How an eye laser operation with SMILE®, the third generation of eye laser surgery, is performed

SMILE® pro is the new ReLEx SMILE. This eye laser procedure is performed only with the latest ZEISS femtosecond laser VISUMAX. The VISUMAX 800, prepares a lenticule in about 10 seconds per eye. The SMILE pro procedure is painless and does not require the flap typical of LASIK. Here we explain all the steps from SMILE eye laser surgery to follow-up.

Darstellung einer SMILE Pro Operation mit dem neuen VisuMax 800 (Zeiss)

Specialist in this field

Portraitfoto von Dr. Detlev Breyer

Dr. Detlev Breyer

Ophthalmologist, eye surgeon and lead surgeon
Focus Top Mediziner Award

SMILE surgery is more demanding for the surgeon than LASIK or Femto-LASIK. The more SMILE laser eye surgery the eye surgeon has performed, the safer it is for you as a patient. Focus top physician (list of top physicians curated by the magazine Focus) Dr. Detlev R.H. Breyer has been using the eye laser procedure since 2011 and has already performed over 5.000 procedures independently with success. Since 2022, he is one of the five first worldwide to offer the latest procedure SMILE pro.

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The ReLEx SMILE Surgery by Detlev Breyer

The SMILE surgery of our employee performed by Detlev Breyer in Düsseldorf, Germany.

What to consider before the operation

You may not wear your contact lenses for three days before the operation. One day before the treatment and on the day of the treatment itself, you should not apply any facial creams, lotions, make-up or perfume. These products could increase the risk of infection or contamination of the operation site during the procedure and also afterwards. On the morning of the operation, please clean the area around your eyes carefully.

Preparations on the day of the SMILE® operation

When you arrive at Premium Eyes on the day of the outpatient SMILE® treatment, you will first complete a form by hand. In it, you write down the following: Your name, your date of birth, which eye is to be operated and the agreed surgical method. This form is stapled to your surgery documents. This way, you can be absolutely sure that you will receive the right treatment. Half an hour before the eye laser treatment, you will receive a nasal spray to calm your nerves and also a pain killer if you want; however, we can promise to you that you won't need it.

In the operation theater, you will lie down comfortably on the patient bench. The surgeon will greet you and introduce himself by the name on the name tag he is wearing. An assistant will read out the data on the laser, and the doctor will compare them to your file; you are listening to all of this as well. All of this is for your and our safety. After the surface of your cornea was numbed with eye drops, a so-called eye speculum will be placed in your eye. This eye speculum prevents you from blinking during the procedure. The other eye is covered. To fix the eye in place for the procedure, a contact lens shaped like your cornea is used.

The SMILE pro eye laser operation

Step 1: First, the corneal flap inside the cornea (the lenticle) is prepared using the VISUMAX femtosecond laser. This procedure takes about 10 seconds. Meanwhile, you will see a bright spot but hardly feel anything.
Step 2: Immediately after the lenticle preparation, a small opening of 2 to 3 mm is cut - this is also done with the VISUMAX.
Step 3: Through this opening, the surgeon releases the lenticle and carefully pulls it out. Afterwards, the small incision opening is checked again.

Afterwards, like all our patients, you will be amazed at how quickly everything went and how little you felt. Because of the small opening, no postoperative precautions are necessary; you may exercise, wash your hair, or shower as soon as 20 minutes after the operation.

After the operation: Enjoy the new view of the world

Already on the same day, most of our patients are happy about the newly gained quality of life. And many regret not having taken this step earlier.

The check-ups after the operation

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Aftercare of our employee 5 days after his SMILE operation

On the day after the eye laser operation, the surgeon will examine your eyes again. The next check-ups are one week and one month later. After that, you only need to attend the usual check-ups, and of course you are also welcome to make an appointment if you have eye or vision problems.

If you only have come to us for the eye laser treatment, we will be happy to co-ordinate with your ophthalmologist whether aftercare can be performed by them. In this video our optometrist describes his experience after his ReLEx SMILE surgery (in german language).

What’s precious to you belongs in good hands

If you are interested in having the best vision without glasses, please feel free to make an appointment with Dr. Breyer for a non-binding individual consultation or preliminary examination. You can make an appointment by phone, e-mail, WhatsApp or our appointment app. We are also happy to call you back. We are looking forward to your message.

