I have been doing these types of procedures for over twenty years. Without photos, it sounds like you probably need a mons pubis lift, possible labia majora fat injections with or without skin excision, and vaginal tightening. You may also need your inner lips reduced. All these procedures can be done at the same time. You can read about them on my website. The mons treatment depend on the your anatomy. I have published extensively on mons pubis reductions and invented some of the techniques. If you have a fat deposit with no excess skin, then you can just have pubic liposuction. However, liposuction will only reduce 50% of the bulge. If you have skin excess or you want a more dramatic reduction of the bulge, then you need a pubic lift with fat removal and stabilization of the pubic skin to the abdominal muscles. The incision is usually like a caesarean incision. The potential complications are over lifting the pubic area, concavities, and unnatural scars, so be careful of your choice of surgeon, Many women with a large mons also complain of labia majora enlargement, so this can be doneat the same time. Many women with sagging or wrinkling of the majora have stretching of skin and normal fat. In that case, the skin only can be removed. If the skin only is saggy due to fat loss, then only fat can be injected. However, over-injection can cause a large bulge in the genitalia, which can be unsightly. If skin is excessive and fat is diminished, then skin can be excised and fat injected at the same time. If you only have slight wrinkling, then a laser can tighten the skin. If your labia majora skin and fat are excessive, then skin and fat can be excised to make them smaller and less protruding. The skin excision technique I pioneered leaves a scar on the inside of the majora in the concavity between the majora and the minor and clitoral hood. I have published and lectured extensively on this procedure in textbooks and throughout the world. Many physicians are not comfortable or trained in this procedure resulting in poorly placed scars, asymmetry, and poor results. You need to have the surgeon show photos of his past patients. Vaginal tightening can also be performed at the same time. You did not mention your inner labia, but that can also be addressed at the same time with a labiaplasty. A labiaplasty must be performed by a surgeon with experience. One of the two most common techniques is the central wedge technique, which I invented in 1995 and published in the plastic surgery textbooks. It is also known as the "V" or wedge technique. Gynecologists and most plastic surgeons perform a labioplasty very differently. They essentially trim the labia minora (inner vaginal lips) and leave a long suture line instead of the normal labial edge. Their technique is the same whether a scalpel or a laser is used. This can lead to scallops and irregularities. In contrast, the central wedge removes triangles of tissue and bring the normal edges together. Thus, the normal labial edges, normal color, and normal anatomy are preserved, but the darkest labial tissue is usually removed. If you have extra tissue on your clitoral hood, it can be reduced it at the same time. No matter the technique, an inexperienced or unskilled surgeon can lead to a high rate of complications, chronic scar discomfort, labial deformities, and further surgery. About 40% of the female genital cases I perform are revisions of labiaplasties and clitoral hoods botched by other doctors. Gary J. Alter, M.D. Beverly Hills, CA - Manhattan, NY