OBJECTIVE: Submucosal minimally invasive lingual excision (SMILE) is a novel approach to address hypopharyngeal obstruction. This study compares the efficacy, morbidity, and complications of this technique to radiofrequency reduction of the tongue base (RFBOT), the current standard in minimally invasive tongue base reduction. STUDY DESIGN: Retrospective analysis of data extracted from a prospective database. METHODS: Ninety-six patients who underwent SMILE (n=48) or RFBOT (n=48) were studied. Efficacy and safety of the procedures were compared on the basis of polysomnography results, morbidity measures, and complications. RESULTS: Patients in both groups demonstrated a significant reduction in the apnea/hypopnea index. Success rates for SMILE and RFBOT were 64.6 percent and 41.7 percent, respectively (P=0.024). SMILE, however, was associated with increased morbidity and complications. CONCLUSION: In a comparable surgical protocol for obstructive sleep apnea-hypopnea syndrome, SMILE technique for tongue base reduction demonstrated increased efficacy over RFBOT but resulted in more complications. Additional experience with the procedure may reduce complications and increase overall efficacy.