This Teenage Girl Uses Botox. No, She’s Not Alone.

LAST month, Charice Pempengco, the petite Filipino teenager whose knockout voice has wowed Oprah and millions worldwide, caused a stir of another kind.

To prepare for her appearance on the Fox show “Glee” this fall, Ms. Pempengco, who is 18, got Botox injections and a skin-tightening treatment called Thermage. “I want to look fresh when I appear before the camera,” she said on Philippine television during the visit at which her doctor, Vicki Belo, injected her jaw.

Outrage ensued. Doctors, child-rearing experts and others — including New York magazine and Psychology Today — chimed in to lament the regrettable message sent to young fans of “Glee,” a show with a theme of self-acceptance. Even the celebrity blogger Perez Hilton was apoplectic, pronouncing what Ms. Pempengco had done, “SICK!!!”

But like it or not, Ms. Pempengco has plenty of company. According to the American Society of Plastic Surgeons, last year, botulinum toxin, which is sold here under the brand names Botox and Dysport, was injected into Americans ages 13 to 19 nearly 12,000 times, including some teenagers who got multiple doses. The number represented a 2 percent increase from 2008, the society said.

Needless to say, teenagers do not have wrinkles, which is the usual cosmetic reason adults seek out Botox. Before the Food and Drug Administration approved Botox, a muscle-relaxing toxin, for cosmetic use in 2002, it was used as a medical treatment for neuromuscular and eye disorders.

Today, nobody knows how many teenagers who get injections of Botox or Dysport are using them for medical rather than aesthetic purposes. The lines can be blurry, since the drug can help with physical problems — like pain in the temporomandibular joint of the jaw — and improving the patient’s looks can be a side effect.

In February, Phu Pham, who is 19 and lives in San Antonio, got Botox injections to narrow what he considered to be his “bodybuilder”-big jaw muscle, which he felt didn’t fit his otherwise slim face.

“I was nitpicking myself a little bit,” said Mr. Pham, a student and X-ray technician for the Air Force. Before his $800 Botox procedure, his left jaw muscle bulged a bit more than the right one, he said, and now, “neither side really bulges out as much.”

“If your daughter is begging for Botox, believe me, an injection is not the cure,” Ms. Borba wrote. “There’s a much deeper issue at stake and I’m betting it’s self-esteem. Say no to that injection. Address her feelings of ‘inadequacy’ and not her need to cover up a so-called wrinkle.”

The fact that any teenagers would use a toxin to improve their looks surprises and upsets many adults. On her Web site, Michele Borba, the author of many parenting books, didn’t disguise her scorn. Read more at www.nytimes.com