INTRODUCTION: Mandibular angle resection is an important procedure in facial feminization surgery. Two different approaches are described: trans-oral and cervico-facial lift (CFL) approaches. The aim of the study was to compare surgical outcomes and patient's satisfaction between the two approaches. MATERIAL AND METHODS: We retrospectively analyzed medical charts of patients who underwent mandibular angle resection in the same center by the same surgeon between 2017 and 2019. Aesthetic and functional results were objectively assessed using serial photographs and subjectively with patient self-assessments. All patients benefited from a medical consultation at least 6 months after the surgery. RESULTS: Seven patients benefited from trans-oral approach and 14 from CFL approach. The mean age was 42. No major complications occurred. No long-term nerve damage was found. Aesthetic evaluation showed mostly an improved result. All patients answered positively to the quality of life survey. DISCUSSION: These preliminary results of the study suggest that mandibular angle resection is a much-needed and safe surgical procedure regardless of the surgical approach. Patients who underwent facial feminization surgery frequently present a mixed indication of CFL and mandibular angle resection. The study is limited by the low number of patients included. Moreover, interpretation of results is biased because the patients benefited from other minor facial cosmetic procedures in the same surgery. We reported the first analysis of transgender patient's satisfaction concerning mandibular angle resection. This procedure improves quality of life as well as facial aesthetics for transgender patients.