SMILE in Paris and Cachan: Minimally Invasive Refractive Surgery

Refractive surgery

SMILE (Small Incision Lenticule Extraction) is a third-generation refractive surgery technique. Instead of lifting a corneal flap as in LASIK, SMILE involves cutting a thin disc of corneal tissue (the lenticule) with a femtosecond laser, then removing it through a 2 to 3 mm micro-incision. This all-in-one, flapless approach preserves more of the cornea’s nerve supply and offers an option particularly well suited to patients with a dry eye profile or those involved in activities carrying a risk of ocular trauma.

Dr Tourabaly performs SMILE at the Clinique Laser Victor Hugo (Paris 16th arrondissement) using the Zeiss VisuMax 800 platform, the latest generation of femtosecond laser dedicated to precision refractive surgery.

Written and medically reviewed by Dr Moïse Tourabaly · Last updated: August 20, 2026

UNDERSTANDING SMILE

What is SMILE? Principle and technology

SMILE is a corneal surgery carried out in a single step with the Zeiss VisuMax 800 femtosecond laser. Unlike LASIK, which requires two lasers (a femtosecond laser for the flap plus an excimer laser for the reshaping), SMILE uses a single laser for the entire procedure.

The principle in three stages

1. Creating the lenticule: The femtosecond laser draws, within the thickness of the cornea, a small disc of tissue (the lenticule) whose shape corresponds exactly to the visual correction required. On the VisuMax 800, this step takes less than 10 seconds (compared with about 25 seconds on the previous VisuMax 500 generation).

2. Creating the micro-incision: The laser then makes a small opening of 2 to 3 mm at the surface of the cornea, which serves as the access point to the lenticule.

3. Extracting the lenticule: The surgeon gently removes the lenticule through this micro-incision. The cornea then reshapes, altering its curvature and correcting the visual defect.

The whole procedure takes around 5 minutes per eye, including less than 10 seconds of active laser time (Yoo 2024: Sci Rep, comparative study VisuMax 800/500).

Why “minimally invasive”?

What sets SMILE apart is the absence of a corneal flap. Whereas LASIK opens a lamella of roughly 20 mm in circumference to reach the stroma, SMILE creates only a 2 to 3 mm micro-incision, affecting less than 15% of the corneal perimeter. This tissue preservation translates into:

• Better preservation of the corneal nerve fibres (responsible for sensitivity and tear regulation)
• Long-term biomechanical stability of the cornea is preserved
• The absence of any flap-displacement risk in the event of post-operative ocular trauma (contact sport, accident)

Which visual defects does SMILE correct?

SMILE is mainly indicated for the correction of myopia and myopic astigmatism, within the following ranges:

Indications validated on the VisuMax 800

The European and Asian post-market pivotal study on the VisuMax 800 (Sekundo et al., J Refract Surg 2025, n=473 eyes) confirmed the efficacy and safety of SMILE for these indications, with a mean preoperative spherical equivalent of -4.49 ± 1.87 D and extremes reaching up to -10 D.

Who is SMILE indicated for?

SMILE is suitable for patients meeting the following criteria.

Eligibility criteria

• Age: from 18 years, ideally 21-50 years
• Refractive stability: prescription stable for at least 1 year (ideally 2 years)
• Corneal thickness: pachymetry ≥ 480 µm (measured at the preoperative assessment)
• Regular cornea: no sign of keratoconus or corneal fragility (corneal topography, corneal OCT)
• General ocular health: no progressive corneal disease, no glaucoma, no significant cataract
• Personal profile: a patient who is informed of the benefits and risks and does not expect a “perfect”, 100% result

SMILE is particularly well suited to

• Patients with a dry eye profile (contact-lens wearers who no longer tolerate lenses, occupations involving prolonged screen use)
• Athletes practising contact disciplines or activities carrying a risk of ocular trauma (rugby, martial arts, diving, combat sports)
• Patients seeking rapid recovery without a flap
• Corneas of moderate thickness where LASIK might be borderline

Contraindications

• Presbyopia requiring correction
• A cornea that is too thin (< 480 µm)
• Keratoconus or suspected keratoconus
• Uncontrolled autoimmune diseases (lupus, severe rheumatoid arthritis)
• Pregnancy, breastfeeding (hormonal variations that alter refraction)

Only a complete preoperative assessment can confirm eligibility for SMILE. This assessment is carried out at the Cachan practice (94), equipped with the Sirius corneal tomographer (CSO), the IOL Master 700 biometer (Zeiss) and anterior-segment OCT. See the preoperative assessment page.

