© 2017 American Academy of Dermatology, Inc. Background Brimonidine topical gel may be useful in cutaneous surgical procedures because of its vasoconstricting properties. Objective Assess the hemostatic effect of topically applied brimonidine in patients being treated with anticoagulants and undergoing Mohs micrographic surgery (MMS). Methods Subjects undergoing MMS were randomly assigned to the control (n = 10) or study arm (n = 14). Controls received standard-of-care MMS, whereas the study arm received the same and preoperative application of brimonidine. Evaluations included rate of blood flow, percentage of wound bed surface area needing electrocautery, and changes in skin colorimeter readings. Results The treatment arm had 68% less blood loss over 30 seconds versus the control arm (P <.05). No patient in the brimonidine arm had more than 50% of the wound bed cauterized versus 80% in the controls. Erythema in the treatment arm was decreased by 3.89 times (P <.01) versus in the control arm. Limitations Limitations were small sample size; sites limited to the face; the fact that measurement of bleeding did not account for anesthetic mixed with blood; visual estimation of percentage of wound surface area requiring cauterization; and no measurement of volume of anesthesia, wound depth, or postoperative complications. Conclusion Preoperative application of brimonidine 0.33% gel may help decrease blood loss and the need for electrocautery during MMS for patients taking anticoagulants.