Objective is to identify the advantages and disadvantages of different approaches for carotid endarterectomy (conventional, longitudinal and transverse incision). Material and methods. There were 58 patients who underwent carotid endarterectomy. Patients were divided into 2 groups depending on surgical approach. Group 1 (n=37) — minimal skin incision (less than 5 cm). There were subgroup 1A (transverse minimal skin incision along the natural skin wrinkle, n=17) and subgroup 1B (longitudinal minimal skin incision, n=20). Group 2 (n=21) — conventional longitudinal incision. Surgical outcomes were analyzed after 1 month and 1 year. End-points were mortality, stroke, TIA, cranial nerve neuropathy. Cosmetic effect was evaluated using POSAS scale (Patient and Observer Scar Assessment Scale, Draaijers, 2004). Results. Mortality, stroke and TIA were absent after 1 month. Cranial nerve neuropathy was not observed in subgroup 1A and diagnosed in 2 (10%) patients of subgroup 1B and 6 (28.5%) patients of group 2. Cosmetic effect: subgroup 1A — 48.4±9.5 scores, subgroup 1B — 52.4±9.2, group 2 — 63.1±11.1 (p<0.05). The outcomes after 12 months: mortality was absent in subgroups 1A and 1B, 2 patients died in group 2 from AMI. Stroke was absent in subgroups 1A and 1B, group 2 — 1 patient. Cranial nerve neuropathy was absent in 1A and 1B subgroups and diagnosed in 4 (21%) patients of group 2. Cosmetic effect: subgroup 1A — 37.2 scores, subgroup 1B — 40.0 scores, group 2 — 55.1 scores. Physical component of QOL: subgroup 1A — 51.63±6.31 scores, subgroup 1B — 46.01±7.53 scores, group 2 — 38.85±5.33 scores. Psychological component of QOL: subgroup 1A — 49.64±6.72 scores, subgroup 1B — 45.68±5.63 scores, group 2 — 48.6±7.36 scores (p<0.05). Conclusion. Transverse minimal skin incision for carotid endarterectomy is a safe alternative to classic longitudinal incision and reduces the risk of postoperative complications with significant cosmetic effect.