HOW THE PROCEDURE UNFOLDS

How does a SMILE operation take place?

On the day of the procedure

The SMILE procedure is performed on an outpatient basis at the Clinique Laser Victor Hugo (Paris 16th arrondissement). You arrive about 1 hour before the operation, with no need to fast (local anaesthesia only). Anaesthetic drops are instilled in the eyes, then you settle under the VisuMax 800 laser.

The procedure in 5 steps

Step 1: Getting into position (1-2 min)

• Lying position under the laser
• Head rest, eyelids held open with a lid speculum
• Local anaesthesia with drops only (no needle, no injection)

Step 2: Creating the lenticule (less than 10 sec per eye on the VisuMax 800)

• The femtosecond laser draws the lenticule within the cornea
• You fixate on a green light target
• A sensation of light pressure, well tolerated under anaesthetic drops

Step 3: Creating the micro-incision (~3 sec)

• The laser cuts the lateral opening of 2 to 3 mm

Step 4: Extracting the lenticule (1-2 min)

• The surgeon introduces a fine instrument through the micro-incision
• Detaches then removes the lenticule in a single piece
• A technical step requiring the surgeon’s dexterity

Step 5: End of the procedure

• No suture (the micro-incision closes on its own)
• Check under the operating microscope
• Instillation of antibiotic drops and placement of a protective shield for the night

Total duration: about 5 minutes per eye on the VisuMax 800, most often both eyes on the same day.

Comfort and anaesthesia

SMILE is performed under local anaesthesia with drops only. A slight sensation of pressure is felt during the laser phase, without significant pain for most patients. Visual comfort returns quickly: most patients leave the clinic on foot, sometimes accompanied as a precaution for the journey home. Mild discomfort (a gritty, sandy sensation and watering) is usual during the first few hours.

CLINICAL RESULTS

What results can you expect from SMILE?

Recent scientific literature, in particular on the VisuMax 800 platform used by Dr Tourabaly, shows high and stable efficacy results.

Results at 6 months (VisuMax 800 pivotal study)

The European and Asian multicentre post-market study on the VisuMax 800 (Sekundo et al., J Refract Surg 2025) included 473 eyes from 237 patients, followed up 6 months after their SMILE. The main results:

• 93.2% of eyes achieved an uncorrected visual acuity of 20/20 or better
• 98.3% of eyes reached 20/25 or better
• 95.1% of eyes had a refraction within ±0.50 D of the target
• 99.6% of eyes within ±1.00 D
• No eye lost 2 lines or more of corrected acuity

Long-term stability

A Spanish study with ≥ 5-year follow-up (Papa-Vettorazzi et al., Eur J Ophthalmol 2022) shows good refractive stability of SMILE, with a very small mean myopic regression (-0.19 D at 6 years on average) and no sign of corneal ectasia on standard criteria. Another Chinese study with 5-year follow-up (Tian et al., Ophthalmol Ther 2022) confirms no significant variation in spherical equivalent between 1 month and 5 years after the operation.

The largest published SMILE series in the world

Prof Dan Reinstein (London Vision Clinic), an internationally recognised authority on SMILE and co-developer of the VisuMax 800 technology, published in 2022 (J Refract Surg) the largest SMILE series ever documented: 4,138 consecutive procedures carried out between 2012 and 2018, with data available at 12 months on 3,722 eyes. Results: 98.7% of eyes at 20/25 or better, 99.6% within ±1.00 D of target, and only 0.08% (3 eyes out of 3,722) with a loss of 2 lines or more of corrected acuity: all restored with therapeutic photoablation.

When can I drive, work, do sport?

• Driving: allowed from D+1 (fitness confirmed by the surgeon)
• Screen work: gradual return from D+2 to D+3
• Gentle sport (walking, stationary cycling, gentle yoga): from 24 to 48 h
• Moderate sport (running, tennis, golf, non-contact football): from 1 week
• Contact sport (rugby, martial arts, combat sports), swimming, diving: from 4 weeks
• Eye make-up: D+15

SMILE allows a faster return to sport than PRK (which requires epithelial healing) and is comparable to LASIK for gentle and moderate sport. The distinguishing advantage of SMILE remains the absence of any flap-displacement risk for contact sports.

