SMILE — laser eye surgery without a corneal flap
SMILE (Small Incision Lenticule Extraction) is an all-femtosecond refractive surgery performed without creating a corneal flap. In Boulogne-Billancourt, just outside Paris, I remove a thin lenticule of tissue from inside the stroma through a 3 mm micro-incision. Because the anterior corneal layers and corneal nerves are preserved, this technique is particularly well suited to contact-sport athletes.
What is SMILE?
SMILE — short for Small Incision Lenticule Extraction — is a refractive surgery performed entirely with a femtosecond laser, without creating a corneal flap. It is a minimally invasive technique, particularly valuable for preserving the strength and nerve supply of your cornea.
In practice, the femtosecond laser cuts a thin lenticule of tissue within your cornea. I then remove this lenticule through a micro-incision of just 3 mm. The procedure takes about 15 minutes for both eyes and is performed under local anesthesia with simple eye drops.
All-femtosecond, no flap. SMILE uses a single laser, the femtosecond laser, and does not create a corneal flap. Preserving the anterior corneal layers may be associated with less post-operative dryness in the short term, and provides a relevant theoretical biomechanical argument for contact-sport athletes.
Animated demonstration below ↓
Scroll through the steps of the procedure at your own pace.
SMILE step by step
Click ▶ to start the animation, or go through the steps one by one at your own pace.
Interactive animation — for a larger view, open the diagram in full screen ↗
Who is SMILE for?
SMILE is well suited to patients with myopia, hyperopia or astigmatism who wish to preserve the biomechanics of their cornea as much as possible. Only a comprehensive assessment — including a precise map of your cornea — allows me to confirm your eligibility.
- You are over 18
- Your prescription is stable
- Myopia up to −10 diopters
- Hyperopia up to +5 diopters
- Astigmatism up to −5 diopters
- You play sports (contact sports, combat sports, martial arts)
- You have mild dry eye (better tolerated than with LASIK)
- Regular cornea of sufficient thickness
- You have keratoconus or suspected keratoconus
- Your cornea is too thin
- Your prescription is still changing
- You have uncontrolled dry eye disease
- You are pregnant or breastfeeding
- You have an active eye infection or inflammation
If your cornea is too thin, PRK or a phakic lens is often still an option — we will discuss this together.
Advantages and points to consider
- No corneal flap → better preservation of corneal biomechanics
- Post-operative dryness generally reduced in the short term, thanks to preservation of the corneal nerves
- Earlier return to contact sports than after LASIK
- Quiet, quick procedure — a single laser, a single surgical step
- Particularly suitable for athletes, military personnel, firefighters and occupations with a risk of eye injury
- Precise, reproducible cut by the femtosecond laser
- Slightly slower visual recovery than LASIK (24–48 h vs 24 h)
- A possible enhancement is technically more complex than after LASIK
- More recent technique: about 19 years of follow-up (first human procedures in 2007), compared with more than 35 years for LASIK
- As with any refractive surgery: it does not prevent presbyopia or cataract
- Temporary halos at night are possible early in recovery
SMILE in pictures
This short animation illustrates the principle of SMILE: a thin lenticule of tissue is cut inside the cornea with a femtosecond laser, then removed through a 3 mm micro-incision — without creating a corneal flap.
From your first assessment to visual freedom
Pre-operative assessment
At your first consultation, I carry out a comprehensive assessment: precise measurement of your prescription, corneal mapping (Anterion), measurement of corneal thickness and examination of the anterior segment. This allows me to confirm your eligibility for SMILE and to plan the procedure precisely. A check-up with pupil-dilating drops (Skiacol) may be needed before surgery.
Preparation
If you wear contact lenses, you will need to stop wearing them 1 to 2 weeks beforehand (soft lenses) or 3 to 4 weeks beforehand (rigid lenses); a longer period may be needed for rigid lenses worn extensively. I give you a detailed quote, the informed consent form and the prescriptions for your post-operative eye drops.
The day of surgery
The procedure takes about 15 minutes for both eyes, as an outpatient, under anesthetic eye drops. I am with you throughout and explain every step. You go home 30 minutes later, ideally with someone accompanying you.
Post-operative follow-up
I see you again at Day 1, Day 7 and Month 1. You will use anti-inflammatory eye drops for one week. I remain reachable by phone between appointments. The result fully stabilizes within a few weeks.
What happens after SMILE?
Here is what the first days and weeks after the procedure look like. Every patient recovers at their own pace — these milestones are observed averages.
The day of surgery
Mild foreign-body sensation and watery eyes for a few hours. Rest your eyes: no screens, no reading. First application of the prescribed eye drops.
First check-up
I see you in consultation. Your vision is already clear but may still be slightly blurry. You can resume short drives and walking outdoors (with sunglasses).
Back to screens and work
You can resume screen work, taking regular breaks. Your vision continues to sharpen.
Light exercise and extended reading
You can resume brisk walking, cycling and running. Reading is comfortable. Anti-inflammatory eye drops are gradually stopped.
Contact sports possible
With no corneal flap to protect, you can return to contact sports (boxing, judo, martial arts, pool swimming) earlier than after LASIK, depending on your profile and how your eye is healing.
Stabilization check-up
I check healing, the quality of your vision and the condition of the ocular surface.
Final result
Your vision is fully stabilized. You can fully enjoy your visual freedom.
Comparison of techniques
Each technique has its own indications and limitations. Here is a brief comparison to guide you — the final decision rests on your personalized assessment. For a closer comparison of the two most common laser techniques, read my article “LASIK or SMILE: how to choose?”.
| LASIK | SMILE | PRK | Phakic lens (ICL/IPCL) | |
|---|---|---|---|---|
| Action on the cornea | Flap + reshaping | Lenticule extraction | Surface (no flap) | None |
| Visual recovery | 24 h | 24–48 h | 5–7 days | 24–48 h |
| Myopia up to | −10 D | −10 D | −6 D | −30 D ¹ |
| Hyperopia up to | +5 D | +5 D | +4 D | +15 D ¹ |
| Astigmatism | Yes | Yes | Possible | Yes |
| Thin cornea | Contraindicated | Contraindicated | Possible | Ideal |
| Contact sports | After 4 weeks | After 2 weeks | After 2 weeks | After 3–4 weeks |
| Reversible | No | No | No | Yes |
| Anesthesia | Eye drops | Eye drops | Eye drops | General or local |
¹ Corrections beyond −18 D (myopia) or +10 D (hyperopia) require the IPCL (Care Group). The EVO Visian ICL (STAAR) covers myopia up to −18 D and hyperopia up to +10 D.
SMILE fees
SMILE: €3,000 for both eyes — this all-inclusive fee covers the procedure, post-operative check-ups and any enhancement needed within the year. For your information: these are unregulated fees, not reimbursed by the French national health insurance (Assurance Maladie); some complementary health insurance plans (mutuelles) contribute, depending on your policy. A detailed quote is always provided before any decision, and payment in installments may be offered — ask about it during your consultation.
SMILE FAQ
Your SMILE assessment starts here
A comprehensive assessment allows me to check your eligibility, choose the best technique with you (LASIK, SMILE, PRK or ICL) and answer all your questions.
Explore the alternatives
If this technique is not right for you, other options may be perfectly suitable.