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To identify whether an increased body mass index (BMI) predisposes patients to more soft tissue problems after placement of a Bone-Anchored Hearing Aid implant.We retrospectively reviewed 88 adult patients who met criteria for inclusion in the study.Ten (11.4%) of the 88 patients had significant soft tissue reaction requiring excision, revision of the skin graft, or placement of a longer abutment (8.5 mm). Of these 10 patients, 4 required placement of a longer abutment, whereas 4 underwent revision skin grafting. All 10 patients had scar excisions in the office. Of the 10 patients, 9 were considered obese with a BMI of 30 lb/in2 or greater. One patient was considered overweight with a BMI of 28.1 lb/in2. The mean BMI for those patients with significant soft tissue reactions was 34.2 lb/in2. The mean BMI for patients with no reaction or minor reactions was 27.6 and 27 lb/in2, respectively. No patient lost an implant due to soft tissue reaction during the follow-up period.Our study demonstrates that after Bone-Anchored Hearing Aid surgery, most patients (78/88, 88.6%) had no soft tissue reaction or had only a mild reaction that was easily treated. However, there are a definite percentage of patients who may develop significant scarring over time. This study identified a significant relationship between obesity (BMI > 30 lb/in2) and extensive soft tissue reaction around the implant site.