Objective: To introduce a minimally invasive and image-guided technique for staged placement of a percutaneous abutment after osseointegrated implantation. Patients: Adults undergoing temporal bone resection at two academic medical centers. Interventions: Ultrasound-guided percutaneous installation of a bone conduction hearing device abutment. All patients had lateral temporal bone resection with osseointegrated implantation. Abutment placement followed as a planned staged procedure 3 to 6 months later depending on the use of radiotherapy. Main Outcome Measures: Ability to use a bone conduction hearing device and occurrence of skin reactions or wound complications. Results: Twelve patients successfully underwent abutment installation through a 5 mm skin biopsy punch incision, nine of which had minimal to no skin reaction surrounding the abutment. Two patients developed Holgers grade 1 skin reaction (redness with slight swelling). One patient experienced an osseointegration failure 152 days after abutment placement. Conclusions: Ultrasound is a widely available imaging modality that can be used to precisely localize subcutaneous osseointegrated implants, allowing for minimally invasive percutaneous placement of an abutment under local or general anesthesia.