Skin tightening or skin excision?

Based on what you've described, it sounds like you may be a candidate for pubic liposuction, which can reduce the fat pad and potentially improve the appearance of the genital area.
As for the question of skin excision versus skin tightening, this largely depends on the elasticity of your skin and the amount of fat to be removed. If the skin has good elasticity, it may naturally retract and tighten after the fat is removed, without the need for additional procedures. However, if the skin is significantly loose, additional skin tightening procedures may be necessary, such as radiofrequency treatments, laser treatments, or surgical skin tightening.
As for skin excision, this is typically reserved for cases where there is significant excess skin that hangs down or forms folds. If your skin is not hanging or forming folds, then skin excision may not be necessary. However, the final decision should be made in consultation with a board-certified plastic surgeon, who can assess your condition in person and provide the most accurate advice.
Please remember that any surgical procedure carries risks, and the results can vary from person to person. It's also important to maintain a healthy lifestyle, including regular exercise and a balanced diet, to maintain the results of the procedure and overall health.

In most cases of drooping of the mons area, a formal excision will be required to lift this area up. Skin tightening procedures such as radiofrequency, BodyTite, and other modes typically does not lift the skin off of the vulva or penis enough for most patients to be happy.

Thanks for your question. You are correct in expecting that the liposuction should be combined with skin tightening. Consider a procedure called AccuTite (same as BodyTite but smaller handpiece for smaller area work). Through two small entry points (groin region) both the skin tightening fiber and the lipo cannula can be introduced, to effectively heat the tissues for the tightening effect, then extracting the unwanted fat via liposuction. I hope that helps!