Post-tensioned (PT) anchors are widely used to upgrade and rehabilitate concrete dams, particularly where increased resistance to sliding, overturning, uplift, and seismic loading is required. The use of PT anchors is expanding as dam safety criteria evolve; however, current design practice often relies on simplified assumptions for bond behavior and load transfer that do not fully represent the interaction between anchors, structure, and foundation rock (Brown 2015). This paper presents an integrated methodology that links design analysis with constructability, focusing on how prestress, bond development, geology, and installation constraints collectively influence anchor performance. Practical considerations are highlighted, such as anchorage-zone detailing, corrosion protection selection, procurement constraints, and field verification. Lessons learned from recent dam projects emphasize the importance of early engagement with PT suppliers, selecting corrosion protection as a coordinated system, accounting for supply chain and fabrication limitations, validating bond capacity against site-specific conditions, and ensuring qualified personnel and supervision during installation and stressing. Overall, the findings show that PT anchor performance depends as much on constructability, quality control, and execution as on analytical design. They support a more integrated, system-based approach to improve reliability and reduce unnecessary conservatism in practice.