Introduction: To extract or not to extract is a well-established conflict in the field of orthodontics. The current orthodontic literature have controversial opposing results regarding the effect of orthodontic extraction on the soft tissue profile.The objective of this review was to quantify the soft tissue changes measured in cephalograms in adult orthodontic patients received extraction treatment in comparison with non-extraction orthodontic treatment. Material and Methods: Electronic databases were searched up to March, 2015 in (CENTRAL-Cochrane register of controlled trials, PubMed, Embase, EBESCO HOST, LILACS and Google Scholar). Grey literature and Hand searching was performed. The Selection process included controlled trials on adult patients receiving orthodontic extraction treatment compared within the same study to a group treated without extraction. Results: Out of 11 eligible full texts, 5 were eligible for the quantitative analysis. Quality assessment showed a moderate quality. Meta-analysis showed a significant increase regarding the nasolabial angle, upper lip thickness, labrale superioris to E-Line and labrale inferioris to E-line suggesting the flattening of the profile following extraction treatment. Conclusion:Although a significant retraction of the lips and an increase in the nasolabial angle were associated with extraction protocols, the degree at which is considered detrimental to the profile could be affected by different factors. Therefore, the improvement of a procumbent profile or flattening of a straight profile as result of extraction is relative. Since these finding are based on studies of moderate quality, future research with a well conducted methodology may change the evidence in hand.