Purpose: The purpose of this study was to assess the impact of subepithelial connective tissue graft (CTG) on soft tissue volume and aesthetics around implants placed in aesthetically important areas over a 4-year period. Materials and Methods: A total of 42 participants were divided into groups: implant+CTG (n=20) and implant only (n=22) and evaluated after 48 months using various clinical and radiographic parameters, professional aesthetic assessment, patient-centered aesthetic evaluation, and quality of life improvement measured by OHIP-14 at 12 and 48 months. Results: Eight patients were lost to follow-up, leaving 34 patients for evaluation. Intragroup comparison for the variables TTb (tissue thickness at the buccal aspect), KTW (keratinized tissue width), and BD (buccal defect) showed no statistical difference (p>0.05) in the evaluated periods. However, for PBR (proximal bone resorption), a statistical difference was observed (p<0.05). In the intergroup comparison, statistical differences (p<0.05) were observed in the variables TTb and BD in the 2 evaluated periods. In the analysis of Pink Esthetic Score/White Esthetic Score (PES/WES) and Jent index, there was no difference between or within groups in the evaluated periods. Regarding patient-centered measures, there was no difference between the groups in terms of aesthetics (VAS), but for OHIP-14, there was an intragroup difference in both groups between 12 and 48 months. Conclusions: The association of CTG with dental implants in aesthetic areas, after a 48-month follow-up, led to an increase in TTb. Therefore, CTG is indicated due to the increase in TTb during the follow-up period. However, there were no improvements in BD, PBR, or PES/WES over time. Aesthetics and quality of life were similar between the two groups 4 years post-implant placement.