We usually judge our skin on its esthetic value instead of appreciating it as the body’s largest organ. We often abuse it with harsh products and chemical peels or simply by bumping, bruising, scraping, and cutting it without any real awareness of the stress such hurts cause this valuable body shield. Fortunately, the skin has an amazing capacity for self-repair. It is a complex network of capillaries, sweat glands, hair follicles, and tissue cells.
The skin is the body’s armor; it protects the muscles, nerves, and internal organs, and it contains all the other systems. It also controls what passes in and out of the body, acting as its gatekeeper. We could not function without this supple, highly resilient barrier.
The skin also emits and disperses heat, thereby regulating body temperature. When we are too hot, the pores open to release heat; this is called vasodilation. When we are cold, the pores close up, trapping body heat; this is called vasoconstriction. Vasoconstriction causes goose bumps, because when the pores tighten, they form bumps and cause the hair to stand on end. According to the naturopath Leon Chaitow, one of the best ways to relax and calm the nervous system is through maintaining a consistent body temperature. For example, soaking in a warm bath relieves stress because body temperature remains the same while you are submerged in the water. This example also shows the connection between mind and body and how emotional grounding and relaxation can be encouraged through working with the skin.
Another function of the skin is, of course, tactile sensation. According to ayurveda, the skin’s sensory nerve endings are connected to vata and the central nervous system. Thus, a good massage with vata-pacifying sesame oil helps to harmonize the mind.
The skin is a juncture of our internal, external, and emotional selves. It reflects our emotions: when we are embarrassed, we blush; when we are shocked, we turn pale. Since the skin mirrors the emotions, it is not surprising that skin ailments often have emotional triggers. I know that stress is the main cause of my eczema outbreaks, and many of my rosacea clients say stress causes their flare-ups. One of my clients gets a rash on her elbows every time she takes an exam. Lines on the forehead, dehydration, and acne are also related to anxiety and other forms of emotional distress.
The skin is actually an organ of detoxification through excreting sebum (oil) and sweating. According to ayurveda, perspiration is a form of gentle detoxification and is even part of the preparation for the panchakarma process (detoxification through five actions, which is discussed in chapter 8). But many of us prevent this healthy physiological reaction by using pore-clogging products. We actively try to stop sweat production by using antiperspirants. Not only does this inhibit a natural process that is integral to overall health, but antiperspirants contain aluminum, which is toxic; we thoughtlessly apply them to our underarms, where there are lymph nodes important for detoxification and the fighting of disease needlessly taxing their function. By contrast, encouraging sweating and unclogging pores through dry-brushing and body exfoliation aids detoxification, and when performed all over, also reduces cellulite.
The capillaries in the skin also transport debris such as bacteria, pollution, dead cells, and absorbed skin care ingredients to the heart to be cleared and filtered out. Keeping the walls of the blood vessels moist and supple through keeping the skin moisturized is important to this detoxification.
The skin is an organ of absorption; even a small percentage of our total oxygen intake is absorbed through our pores. This is why we must choose carefully what we put on our skin. What is applied topically travels into the bloodstream through a network of capillaries connecting to larger vessels that supply the internal organs. The skin actually absorbs materials faster than the digestive system. What we eat must be processed before it fully affects our health, but anything applied to the skin has direct access to our blood. Nicotine patches used to wean smokers from cigarettes are a good example of this.
The skin’s absorptive ability can also be an avenue of healing and medication, as with prescription hormone creams used for hormonal supplementation. But topical therapy is not new to ayurveda. Topical treatment is a traditional part of practice that offers astonishing results. During a lecture at the Ayurvedic Academy at Bastyr University in Seattle, Washington, Dr. Subhash Ranade spoke of an experiment conducted in an underprivileged village in India. Starvation had damaged the digestive systems of many children, making it difficult for them to absorb nutrients from their food. These children were given a daily massage of milk infused with healing herbs, the absorption of which gradually restored the lining of their digestive tracts. The treatments these children absorbed through the skin made profound improvements in their weight and digestive systems.
When we understand how profound our ability to absorb through the skin is, we can begin to also comprehend the importance of choosing healthy skin and body care products. Many people may think of beauty care as only superficial and fun, yet its impact on the body as a holistic system is highly significant.
