Context Preauricular sinus (PAS) can lead to severe complications such as facial paralysis, and squamous cell carcinoma may develop from this sinus later in life. Asymptomatic sinus needs no intervention, but symptomatic sinus needs surgical interventions. Aims: This study compares the surgical outcome of microscope-assisted sinus tract excision technique with the supra-auricular sinectomy technique. Settings and Design: This was a retrospective, observational study conducted at a tertiary care hospital in Purulia District, West Bengal, India. Subjects and Methods: Records of patients operated on for PAS were included following the proper inclusion and exclusion criteria. These patients were categorized and followed up based on disease pathology and the type of intervention received. Statistical Analysis Used: Data were collected, tabulated, and analyzed using the standard statistical software. Results: Fifty-two patients were included in our study. About 48.07% of patients were found in the age group of 11–15 years. In the microscope-assisted sinectomy category, recurrence of the disease was seen in 2 out of 15 operated patients compared to 1 patient among 13 in the supra-auricular sinectomy approach for uncomplicated cases. In complicated cases, the supra-auricular sinectomy approach had a nil recurrence rate compared to three patients out of ten operated in microscope-assisted technique (Fisher's exact test - 0.0593). Both the outcomes are not statistically significant. Conclusion: Supra-auricular sinectomy technique has the lowest recurrence rate for preauricular sinus surgery.