The postoperative outcomes which are clinically relevant now in bone anchored hearing device surgery have come a long way over the past decade. The newer techniques have meant that previous concerns with skin numbness and cosmesis are now such rare complaints, as the results of this study supports, that complications such as skin breakdown and extrusion should now be the focus of comparison studies to determine the optimum insertion technique. The authors claim that this is the largest study with the longest (six months) postoperative follow-up comparing these two techniques. The control group in this study was the ‘linear incision with soft tissue preservation’ technique with a 5mm punch in or posterior to that incision, versus the solely keyhole technique, termed ‘minimally invasive ponto surgery (MIPS). Both groups (25 patients in each, not randomised) had the same brand of implant, single stage surgery, and uniform postoperative care with healing cap for seven days, and ointment for two weeks. The outcomes included subjective and objective changes in sensation and cosmesis. Surgical time was reduced in the MIPS group. They also assessed skin status which revealed a statistically significant higher incidence of temporary minimal skin dehiscences in the MIPS group, and in this group there was a (non-significant) higher rate of implant loss of 12%. In general, implant loss after bone anchored hearing aid surgery is around 3% for the newer generation implants. A larger sample size to asses this important outcome in more detail and over a longer postoperative period is needed. This will then determine whether the arguably small benefit of shorter operative time means that the MIPS technique is preferable to the more established linear technique.