Objective <p>Dermatochalasis is defined as a skin excess in the upper or lower eyelid which may be associated with orbital fat prolapse, lacrimal gland prolapse, and involutional blepharoptosis. Upper blepharoplasty is the gold-standard procedure for correcting dermatochalasis and is the third most common cosmetic surgery performed in the United States. However, it is frequently performed on elderly patients, who are often ongoing anticoagulant and/or antiplatelet therapy. Due to the associated elevated risk of bleeding, it remains unclear whether upper blepharoplasty can be safely performed in this patient population. This study aimed to investigate the safety of upper blepharoplasty in patients receiving antithrombotic therapy.</p> Material and Methods <p>A retrospective comparative study was conducted on 392 consecutive patients who underwent upper blepharoplasty for dermatochalasis at a single academic center over a three-year period. Patients with a history of prior eyelid or orbital surgery were excluded. The cohort was stratified into two groups: a study group of 100 patients on anticoagulant/antiplatelet therapy (including aspirin, warfarin, and apixaban) and a control group of 292 patients not on such therapy. Postoperative complications, clinical outcomes, and satisfaction scores (from both patients and surgeons) were compared between the groups.</p> Results <p>Baseline characteristics differed significantly between groups, with patients on anticoagulant/antiplatelet therapy being older and having higher comorbidity rates. Operative time, estimated blood loss, time to return to work, and follow-up duration were comparable. The overall complication rate was not significantly different between the antithrombotic and control groups (6.0% vs. 3.5%, <i>p</i>=0.380). Notably, no major bleeding events occurred. The incidence of ecchymosis requiring extended observation was low and not significantly different (1.0% vs. 0.0%, <i>p</i>=0.573). Patient-reported and surgeon-assessed satisfaction scores were high and similar between groups. Reoperation rates were also equivalent. On multivariable logistic regression analysis, no variable was identified as a significant independent predictor of complications; however, hypertension demonstrated the highest odds ratio (OR 2.9, 95% CI 0.29-28.56, <i>p</i>=0.370).</p> Conclusions <p>Upper blepharoplasty appears to be safely performed in carefully selected patients receiving anticoagulant or antiplatelet therapy. In this retrospective cohort, continuation of antithrombotic therapy was not associated with an increased rate of detected complications compared with controls. These findings support the feasibility of maintaining therapy in appropriately selected cases, although larger prospective studies are required to confirm these observations.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>