Rarely, teenagers present with hip issues that impair their independence and impact their activities of daily living. The great physical demands placed on a teenager's hip present a challenge if arthroplasty is needed. The femoral head is precious; it is not a surplus part, even when damages. Keeping the femoral head preserves the important load-bearing relationship. The bone conserving hip resurfacing procedure can be conceptually more appealing than hip replace when prolonger service is needed. Also, the reconstructive option of hip replacement is preserved for a later time. We performed hip resurfacing for more than 120 teenagers and 92% achieved excellent outcomes and with two failures over 25 years. Hip resurfacing is a highly technical procedure. Careful implant selection using highly cross liked polyethylene and a metal free ceramic coated femoral implant is necessary. The meticulous preoperative planning, careful extensile surgical exposure, and exacting implant placement contributed to the favorable outcomes. Hip resurfacing allow hip replacement as a future option in patients where the lifetime revision rate is a major consideration.