surgery itself, and post-op follow-up care.
Comparing SMILE to Other Vision Correction Options
| Feature | SMILE | LASIK | PRK |
|---|---|---|---|
| Invasiveness | Less invasive | Flap-based | Surface procedure |
| Recovery Time | 1–2 days | 2–5 days | 1 week or more |
| Dry Eye Risk | Lower | Higher | Moderate |
| Ideal For | Myopia & Astigmatism | Myopia, Hyperopia, Astigmatism | Those with thin corneas |
| Flap Required | No | Yes | No |
| FDA Approved | Yes (2016) | Yes (1999) | Yes (1995) |
Each method has pros and cons. It is especially appealing for athletes, people with active lifestyles, or those who want a flap-free laser procedure.
FAQs About SMILE Eye Surgery
Is SMILE permanent?
Yes, the results of SMILE are long-lasting. However, as you get older, natural changes in your eyes—like presbyopia (age-related farsightedness)—may still affect your vision over time.
Can I get SMILE if I had LASIK before?
No, SMILE is not recommended for eyes that have already had LASIK surgery. This is because LASIK changes the shape and structure of the cornea, which can affect how SMILE works.
How soon can I return to work?
Most people are able to return to work within 24 to 48 hours after SMILE surgery. However, it’s a good idea to limit screen time during the first few days to help your eyes heal properly.
Will I need glasses after SMILE?
Most patients find that they no longer need glasses or contact lenses after SMILE surgery. However, as they get older, some may still need reading glasses due to natural age-related changes in vision.
Does SMILE hurt?
The SMILE procedure itself is painless. You might feel slight pressure during the surgery and experience mild discomfort or dryness for a few hours afterward as your eyes begin to heal.
Final Thoughts: Is SMILE the Right Vision Correction for You?
Small Incision Lenticule Extraction is a safe, fast, and effective way to correct nearsightedness and astigmatism. With fewer risks and a quick recovery, SMILE is becoming a popular choice for people looking to ditch their glasses or contacts.
Many patients are thrilled with their results and enjoy the freedom of living without corrective lenses. Whether you play sports, travel often, or simply want a clearer view of life, SMILE could be your next step toward better vision.
If you’re wondering whether SMILE is the right choice for you, speak with a certified eye surgeon today. They can explain your options and help you decide what’s best for your vision needs.
Take the First Step to Clearer Vision
Are you thinking about SMILE laser eye surgery? Set up a consultation with a local eye care specialist to find out if it’s right for you. It’s your chance to see the world more clearly—one small incision at a time!
Have questions or want to share your SMILE experience? Drop a comment below—we’d love to hear from you!