The album version of the song is known for its extended piano outro, played by former Squeeze keyboardist Jools Holland.

Stevo Pearce, the owner of Some Bizzare Records, told bandleader Matt Johnson to keep reworking it so that it could become a single.

[2] The first version of "Uncertain Smile" differed from the "Cold Spell Ahead" demo by adding a Roland TR-808 drum machine beat, a bassline played by Johnson on a Fender Precision, lead and rhythm guitar leads on a 12-string Rickenbacker, and a xylimba which Johnson had purchased from Manny's Music on Manhattan's 48th Street.

String samples came from producer Mike Thorne's Synclavier, and session musician Crispin Cioe of The Uptown Horns played saxophone and flute.

Smash Hits gave it top honors and declared, "Never mind record of the week, this is the week of the The The record... [Johnson's] sleazy Lou Reed vocals contrast beautifully with a bubbling melange of smoochy synthetics, around which a delicate, folksy flute flutters from time to time.

[5] "Uncertain Smile" ranked in third place during Australia's inaugural Triple J Hottest 100 songs of all time poll in 1989.