Surface Mechanical Attrition Treatment (SMAT) has been carried out at cryogenic and room temperatures on a 5553 β-metastable Ti alloy to describe its effects on the modification of the microstructure and fatigue properties. The cryogenic temperature promoted the martensitic transformation and the width of the kink bands produced by SMAT. The kink bands formation was promoted by the high strain rates of the SMAT process. The samples SMATed at cryogenic temperature showed an increase in fatigue resistance, by about 8%, compared to samples processed by SMAT at room temperature. This improvement was possibly due to a combination of several factors: compressive residual stresses, lower roughness, deeper formation of martensite and larger kink bands. On the contrary, the SMAT at room temperature did not provide any improvement in terms of fatigue compared to the polished condition. The large grain size provoked the appearance of subsurface crystallographic defects on which primary cracks initiated. This greatly limited the effectiveness of the reinforced surface layer produced by SMAT.