SMILE surgery in 5 stages

1. The preoperative assessment: carried out at the Cachan practice: corneal topography and Sirius tomography (CSO), IOL Master 700 biometry (Zeiss), pachymetry, refraction measurement, corneal OCT, and confirmation that there are no contraindications. Preoperative assessment page.
2. The anaesthetic consultation: not required for SMILE (local anaesthesia with drops).
3. The day of surgery: outpatient procedure at the Clinique Laser Victor Hugo, Paris 16th arrondissement.
4. The post-operative checks included in the package: D+1, D+7 (at 1 week) and D+30 (at 4 weeks), with a consultation in Cachan (94) or Paris 13 depending on which is closer to you.
5. Final stabilisation: definitive refraction reached between 1 and 3 months after the procedure.

How is recovery after SMILE?

Post-operative treatment (eye drops)

Following the post-operative protocol is essential for the quality of the result and the prevention of complications. At the clinic you will receive:

• Antibiotic drops (infection prevention): 4 times a day for 1 week.
• Steroid anti-inflammatory drops (cortisone drops, to control healing): tapered over 4 weeks according to a precise prescription (e.g. 4×/day the 1st week, 3×/day the 2nd, and so on).
• Preservative-free artificial tears (comfort + dry-eye prevention): 4 to 6 times a day for at least 1 month, to be continued for 2 to 3 months in patients prone to dry eye.

Precautions to observe

• Sunglasses from the moment you leave the clinic, worn daily outdoors for 1 month.
• No rubbing of the eyes: a precaution to observe strictly for the first 4 weeks (the corneal nerve fibres are regenerating), then over the long term as general good ocular hygiene (chronic rubbing remains a corneal risk factor throughout life).
• Protective shield at night for 7 days (to avoid involuntary rubbing during sleep).
• No exposure to dust (building sites, desert, strong wind) for 2 weeks.
• No eye make-up for 15 days.

FAIR INFORMATION

Possible risks and complications

Like any surgery, SMILE carries risks. Providing fair information to the patient is a deontological obligation (article R.4127-19-1 of the French Public Health Code). Here, in full transparency, are the risks reported in the international literature. See also our page dedicated to the safety of refractive surgery.

Intra-operative risks (during the procedure)

• Suction loss (loss of laser fixation, < 1%): may require the procedure to be resumed at a later time. Benign, with no visual consequence.
• Lenticule tear during extraction (rare, < 1%): sometimes requires an additional manoeuvre or postponement of the procedure.

Early post-operative risks (first few days)

• Gritty sensation, watering: almost systematic in the first hours, resolving within 24-48 h.
• Night-time light halos: common in the first weeks, regressing within 3 months in the great majority of cases.
• Transient dry eye: possible but less marked than after LASIK (see the Chen 2025 meta-analysis).

Late post-operative risks

• Under-correction / over-correction: possible (~3-5%); an enhancement may be offered if the residual error becomes bothersome. Note: enhancement after SMILE is more complex than after LASIK: the corneal tissue cannot be re-sculpted identically. The enhancement is done either by surface PRK or by creating an independent LASIK flap. Recovery after enhancement is in practice a little longer than after a direct LASIK enhancement. This difference should be taken into account in the initial choice of technique.
• Residual optical aberrations: more frequent with high myopia. The Reinstein meta-analysis (J Refract Surg 2022) documented this point specifically.
• Infectious keratitis (< 0.1%): very rare thanks to the mini-incision. The risk is lower than with LASIK.

The advantage of SMILE in terms of risk

• No flap = no risk of flap displacement after trauma (a strong distinguishing advantage vs LASIK)
• Mini-incision = a natural barrier to microbial invasion
• Nerve preservation = less persistent dry eye (Chen et al. 2025, meta-analysis of 18 studies)
• Late-onset photophobia (TLSS) is rarer: the Reinstein 2023 study (J Refract Surg) shows an incidence of 1.2% after myopic SMILE versus 5.3% after myopic LASIK (p < 0.001).

SMILE vs LASIK vs PRK: how to choose?

The choice between SMILE, LASIK and PRK is never based on price or on current trends. It depends on several medical parameters: corneal thickness, the size of the correction, dry-eye profile, lifestyle (athletic, exposed occupation) and ocular history.

Summary table

The choice of technique is made case by case at the preoperative assessment, according to your cornea, your correction, your lifestyle and your preferences.

Where do the procedure and consultations take place?

