Is this skin or fat or both? Do I need skin removal? (Photo)

From your photos it doesn't appear there is significant fatty pockets. A couple of options to consider are BodyTite which is a minimally invasive procedure which uses RF technology to tighten skin. Liposuction can be added as well. Another option would be liposuction with J Plasma to tighten the skin. I encourage you to visit with a board certified plastic surgeon near you for an evaluation.

Based off the photos, this appears to be a combination of both volume and skin. For best results, I would recommend touch-up liposuction to the flanks/waist with Renuvion for additional skin tightening.

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon