Background: Conventional thyroidectomy usually requires a long collar incision to provide exposure to the thyroid gland. Thyroidectomy with less postoperative pain and better aesthetic outcome was and still the desired goal for thyroid surgeons. This study aimed to assess the safety, feasibility, and efficacy of high cervical mini-incision thyroidectomy compared to the conventional technique regarding postoperative pain, cosmesis, operative time, and postoperative complications. Methods: It was a randomized controlled study done between January 2019 and June 2022 on 118 selected patients with small sized benign thyroid diseases. Patients were randomly divided into two equal groups of 59 patients each. Patients in group A were subjected to high cervical mini-incision thyroidectomy, while those in group B were subjected to the standard technique. The new approach was different from the standard one in that it provided mobile access to the thyroid gland through a small wound (2.5-3) cm with extended subplatysmal flaps dissection. Results: Patients in group A reported less postoperative pain and were more pleased with the aesthetic outcome than those in group B. The less invasive technique also showed less intraoperative blood loss with no significant difference regarding operative time, hospital stays, and postoperative complications. Conclusion: High cervical mini-incision thyroidectomy is a feasible, safe option performed by experienced surgeons for selected patients. It showed excellent cosmetic outcomes and less postoperative pain with the shorter skin incision.