I am encountering dilemmas with patients that require sinus lifts and are smokers. Can anyone share their experiences with performing sinus lifts on patients that smoke? It is my understanding that membranes in smokers are very frail and attempts to lift them, end up with severe perforations that are beyond repair. The second issue that goes beyond lifting the membrane is the influence of nicotine and an assault by a gas of higher than the normal temperature on the maturation of any kind of a graft. Please share your experiences and your thoughts.