---
title: How Is Enhancement Performed After SMILE?
description: "SMILE (Small Incision Lenticule Extraction) does not create a traditional LASIK flap, which influences enhancement options. When residual refractive error occurs after SMILE, three strategies may be considered: - Surface ablation (PRK) - Creating a thin LASIK flap above the…"
url: "https://bluefinvision.com/knowledge-base/topics/treatments-procedures/how-is-enhancement-performed-after-smile/"
updated: "2026-02-23"
category: "Treatments & Procedures"
---

# How Is Enhancement Performed After SMILE?

SMILE (Small Incision Lenticule Extraction) does not create a traditional LASIK flap, which influences enhancement options.

When residual refractive error occurs after SMILE, three strategies may be considered:

- Surface ablation (PRK)
- Creating a thin LASIK flap above the SMILE cap
- Cap-to-flap conversion techniques in selected cases

Long-term studies of SMILE demonstrate high refractive predictability overall, but retreatment rates increase in higher myopia groups¹. When LASIK is used as an enhancement technique after SMILE, two stromal interfaces exist:

- The original SMILE cap interface
- The new LASIK flap interface

This dual-plane architecture is biomechanically relevant and must be considered when planning retreatment.

Surface ablation avoids creating a second interface but requires epithelial healing and carries small risk of haze, mitigated by mitomycin C².

Published analyses show enhancement after SMILE is safe and effective when conservative stromal bed thresholds are respected³.

Enhancement planning therefore begins at primary procedure selection. Higher myopes (>–5.00 D), who demonstrate higher regression likelihood, may require strategic consideration of initial procedure choice.

SMILE remains predictable. Enhancement is simply more technically nuanced.

**References**

1. Vestergaard A, Ivarsen A, Asp S, Hjortdal J. Small-incision lenticule extraction for moderate to high myopia. J Cataract Refract Surg. 2012;38(11):2003-2010.
2. Carones F, Vigo L, Scandola E, Vacchini L. Mitomycin C to prevent haze after PRK. J Cataract Refract Surg. 2002;28(12):2088-2095.
3. Reinstein DZ, Carp GI, Archer TJ, Gobbe M. Small incision lenticule extraction outcomes. J Refract Surg. 2014;30(10):680-692.

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