Aim: This study aimed to compare the efficacy, safety, and patient satisfaction of Laser-Assisted In Situ Keratomileusis (LASIK) and Small Incision Lenticule Extraction (SMILE) techniques in the treatment of myopia. Materials and Methods: A prospective, comparative study was conducted on 100 myopic patients who were randomly allocated into two equal groups: LASIK (n = 50) and SMILE (n = 50). Inclusion criteria included patients aged 18–40 years with stable myopia (-1.00 to -10.00 D) and a minimum corneal thickness of 500 μm. Preoperative assessments included uncorrected and best-corrected visual acuity (UCVA, BCVA), manifest and cycloplegic refraction, corneal topography, pachymetry, tear film assessment, and intraocular pressure measurement. Postoperative evaluations were performed at Day 1, Week 1, Month 1, Month 3, and Month 6 to assess visual acuity, refractive error, corneal integrity, dry eye symptoms, and patient-reported satisfaction. Results: Baseline characteristics, including age, gender distribution, preoperative UCVA, BCVA, spherical equivalent, and corneal thickness, were comparable between the groups (p > 0.05). Postoperative UCVA improved progressively in both groups, with no significant difference at six months (LASIK: 0.06 ± 0.02 LogMAR, SMILE: 0.07 ± 0.02 LogMAR, p = 0.50). Residual refractive error was minimal in both groups, with values of -0.08 ± 0.05 D for LASIK and -0.10 ± 0.06 D for SMILE at six months (p = 0.60). Corneal thickness was better preserved in the SMILE group (488 ± 19 μm for LASIK vs. 493 ± 18 μm for SMILE; p = 0.38). Dry eye symptoms were significantly higher in the LASIK group at one week (OSDI: 25.0 ± 5.1 vs. 18.5 ± 4.8, p < 0.01), but the difference became non-significant by six months. Patient satisfaction remained high, with 96% satisfaction in both groups at six months (p = 0.75). Conclusion: Both LASIK and SMILE are effective, safe, and reliable procedures for myopia correction, providing excellent postoperative visual outcomes with minimal residual refractive error. While LASIK offered slightly faster visual recovery, SMILE preserved corneal integrity better and was associated with fewer dry eye symptoms. The choice between LASIK and SMILE should be guided by individual patient characteristics and ocular health considerations.