OBJECTIVE: To determine the morphological characteristics affecting extraction decision in Class II Division 1 malocclusion in females. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Dental Section, The Aga Khan University Hospital, Karachi, from June 2002 to June 2004. PATIENTS AND METHODS: Lateral cephalograms and study casts of 35 female patients having Class II Division 1 malocclusion were taken. Out of those, 13 were treated with 4 premolar extractions while 22 were treated on non-extraction basis. The cephalometric and cast analysis of Aga Khan University Hospital was used. RESULTS: Patients in the extraction group had larger SN-MP, FMA, and LFH: AFH, L1-NB (mm), E plane-LS, E plane-LI, S line-LS, S line-LI, and smaller Z angle. However, the sagittal discrepancy and tooth size arch length discrepancy had no significant difference between the two groups. CONCLUSION: The vertical dimensions and the upper and lower lip were the key structures to decide about extraction or non-extraction.