Skin Structure
To truly understand skin and how to keep it healthy, we must understand its makeup. Our skin is not just what we see; it is an entire factory, support system, and shield for a variety of vitally functioning cells. As shown in the diagram below, the skin is made up of three main layers: the epidermis, the dermis, and the hypodermis. The epidermis is the layer closest to the surface. It is the outer shell that we see, and it acts as both a barrier and a gateway. It is composed of five layers of dead skin cells made up of keratin (protein). Keratinization is the process by which cells travel up through these layers to become the surface. This process ends when the cells are eventually sloughed off. The life cycle of skin cells becomes slower over the years, producing the effects we call aging.
The layer beneath the epidermis is called the dermis. This is the main factory of the skin, containing its network of collagen and elastin fibers. The dermis’s connective tissue provides elasticity and nutrition to the epidermis. The sweat and oil glands reside here, excreting through the epidermis. This layer also contains the nerve endings that provide our sense of touch and temperature. Its health dictates the quality of the epidermis.
Under the dermis layer is the hypodermis, also referred to as subcutaneous fatty tissue. This lowest layer of skin is the fatty cushion that insulates the body and protects the organs. Composed primarily of fat and some connective tissue, it also possesses many skin-nourishing blood vessels and nerve endings.
With age, the structure of the skin begins to change. As the quality and thickness of each layer alters, so do the skin’s needs. At twenty-five, the skin is at its peak of health. The dermis layer is thick, producing lots of plump, moist cells to be transferred to the epidermis. Cell turnover takes approximately twenty-eight days. As we age, the epidermis thickens, giving way to fine lines and wrinkles as cell turnover slows down. By forty-five, the rate of this turnover decreases to approximately forty days. An accumulation of dead cells causes the skin to feel drier, and it is less able to absorb moisture.
At seventy-five, cell turnover drops further to ninety days, and the skin’s metabolism and circulation also slow down. An even thicker epidermal layer causes wrinkles to deepen, with the top layer forming a crustlike appearance. This is why skin peeling and abrasion has become so popular. Exfoliation is one of the most result-oriented treatments for both rejuvenating skin and preventing signs of aging. The erosion of the thickened epidermis forces the dermis to increase cell production and sloughs away dead skin-cell buildup so the skin can absorb moisture more deeply.
Now that we have an overview of the skin’s nature and capabilities, we can discuss how to assess it and diagnose problems. To treat a problem, we need to classify and analyze it to find its root cause. Given that the body is so complex and that everyone is unique, different treatments are needed for each individual. This is the basis of ayurveda. When we can classify the skin and its imbalances from an ayurvedic perspective, we can identify its proper treatment and care. First, however, let us examine the different ways to diagnose skin from an esthetician’s viewpoint.
THE CLASSIC SKIN TYPES
If you go to a department store cosmetics counter, the clerk will most likely base her suggestions on classic skin typing. This classification breaks each person into one of four categories: dry skin, oily skin, combination skin, and normal skin.
Dry skin lacks oil and has small pores and a fine texture. Because this skin type has little moisture, it may take on a leathery appearance during maturity. Dry skin is also said to be free from acne. In contrast, oily skin has (surprise!) an abundance of oil. Excess sebum is visible on the skin’s surface, and this skin type also displays enlarged pores and a thick texture. It is not prone to fine lines, but eventual wrinkles appear as deep expression lines. Oily skin is said to be prone to acne.
Combination skin is a mixture of dry and oily skin types. Such complexions are oily in the T-zone area (the forehead, nose, and chin) and dry on the cheeks. Perfectly balanced skin is ironically referred to as normal, even though it’s actually the least common skin type and denotes a flawless complexion.
Classic skin typing takes only the innate genetic characteristics of the skin into account; it does not consider environmental factors or past skin care efforts that may have caused sebaceous imbalance. It also looks only at the amount of oil in the skin, ignoring water content and other skin conditions. This classification alone is not effective in accurately diagnosing the skin.
SKIN TYPING BY CONDITION
While classic skin typing focuses on what skin qualities we’ve inherited, what beauty professionals call “skin conditions” refers to what we have acquired. This skin classification is based on environment and grooming history, and it also indicates that these conditions are reversible. Skin typing by condition most notably uses the terms “dehydrated skin,” “sensitive skin,” “unbalanced skin,” and “problem skin.”
