Objectives: The purpose of this article is to describe a modified surgical approach to the thyroglossal duct cyst (TGDC) where the incision is given at the upper pole of the cyst which offers easy cephalic dissection which is at times difficult and requires multiple incisions like Sistrunk operation. Further it gives better cosmetic results with no recurrence. Study Design: A total of 48 patients with the diagnosis of TGDC were assigned from September 2012 to October 2014 to have either Sistrunk (n=20) or Sistrunk with modified incision (n=28) after clinical and radiological assessment. Ease of resection, recurrence rate and cosmetic outcome were noted.  Results: There was no significant difference in the rate of complications and operative time of the procedure between the two procedures. There was statistically significant difference in recurrence rate in Sistrunk procedure (3/20) as compared to Sistrunk procedure with modified incision (0/28) (P=0.04).  All of whom presented with an infected neck mass, were treated with Sistrunk procedure with modified incision. Conclusions: Modified incision gave good results in our series with decrease operative time of the procedure, allows the surgeon to achieve and maintain an excellent exposure at the level of hyoid as well as foramen caecum making it easy for complete excision and decrease recurrence rate. Further it has better cosmetic outcome as the high scar is not visible as it merges within Langers lines.