Use of shorter incisions in minimally invasive surgery total hip arthroplasty (THA) may come at the cost of poorer cosmesis, possibly a result of the excessive retraction needed for visualization. This may be particularly relevant in the direct anterior approach, in which wound-healing issues are common. We prospectively investigated whether a specialized ring retractor was effective in minimizing wound-edge trauma, as evidenced by improved scar cosmesis. Fifty patients having direct anterior THA were randomized to surgery with or without ring retractor. Incisional photographs 2, 6, and 12 weeks after surgery were graded by 2 blinded plastic surgeons. Wound scores and patient satisfaction with scar appearance were similar between groups. Our results suggest no improvement in wound cosmesis with use of this retraction device.