Dehydrated skin is probably the most common skin condition and is due to a lack of water in the skin. This should not be confused with dry skin, which lacks oil. Dehydrated skin lacks water. This translates into many symptoms, such as a crepey or crinkled texture, lack of color, congested pores, and poor circulation. Dehydrated skin feels tight and sometimes rough. A lack of water weakens the skin and impairs its barrier function; it also contributes to many other skin ailments not regularly associated with skin dehydration. The best way to tell if your skin is dehydrated is to do a press test. Gently press the side of your cheek; if the surrounding area shows tiny lines, the skin is dehydrated.
Another common skin condition is sensitive skin. While this may be genetic, it is aggravated by the elements, diet, mindset, and improper care. Inflammation caused by these factors results in redness, broken capillaries, and/or a chafed appearance. People with sensitive skin blush easily, and in more extreme cases, they may break out in rashes or hives when upset. Allergic skin is a type of sensitivity; while many may consider allergies unavoidable, ayurveda considers allergies to be an indication of internal toxicity. An overload of toxins makes our body delicate and weakens the defenses, leading to highly reactive skin all over the body.
Unbalanced skin indicates an imbalance in oil production. While this seems similar to the classic skin types, it is not genetic but is caused by overdrying, negligent skin care, or high stress levels (causing overactive adrenal glands). Unbalanced skin can take the form of oily skin that also peels; exhibits fine lines, dryness, or tightness combined with acne; or has whiteheads beneath the skin. (We will discuss this in more detail later in this chapter.) Unbalanced skin has usually been dehydrated for so long that the skin’s attempt to rebalance causes dysfunction in the sebaceous glands.
Unbalanced skin conditions often lead to problem skin, which is “beautyspeak” for skin with pimples and blackheads. It is important to mention that this does not refer to one or two pimples but to a condition in which the skin constantly breaks out with acne and blemish clusters all over the face and sometimes the neck. Signs of problem skin include whiteheads, blackheads, inflamed pimples, and cystic acne. Causes vary from person to person and are discussed further in chapter 6.
Skin typing through skin condition only identifies what is out of balance with your complexion. From this point of view, you simply treat what needs to be “corrected” rather than deeply understanding the nature of the skin. For this reason, it is only one aspect of skin diagnosis, and other measures must be taken into consideration.
Female versus Male Skin
While many grooming practices are gender neutral, some differences cannot be ignored. Because of the nature of male and female skin, we must examine the influence of gender on skin structure and how it must be treated.
Men have thicker, tougher, and rougher skin than women do; even the most delicate male skin is much thicker and less sensitive than female skin. The male hormone testosterone increases collagen production, which is the main reason for the greater thickness. Estrogen decreases collagen synthesis but supports the presence of hyaluronic acid, which makes for a thinner, softer texture.
While male skin owes much to physiology, men also have a skin-thickening, antiaging practice ingrained in their grooming regimens from adolescence: shaving. This continual exfoliation acts the same way as microdermabrasion: it thickens the skin while it abrades it, causing regeneration. This is a major reason why men often have fewer fine lines and more vital skin. They also tend to have oilier skin. Because testosterone creates more active sebaceous glands, men are more prone to acne and breakouts. Women with hormonal imbalances also share these attributes.
For women, the same hormonal influences that cause menstruation can also cause preperiod breakouts, skin sensitivity, and water retention. According to ayurveda, this is because both water and heat in the body are increased before menstruation increasing inflammation and contributing to edema. Many women crave sweet, cooling foods at this time and have mood swings ranging from anger (heat aggravated) to feelings of lethargy (water aggravated).
Women are also more likely to have rosacea, although severe stages of the disease are usually only seen in men, due to neglect of care. Water retention during menstruation also contributes to sensitivity, because if the lymph is full, the capillaries are pushed toward the skin’s surface. This pressure can create broken capillaries, further increasing the skin’s delicacy. For all these reasons, women who want beautiful skin must pay attention to their menstrual cycles.
Master the Balancing Act of Oil and Water
When diagnosing the skin, it is beneficial to overlook the traditional categories of dry, oily, and combination, because many people with oil on the skin surface are actually dry-skinned and have self-induced the overproduction of oil. The opposite can also happen. Some people attempt to treat dryness by slathering on oil-rich products, when they really suffer from a lack of water.
