In this report, we discuss a case of a high myopic patient who underwent mechanical LASIK surgery in 2008 that respected the Randleman criteria for ectasia risk but incurred in a percentual thickness alteration (PTA) over 40%. The patient underwent reoperation in 2016 to correct the residual refractive error with wavefront-guided photorefractive keratectomy. At the time of the first surgery, the concept of PTA did not exist. Currently, a PTA that exceeds 35%–40% correlates with an increased risk of ectasia. We reviewed the literature focusing on the differences between the current rationale for post-LASIK enhancement and the selected strategy at the first reintervention. The purpose of this provocative case report is to emphasize the importance of personalized surgery in reoperations, always aiming for the welfare and best vision for the patient.