Jim is right that mid-grade cards are altered too, but it probably entails removing a crease or something like that. If a card is trimmed, it surely will end up with square corners, hence a high grade.
Wherever there is easy money to be made there will be someone out there figuring out the best way to do it. If spooning a crease can turn a 3 into a 4, there's plenty of incentive to do it.
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