Autogenous grafts are broadly regarded as the gold standard material for soft tissue augmentation in periodontal and implant-related surgery. However, intraoral harvesting of autogenous soft tissue grafts can pose challenges for clinicians due to technical complexity, limited available tissue, and the potential for patient morbidity, among other reasons. This comprehensive review explores key aspects of autogenous connective tissue graft harvesting with a particular focus on approaches involving the de-epithelialization of free masticatory mucosal grafts (DFMMGs), such as the main advantages and disadvantages of extra- and intraoral de-epithelialization, emerging technologies to assist and streamline harvesting, donor site healing dynamics, postoperative pain perception, wound management strategies, and common intra- and postoperative complications.