Further literature

Adjustment of Spherical Equivalent Correction According to Cap Thickness for Myopic Small Incision Lenticule Extraction.

Hun Lee, MD; David Sung Yong Kang, MD; Dan Z. Reinstein, MD; Cynthia J. Roberts, PhD; Renato Ambrósio Jr, MD, PhD; Timothy J. Archer, PhD; Seung Ki Jean, MR; Eung Kweon Kim, MD, PhD; Kyoung Yul Seo, MD, PhD; Ikhyun Jun, MD, PhD; Tae-im Kim, MD, PhD. Journal of Refractive Surgery. 2019;35(3):153-160 doi.org/10.3928/1081597X-20190205-01.

Five-year results of Small Incision Lenticule Extraction (ReLEx SMILE)

Blum M, Täubig K, Gruhn C, Sekundo W, Kunert KS. Br J Ophthalmol. 2016 Jan 8. pii: bjophthalmol-2015-306822. doi: 10.1136/bjophthalmol-2015-306822. [Epub ahead of print] PubMed PMID: 26746577.

Auswertung der Percentage of Tissue Altered (PTA) bei zwei unterschiedlichen Cap-Dicken bei ReLEx-SMILE und später Keratektasie

Breyer D., Kaymak K., Karsten K., Taylor E., Kongressband der Deutschsprachige Gesellschaft für Intraokularlinsen-Implantation, Interventionelle und Refraktive Chirurgie (DGII): – Gießen : DGII [Mehrteiliges Werk] ISBN: 978-3-9816717-1-1 Pp. Teil: 29; 26. bis 28. Februar 2015 in Karlsruhe, S. 137 ff., s. auch (link: /forschung/vortragsthemen/dgii-kongress-2015 text: Unsere DGII Vortragsthemen 2015)

Small-incision lenticule extraction for moderate to high myopia: Predictability, safety, and patient satisfaction

Original Research Article, Anders Vestergaard, Anders R. Ivarsen, Sven Asp, Jesper Ø. Hjortdal, J Cataract Refract Surg. 2012 Nov;38(11):2003-10. doi: 10.1016/j.jcrs.2012.07.021. Epub 2012 Sep 14. PMID: 22981612

Clinical Outcomes of Small Incision Lenticule Extraction with Accelerated Cross-Linking (ReLEx SMILE Xtra) in Patients with Thin Corneas and Borderline Topography

Ganesh S, Brar S. J Ophthalmol. 2015;2015:263412. doi: 10.1155/2015/263412. Epub 2015 Jun 28. PMID: 26221538; PMC ID: PMC4499409

Influence of femtosecond lenticule extraction and small incision lenticule extraction on corneal nerve density and ocular surface: a 1-year prospective confocal, microscopic study

Ishii R, Shimizu K, Igarashi A, Kobashi H, Kamiya K. J, Refract Surg. 2015 Jan;31(1):10-5. doi: 10.3928/1081597X-20141218-01. PubMed PMID: 25599538.

SMILE Procedures With Four Different Cap Thicknesses for the Correction of Myopia and Myopic Astigmatism

Jose L. Güell, MD, PhD; Paula Verdaguer, MD; Gloria Mateu-Figueras, PhD; Daniel Elies, MD; Oscar Gris, MD, PhD; Mostafa A. El Husseiny, MD; Felicidad Manero, MD; Mercè Morral, MD, PhD, [J Refract Surg. 2015;31(9):580-585.], doi:10.3928/1081597X-20150820-02

Outcomes of small incision lenticule extraction (SMILE) in low myopia.

Reinstein DZ, Carp GI, Archer TJ, Gobbe M. J Refract Surg. 2014 Dec;30(12):812-8. doi: 10.3928/1081597X-20141113-07. Erratum in: J Refract Surg. 2015 Jan;31(1):60. PubMed PMID: 25437479.

