Small and Medium-sized Enterprises (SMEs) are under increased pressure to increase their competitiveness and, at the same time, deal with environmental and quality issues. Total Quality Management (TQM) and Green Supply Chain Management (GSCM) have become complementary strategies to enhance the performance, sustainability, and customer satisfaction of the organization. The paper at hand examines the synergistic linkage between GSCM and TQM in stimulating the performance of SMEs. To explain how these practices generate results, innovation capability and process efficiency are introduced as mediating variables. Additionally, organizational culture, leadership commitment, and regulatory pressure are considered as moderating variables shaping the strength of these relationships. The analysis of the literature and conceptual development of the study determines the ways in which the combination of environmental practices and quality improvement systems can allow SMEs to minimize wastes, improve operational processes, develop brand image, and adhere to the regulatory measures. The results indicate that SMEs that integrate GSCM and TQM at the same time reach high levels of success in cost reduction, innovation, and long-term sustainability.