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Hydraulic Lifting is a great way to lift the Schneiderian membrane of sinus floor of the Maxillary arch. In this particular surgery, tissue punch was not used to preserve keratinized epithelium and flap was not lifted (since predictable bone all around implant neck was confirmed in CBCT )to eliminate trauma . Osteotomy was performed with tissue spreading using incremental drilling, the sinus membrane was lifted with gentle hydraulic force in crestal approach . By introducing push and pull action with a .5cc saline solution , increasing up to 1.5 cc in .5cc increments ,thus membrane was lifted. Under Membrane PRF was introduced for added strength, to eliminate risk of perforation . PRF can increase leukocytes count by 65% thus reducing bacterial count ,it works as scaffold and releases bone Morphogenetic protein. Bone graft ( HA+TCP) was mixed with PRP to take advantage of its growth factors like FGF , EDGF, PDGF ,TGF ,BMP and so many more thus increasing its angiogenesis,osteoconductive, osteogenesis and Osteoinductive properties. Implant bed was cleaned with PPP then few drops of PRP was introduced to jump start the healing and Osseointegration. Patient stated antibiotic 2 days before surgery and will continue for 5 more days. Patient using mouthwash Chlorohexidin.12% for next 2 weeks to eliminate any bacterial adherence to surgery site and healing abutment. CBCT shows sinus floor was appropriately lifted and bone graft about 2mm -4 mm all around implant body. Buccal fold around surgery site was injected with glucocorticoid.2ml No Scalpel, no stitches was used and any narcotic was given. Follow up in 2 weeks and final crown will be given in 4-6 months. Woven bone after surgery will take 4 months to mineralized at 60% to bear the loading force . Bone will take one year to be 100% mineralized. Dr Sayema Zerin DDS , Fellow Oral Implantology DHII . USA