Dry Eye Disease after Refractive Surgery – Comparative Outcomes of Small Incision Lenticule Extraction versus LASIK

Alexandre Denoyer, MD, PhD, Elise Landman, MD, Liem Trinh, MD, Jean-François Faure, MD, François Auclin, MD, Christophe Baudouin, MD, PhD, Ophthalmology 2015;122:669-676 2015 by the American Academy of Ophthalmology. doi: 10.1016/j.ophtha.2014.10.004. Epub 2014 Nov 22. PubMed PMID: 25458707

One-year refractive results, contrast sensitivity, high-order aberrations and complications after myopic small-incision lenticule extraction (ReLEx SMILE)

Sekundo W, Gertnere J, Bertelmann T, Solomatin I. Graefes Arch Clin Exp Ophthalmol. 2014 May;252(5):837-43. doi: 10.1007/s00417-014-2608-4. Epub 2014 Mar 20. PMID: 24647595

Comparison of Visual and Refractive Outcomes Following Femtosecond Laser-Assisted LASIK With SMILE in Patients With Myopia or Myopic Astigmatism

Sri Ganesh, MS, DNB; Rishika Gupta, MS, [J Refract Surg. 2014;30(9):590-596.], doi:10.3928/1081597X-20140814-02, PubMed PMID: 25250415.

Early corneal nerve damage and recovery following small incision lenticule extraction (SMILE) and laser in situ keratomileusis (LASIK)

Mohamed-Noriega K, Riau AK, Lwin NC, Chaurasia SS, Tan DT, Mehta JS. Invest Ophthalmol Vis Sci. 2014 Mar 25;55(3):1823-34. doi: 10.1167/iovs.13-13324. PubMed PMID: 24569584

Short-term outcomes of Small Incision Lenticule Extraction (SMILE) for low, medium and high myopia.

Fernández J, MD; Valero A, MD; Martínez J, OD; Piñero DP, PhD; Rodríguez-Vallejo M, OD, Journal of Refractive Surgery 2015, 429, 1.

Five-year results of refractive lenticule extraction

Marcus Blum, Andrea Flach, Kathleen S. Kunert, MD, Walter Sekundo, MD, J Cataract Refract Surg 2014; 40:1425-1429 2014 ASCRS and ESCRS

Refractive lenticule extraction: Transition and comparison of 3 surgical techniques

Marcus Ang, FAMS, FRCSEd, Jodhbir S. Mehta, FRCOph, Cordelia Chan, FRCSEd Hls M. Htoon, PhD, Jane C. W. Koh, Adv. Dip. Statistics, Donald T. Tan, FRCOph, J Cataract Refract Surg 2014: 40:1415-1424 2014 ASCRS und ESCRS

SMILE versus Femto-LASIK. Vergleich von optischer Abbildungsqualität sowie Effektivität und Sicherheit — PDF, 183.31 kB >

Breyer D., Der Augenspiegel, 06, 2013, 32-35

Early clinical outcomes, including efficacy and endothelial cell loss, of refractive lenticule extraction using a 500 kHz femtosecond laser to correct myopia

Kazutaka Kamiya, Akihito Igarashi, Rie Ishii, Nobuyuki Sato, Hiroyuki Nishimoto, Kimiya Shimizu, Journal of Cataract & Refractive Surgery, Volume 38, Issue 11, November 2012, Pages 1996-2002

Small incision lenticule extraction (SMILE) versus laser in-situ keratomileusis (LASIK): study protocol for a randomized, non-inferiority trial

Ang M, Tan D, Mehta JS. Source: Singapore National Eye Centre, Singapore, Trials. 2012 May 31;13:75. doi: 10.1186/1745-6215-13-75. PMID: 22647480 [PubMed - indexed for MEDLINE]

Results of small incision lenticule extraction: All-in-one femtosecond laser refractive surgery

Rupal Shah, MS, Samir Shah, M.Tech, Sayantan Sengupta, DO, From New Vision Laser Centers, Vadodara, Gujarat, India, Journal of Cataract and Refractive Surgery, Jan 2011, Vol 37, Iss 1, Pages 127 – 137

First efficacy and safety study of femtosecond lenticule extraction for the correction of myopia: six-month results

Sekundo W, Kunert K, Russmann C, Gille A, Bissmann W, Stobrawa G, Sticker M, Bischoff M, Blum M. J Cataract Refract Surg. 2008;34:1513–1520. PMID: 18721712 DOI: https://doi.org/10.1016/j.jcrs.2008.05.033.