Adjustable suture surgery helps achieve visual axis alignment in special cases. We describe a modification of adjustable suture surgery that provides better patient comfort and easier assessment of the muscle function at the time of adjustment. These beneficial features are achieved by using the cul-de-sac approach and by delaying final adjustment up to one week postoperatively. We review our experience involving 52 cases and discuss the surgical methods and reasoning behind delayed suture adjustment through the cul-de-sac approach.