The adjustable hang-back suture technique allows for changing the muscle position in the immediate postoperative period, while the patient is awake. Therefore, this technique has the theoretical advantage of allowing fine-tuning of ocular alignment. There are problems, however, with the standard adjustable suture technique. Adjustment must be done within the first 24–48 h after the procedure or the muscle will stick to the sclera and adjustment will be difficult. Unfortunately, this is when the muscle function has not completely returned; plus there is postoperative swelling and edema, so final alignment still is in question. Muscle adjustment requires pulling on the muscle and this is often very uncomfortable for the patient. Also, since the muscle suture knot is anterior, close to the cornea, it often erodes through the conjunctiva and needs to be removed postoperatively.