The skin is constantly striving to be “normal.” In the most basic terms, this means achieving a healthy balance of oil and water, which allows it to be a barrier, absorber, eliminator, and regenerator. When you know which (or both) you lack, it is easy to make skin care decisions to correct the imbalance. Just to clarify, we are going to be talking about skin care made with natural vegetable oils (organic, unprocessed ones are even better) and waters (preferably hydrosols: waters extracted from plants or flowers). Chemical-based systems only exacerbate the imbalance due to their stripping and congesting properties.
When I first started my practice, I quickly became aware of how important our water-to-oil ratio is. Maintaining skin health is basically balancing the water it contains and the protective oil that lubricates its surface. I found this method of looking at whether the skin was hydrated or dehydrated, and either oily or dry, far more useful than the traditional classifications I had learned in esthetics college.
OILY DEHYDRATED SKIN
Oily dehydrated skin lacks water, making it feel tight yet greasy. Sometimes it flakes even though there is oil on the surface. It is prone to clogged pores, because the underlying lack of water causes the oil to dry and harden. A common misconception is that oily skin should never be moisturized; when in fact, it needs hydration to prevent it from overproducing sebum. Therefore, dehydration can be the real cause of acne.
During a facial, extraction (removal of blackheads and whiteheads) is difficult if the skin is dehydrated; often, a client needs to follow a hydrating regimen for at least two weeks before returning for a successful pore cleansing. This regimen must not strip the skin, so it should include a milk cleanser, because astringents can encourage oil production. If you prefer a gel cleanser, it must be gentle and not contain sodium laurel sulfate. Toners must be alcohol-free so as not to dry out the skin.
In addition to avoiding a dehydrating care regimen, those with an oily dehydrated skin also need to replenish with water. A serum is an excellent way to supplement hydration of the skin. This should be followed by a medium-weight moisturizer to seal in the water, slow down evaporation from the skin surface, and soften its texture. Because the skin has a good amount of oil in it to provide protection, it does not require anything too rich.
OILY HYDRATED SKIN
Oily hydrated skin is the traditional oily skin type. Do not fall into the misconception that this skin type needs to be dried out; it still needs protection and moisture to maintain its beauty. Oily hydrated skin ages well, and blackheads and whiteheads can be extracted easily. For this skin type, a light moisturizer is ideal. Sometimes a serum on its own can be sufficient in maintaining moisture during warm, humid months. One way to keep skin clear of impurities is to use a detoxifying clay mask once or twice a week. I like both wet and powder-based masks. While wet clay masks are easier to use, the powdered variety stays fresh longer.
This skin type is very depleted and needs both oil and water; hydration is quickly lost through both evaporation and loss of collagen. Any blackheads or whiteheads are tiny and difficult to extract, and this type of skin tends to show signs of aging earlier than other types. Those with dry dehydrated skin should use a milk cleanser and start using an antiaging serum at a young age. Serums that contain collagen, hyaluronic acid, or other plumping ingredients are especially beneficial and should be followed by a rich, nourishing cream. The cream protects the skin, replaces oil content, and closes off the skin to retain the water from the serum.
DRY HYDRATED SKIN
Dry hydrated skin is genetically oil-poor but still full of water. This usually occurs in younger people with a traditional dry skin type. Pores are small, and the skin looks thin but is actually healthy, plump, and hydrated. Because its surface is dry, it needs oil. Sometimes a face oil or rich cream on its own can be enough. Usually this condition is only temporary, because as the skin ages, it naturally loses collagen and holds less water, making it dry and dehydrated.
COMBINATION HYDRATED SKIN
This skin type is generally healthy and similar to the oily hydrated type. While combination hydrated skin will most likely have excess oil in the T-zone, there is nothing wrong with extra sebaceous secretions in this area—the hydration usually prevents the skin from becoming congested.
If the skin does break out or the pores become clogged, regular facials can clear the pores in the T-zone without overpeeling or drying the entire face. Another way to help keep this mixed skin type in balance is by using an organic lavender hydrosol (lavender water) as a toner. This hydrates the skin by replenishing water, while the lavender purifies, balances oil, and has a slight antiseptic quality. A medium-weight cream should be used following the toner.
COMBINATION DEHYDRATED SKIN
The lack of water in combination dehydrated skin makes it prone to several problems. This type of skin is oily in the T-zone but dry on the cheeks. Pores are easily blocked due to the lack of water. Mixing and/ or layering serums and creams as described for dry, dehydrated skin is important here. We can mix these two moisturizing steps or apply each in the specific areas needed.
