After crestal incision and flap reflection, a diamond round bur is used to thin the sinus floor until the bluish membrane is barely visible.  An osteotome (Magic Sinus Lifter) is used for penetration.  Water lift will be conducted if necessary, considering the already thickened sinus membrane (Fig.3 (CT sagittal section) M).  Insert the first PRF membrane, followed by bone graft (not sticky) repeatedly. 

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Xin Wei, DDS, PhD, MS 1st edition 02/03/2020, last revision 02/03/2020