Yes.  The term 'bikini' is a bit misleading as it implies a gender distinction in the use of the approach.  Dr Williams will tend to suggest a traditional vertical incision for patients with anatomy that make the anterior approach more challenging however, such as well-built males and those with a certain shape to the top of the femur.

Yes. While obesity can make any approach to the hip joint more challenging, the scientific evidence supports the use of a transversely oriented bikini incision in overweight and obese patients.  Some papers show that it may in fact be better than the traditional vertical incision with lower rates of wound complications. 

In larger patients, it is very important that the incision does not cross the groin crease, which is sometimes impossible with a vertical incision and leads to delayed wound healing and the potential for superficial or deep infection.

Anterior approach hip replacement in general may not be suitable if there is active infection of the groin crease, so Dr Williams will always assess the health of the skin fold in your consultation.

Dr Williams closes the top layer with a dissolvable running suture that is just below the surface of the skin, then seals the skin with glue, so there are no stitches to remove.

At the end of the operation, your wound will be dressed with a waterproof surgical dressing that should be left in place for 2 weeks.  It is waterproof enough for showering but not for submersion in a bath, pool or the ocean. Dr Williams will remove your dressing himself at the 2 week wound check if you are in Sydney, or will arrange for this to be done with your local GP.  It usually doesn't need to be redressed.

The original surgical dressing prior to removal at the 2 week check.

Bikini hip replacement scar 2 weeks. Some normal postoperative bruising and swelling of the skin edges can be seen.

The wound takes about 2 weeks to heal and for that time should be covered by the original waterproof surgical dressing that was put on in theatre.  The wound will be checked at the 2 week mark, and if it is completely healed, you may be given the all clear to start swimming or hydrotherapy.  In some cases, an extra week or so is required until the wound is fully sealed.  Dr Williams recommends swimming with a "pull-buoy' floatation device between the knees for the first 4-6 weeks to avoid excessive kicking.

Because the incision follows the natural tension lines of the skin, the good news is that most wounds will heal into a thin white line without any active scar management at all.

The most important thing in the initial period is to achieve good primary wound healing and avoid infection.  You should keep the waterproof surgical dressing in place for the first two weeks and avoid water getting underneath it.

You will have a wound review at the 2 week mark at which point, it has usually healed nicely. Because it is very early in the healing inflammatory response, this is as good as your wound will look for quite a while.  It is normal for the wound to become redder or darker in colour over the next few months, before gradually fading away again.  The entire process of scar maturation can take up to 2 years.

There are several evidence based treatments to minimise scarring long term.  Which one to use (or none at all) is entirely up to individual preference.

• Scar taping with an adhesive semi-permeable fabric dressing such as Hypafix or Fixomull applies gentle pressure and supports the wound edges against stretch.  This can be worn for the first 4 - 6 weeks postoperatively.
• Scar massage with products such as Bio Oil can soften hardened scars
• Silicone sheeting.  Available online, silicone sheets (such as Siltape) are flexible self-adhesive strips of medical grade silicon which are the treatment with the largest evidence base for reduction in scarring.  Silicon keeps the wound hydrated throughout the healing process. They can be used as soon as the wound has healed and should be used for at least 12 hour per day for 6-12 weeks for maximum effect.
• Silicone gels can also be used in place of silicon sheeting.  Gels may be less noticeable once applied.