Those with combination dehydrated skin may find that when the moisture level of the skin is increased, the contrast in oiliness between the T-zone and the rest of the face is reduced.
NORMAL SKIN
Perfectly normal skin simply needs gentle maintenance to prevent future imbalances, but using a natural skin care regimen is important to prevent causing other skin conditions. Gentle, neutral cleansers and toners (not treatment based) are therapeutic enough to keep this skin type healthy. Never use bar soap, as it encourages dehydration. This is an across-the-board rule for all skin types, but it is easily ignored when you have beautiful, normal skin. A simple, medium-weight, natural moisturizer is you need for this perfectly balanced complexion. In dry, cold climates, a facial oil can also be used.
Ayurveda and Skin Type
Understanding skin type according to dosha is not limited to the skin’s oil content, the damage it has acquired, or its hydration levels. Rather when identifying complexions ayurvedically, we look at genetic predispositions, the root or unique cause of the skin’s reactions, and doshic tendencies. While the concept of balancing the skin’s oil and water was enlightening to me as an esthetician, incorporating ayurveda into skin diagnosis looked at my client’s predispositions to different imbalances and allowed me to prevent them.
This section describes the ayurvedic skin types and their qualities and conditions. Here we will learn how to identify our own doshic skin type, which will help us understand how to rebalance it, preventing skin ailments. It will also tell us about our overall body, mind, and spirit.
KAPHA SKIN
Kapha skin is easily the most beautiful skin type when it is in balance. It is thick, oily, and full of moisture, and it has a beautiful clarity of color. Again, the presence of earth and water are translated into the quality of the skin tissue, and the good amount of fatty tissue underlying it makes it firmer, moister, and more resilient to the signs of aging than the other two doshic skin types.
Kapha types usually have large pores brimming with oil, but remember that oiliness is not bad for the skin. It is only when oil is combined with a lack of water that skin issues occur. When kapha skin becomes dehydrated, it becomes the most problematic skin type. Oil dries on the surface, forming deposits of hardened sebum in the pores. This gives way to comedones (blackheads), enlarged pores, and blemishes. This skin type also has a tendency toward pimples with kapha qualities—they are large, full of fluid, and often leave deep scars that alter the skin’s structure. Kapha skin can scar so severely that its surface is altered by “ice pick scars,” indentations that are very difficult to treat.
Dehydration also causes an excess of oil. So when kapha skin becomes dehydrated, the sebaceous glands produce more oil to compensate for the lack of moisture. Not only does it create more oil, but the oil itself becomes heavier and thicker.
Kapha complexions tend to accumulate lymphatic fluid which creates puffiness. Excess kapha can inhibit circulation and promote lymphatic congestion, causing a moonfaced look. This lack of drainage and propensity toward stagnation also can result in dull-looking skin.
Another symptom of too much kapha is thick skin. Regardless of your prakruti, if there is an overabundance of earth and water in your vikruti, the skin on your cheeks and chin can become thick in appearance. This is usually coupled with dehydration and enlarged pores, creating an “orange peel effect” (thickened texture with visible pores) on the skin’s surface.
Because kaphas tend to be lackadaisical about their grooming habits, it is important to try to be strict about regular care. Sometimes imbalance can come from sheer lack of attention or being inconsistent with cleansing, toning, and moisturizing. This can contribute to the transition from innately beautiful skin to skin that is overly oily with clogged pores.
To keep kapha skin beautiful and balanced, you must concentrate on keeping the skin hydrated and the circulation moving. Using skin care products with purifying ingredients such as sage, eucalyptus, and rosemary helps keep kapha skin clear and stimulated. Vitamin C, honey, and citrus ingredients are other great additives for kapha as they are invigorating and prevent aging by increasing hydration and promoting collagen production.
PITTA SKIN
Pitta skin is sensitive and easily inflamed. It is prone to allergic reactions, rashes, eczema, acne, and rosacea. When the capillaries are overactive and dilated, this indicates an excess of pitta in the body and skin; it is also why those with high pitta have a tendency toward broken capillaries and blood vessels, especially in the cheeks and nose.
