Introduction: The purpose of this investigation was to determine the long-term differences in soft tissue profile changes between extraction and nonextraction patients who had been treated to the same incisor position and lip line. Methods: Twenty extraction and 20 matched nonextraction patients, with posttreatment and long-term follow-up (average 15 years) records, were selected from a single private orthodontic practice. Posttreatment and long-term follow-up profile photos of the patients’ nose, lip, and chin areas were evaluated by 105 orthodontists and 225 laypeople, who indicated their preferences and the amount of change they perceived among the 40 profiles. The patients had similar dental protrusion, soft tissue profile measurements, and ages at the posttreatment observation. Results: No significant cephalometric differences between the extraction and nonextraction groups were found at long-term follow-up; both groups showed similar long-term changes. Significant ( P < .05) differences were found between males and females at long-term follow-up; male lips became relatively more retrusive, and their profiles became flatter. Significant ( P < .05) changes in the profiles were also perceived over time, but there was no relationship between the amount of change perceived and profile changes measured cephalometrically. There were also no significant ( P < .05) differences in preferences between orthodontists and laypeople, between extraction and nonextraction patients, or between males and females. Conclusions: If extraction and nonextraction patients are treated to the same incisor position and lip line, the treatment modality does not affect long-term soft tissue profile changes. Furthermore, the amounts of change perceived by either orthodontists or laypeople were not related to the amount of change measured cephalometrically.