Objective: The objective of this systematic review and meta-analysis is to evaluate the changes in the soft tissue profile of Class II division 1 malocclusion patients treated with and without extraction. Methods: Databases were searched and supplemented by hand searching as well. Studies with prospective or retrospective and randomized or non-randomized design and Class II division 1 malocclusion patients receiving orthodontic treatment with extraction compared to patients treated without extraction were included. Outcomes assessed were changes in soft tissue linear and angular cephalometric measurements. Included studies were retrieved and assessed for Risk of Bias based on a validated checklist. Meta-analyses were done to summarize the overall effects and a Random-effects model was applied. Results: Ten studies fulfilled the eligibility criteria and seven were eligible for quantitative synthesis. Meta-analysis showed a significant increase in Nasolabial angle in both extraction groups (four premolar and two premolar), a significant decrease in overjet in the nonextraction group compared to four premolar extraction, and significant a decrease in overjet in the non-extraction group compared to two premolar extraction. While there was no significant difference regarding the upper lip to E line and lower lip to E line. Conclusion: A significant increase in the nasolabial angle is associated with both extraction (four premolar and two premolar) protocols while the decrease in overjet and overbite was significant in non-extraction protocols when compared to four and two premolar extraction respectively.