Objectives This clinical study was designed to compare the patient's opinion of the cosmetic improvement after the placement of direct composite and indirect porcelain veneers. Methods This retrospective study involved a survey of 145 patients (96 responses) each treated with 10 direct composite (Vitalescence) or 10 porcelain (Fortress) veneers. Patients subjectively evaluated multiple aspects of their smile using visual analogue scales before and after treatment for colour, shape, size, smile line and overall facial appearance. Results There were no statistical differences between the cosmetic improvement achieved for porcelain and composite (p ≥0.05). Cost factors were not significant. Significant factors were: tooth conservation (p ≤0.021), time (p ≤0.012), repair costs (p ≤0.009) and replacement costs (p ≤0.024) and favoured the direct composite veneers over the porcelain veneers. Correlation findings relating to what patients feel as the key components of the smile for overall cosmetic improvement showed medium to high correlations (0.301 ≤ r ≤0.718) with tooth shape, colour and level of tooth display, gingival level, gingival symmetry and tooth whiteness. Conclusion The choice of material (direct composite resin vs porcelain) when constructing maxillary anterior veneers does not significantly affect the patient's perception of cosmetic improvement. However, there was a preference towards accepting the composite veneer option. Overall aesthetic satisfaction is multifactorial. The results support the opinion that the more conservative composite veneers are justified and that, given the choice and information, patients may prefer this option.