I went to a surgeon today about getting skin removed an he said I have more then enough. Now I have to write a letter telling them why I need it but I have no idea where to start.

Is this to try to get insurance to cover the cost? If so, stick to health-related reasons - that's what they want to hear. For example, it limits your ability to exercise because it gets in the way, you get rashes from it, it pulls on your back causing pain, etc - whatever fits your particular situation.

Yes it is thank you

Usually, insurance companies require medical documentation of these problems persisting for at least six months. You need to check with your insurance company to find out the exact requirements.

Once you have a list of their requirements, use them as a guideline to write your letter. If possible, rewrite each guideline, with an example of how you fit the requirement.

If for example, one of the requirements is: Must have skin problems or rashes associated with excess skin.

You could rewrite it as: For the past X months, I have to tuck the excess skin around my waist under my belt. This is resulting in pressure sores and itchy flaky skin on the underside of the skin fold.