Pitta skin is a combination type when it comes to oil production (only in the T-zone), with a medium-thick texture and medium-size pores. One sign of excess heat is enlarged pores in the midface that are so dehydrated that the blockages are difficult to extract. Using a cooling, hydrating moisturizer containing an anti-inflammatory ingredient such as aloe vera or rosewater helps soften these pores and minimize their appearance. According to ayurveda, those with too much internal inflammation are prone to dehydration because internal heat burns up the body’s water supply. This further contributes to a pitta’s skin sensitivity and makes blemishes worse.
Pitta skin also scars easily and tends toward changes in pigmentation. Unlike kapha skin, this is in the form of marks and discoloration rather than detexturization. Hyperpigmentation is created by inflammation that disrupts the production of melanin (the pigment that gives skin its color). Because pitta governs transformation and assimilation, the transfer of melanin from melanocytes at the bottom layer of the epidermis to keratinocytes in the middle and top layers is also a pitta activity. Excess pitta disrupts the process of skin color distribution, causing dark spots, freckles, and pigmented lesions.
Those with pitta skin must maintain balance by using soothing skin care products that contain chamomile, calendula, and sandalwood. These are wonderfully calming, anti-inflammatory ingredients.
Most oils and fats induce heat and should be avoided when pitta is overabundant, but coconut oil is actually cooling. Jojoba is another substance that can be used, because although it is often mistaken for an oil, pure jojoba actually contains no fat and therefore does not increase fire. Rosehip oil can also be used for some pitta skin types. It is one of the only natural ingredients that successfully fades pigmented spots and scars and treats sun damage. But this oil is slightly stimulating and should be used as a spot treatment for only a short time to strengthen and diminish hyperpigmentation and scarring. It should not be used on acne-prone complexions.
Ghee is another moisturizing ingredient that can bring down both internal and topical heat. Ghee is a clarified butter and a traditional ayurvedic remedy for rashes and other skin reactions.
VATA SKIN
Vata skin has small, tight pores; a thin texture; and a lack of oil. Because this skin type does not have much fat behind its tissue, it is easily depleted and can begin to sag early. When those with vata skin are young, they do not usually have a problem with blemishes or oiliness. Instead, the skin can appear so clear and delicate that the veins and capillaries show through it faintly. (This does not refer to red, broken blood vessels but to the bluish blood pathways under the skin.)
Unfortunately, vatas are prone to other premature signs of aging besides sagging. As you age, the skin thins, facial fat decreases, and collagen production slows down. Because this skin type is already lacking in tissue and oil, it has less reserves against the aging process than those associated with the other two doshas. Even if you do not have a vata prikruti, if you accumulate too much stress and vata energy, your skin will show vata characteristics—a loss of firmness and plumpness, a decrease in oil content, and internal and external dehydration. For this reason, those with high vata need to work on becoming more grounded and less cerebral, nurturing the connection between mind and body.
When it comes to a skin care regimen, vata skin must be nourished, nourished, nourished! It is important to use products with warming and rejuvenating ingredients like ginseng, frankincense, and ylang-ylang. Geranium oil is also good for vata as it has fabulous antiaging properties and helps relieve anxiety.
Rich oils are vata’s best friend and using liberal amounts of avocado, sesame, borage, and evening primrose oils helps fight dryness and replenishes this skin type. Rosehip oil is excellent for vata skin, as it is slightly stimulating and possesses high amounts of vitamin C, making it a great antioxidant moisturizer. Vatas should apply these oils on both the body and the face to nourish the skin as an organ and to help support, warm, and ground the body as a whole. Vatas need more than just moisturizing with oils; this skin type is so delicate that it also must address dehydration. As with the dry dehydrated skin type described earlier in this chapter, the most effective way to support vata skin is by layering fatty oils over a water-packed serum. A serum with collagen helps bolster depleted skin, and products containing hyaluronic acid can help hydrate the skin.
Identifying your ayurvedic skin type helps you understand categories of characteristics instead of concentrating only on oil content, present appearance, or a specific ailment. When you see your skin from this angle, you are more likely to treat your skin and body with appropriate care products and are better able to maintain internal balance for more beautiful skin.
This holistic approach also illustrates why a skin care regimen needs to be individually tailored according to both topical condition and your ayurvedic constitution. In the next section of this book, we’ll examine what makes up a truly effective skin care routine, the role of facial treatments, advances in natural cosmetic options, and skin care guidance for each of the three doshas.