They remove a section of scalp, size depending on the number of grafts you choose. My husband's was maybe a half inch. Wider in the middle and narrower at the ends. They pull the opposing edges together and suture. Sort of like giving the back of you head a face lift as it tightens things up a bit. Then they harvest the grafts from the slice removed. The above post is incorrect; there is no gap in the donor area. No matter how hard I look, I cannot see a scar on the back of my husband's head.