Preoperative assessment

Cachan practice (94): 1 Ter Rue Camille Desmoulins, 94230 Cachan

• Complete preoperative assessment on a technical platform: corneal topography and Sirius (CSO) tomography, IOL Master 700 (Zeiss) biometry, pachymetry, corneal OCT, refraction measurement
• Confirmation of eligibility for SMILE and choice of the appropriate technique

SMILE procedure

Clinique Laser Victor Hugo (Paris 16th arrondissement): 27 bis avenue Victor Hugo, 75116 Paris

• SMILE procedure on the Zeiss VisuMax 800 femtosecond laser (latest generation)
• Technical platform dedicated to refractive surgery

The procedure is performed on an outpatient basis (admission and discharge on the same day). No overnight hospital stay is required.

Post-operative follow-up consultations

Post-operative checks are carried out at one of Dr Tourabaly’s practices, whichever is closer to you:

• Cachan practice (94): close to Paris, RER B access
• Paris 13 practice: for patients in the south of Paris

The checks at D+1, D+7 and D+30 (4 weeks) are included in the package.

How much does SMILE cost and is it reimbursed?

SMILE costs €3,300 for both eyes at Dr Tourabaly’s practice (package: surgeon’s fees, ZEISS VisuMax laser and Clinique Laser Victor Hugo fees, plus the first month of follow-up; the pre-operative assessment and the drops are billed separately). Your complementary health insurance can help: many policies include an allowance for refractive surgery, which the French national health insurance does not cover. A detailed quote is provided so that you can claim it.

The SMILE fee with Dr Tourabaly is €3,300 (package for both eyes, procedure and first month of follow-up). It breaks down as follows:

• Facility fees (clinic, laser consumables, pre- and post-operative follow-up): €1,200
• Surgical fees: €2,100

This package includes:

• The procedure on both eyes
• The post-operative checks for the first 4 weeks (D+1, D+7, D+30) in Cachan or Paris 13 depending on which is closer to you
• The drops for the post-operative phase (antibiotic, anti-inflammatory, artificial tears)

Cover

• Social security (Sécurité sociale): no cover: refractive surgery is elective surgery.
• Private health insurance (mutuelles): most policies provide a refractive-surgery allowance, generally between €200 and €800 per eye depending on the policy. Ask your insurer for a personalised quote.
• A detailed quote is provided at the preoperative assessment.

See all our detailed prices on the Pricing page

SURGICAL EXPERTISE

Why choose Dr Tourabaly for your SMILE

The choice of surgeon is an important decision in refractive surgery. A few factual pointers about Dr Tourabaly’s background and approach may help inform that decision.

FAQ

Frequently asked questions about SMILE

Book an appointment for a SMILE assessment

Complete preoperative assessment: with no commitment. The assessment determines whether SMILE is suited to your case.

You can also contact the practices directly:

• Cachan practice (94): 1 Ter Rue Camille Desmoulins, 94230 Cachan : +33 1 45 47 08 11 : preoperative and post-operative consultations.
• Paris 13 practice (75013): 12 Rue du Moulin des Prés, 75013 Paris : +33 1 89 31 30 60 : general ophthalmology, diabetes and retina (no refractive assessment or cataract).

Scientific sources

1. Sekundo W, Chang JSM, Ganesh S, Hjortdal J, Wiltfang R. Keratorefractive Lenticule Extraction for Myopia and Myopic Astigmatism With the VISUMAX 800: 6-Month Outcomes of a Prospective Multi-center Post-market Clinical Follow-up Study. J Refract Surg. 2025;41(3):e264-e271. PubMed
2. Reinstein DZ, Carp GI, Archer TJ, Vida RS, Yammouni R. Large Population Outcomes of Small Incision Lenticule Extraction in Young Myopic Patients. J Refract Surg. 2022;38(8):488-496. PubMed
3. Chen KY, Chan HC, Chan CM. How Effective is Keratorefractive Lenticule Extraction Surgery (KLEx) in Reducing Dry Eye Outcomes Compared to LASIK? A Systematic Review and Meta-analysis. J Refract Surg. 2025;41(8):e839-e854. PubMed
4. Reinstein DZ, Potter JG, Gupta R, Yammouni R, Archer TJ. Transient Light Sensitivity Syndrome (TLSS) Incidence Following Femtosecond LASIK and Femtosecond SMILE. J Refract Surg. 2023;39(6):366-373. PubMed
5. Papa-Vettorazzi MR, Güell-Villanueva JL, Cruz-Rodriguez JB, et al. Long-term efficacy and safety profiles following small incision lenticule extraction in eyes with ≥ 5-year follow-up. Eur J Ophthalmol. 2022;32(6):3333-3339. PubMed