By CATHERINE SAINT LOUIS


Girls get nose jobs, so why the outrage over face shaping?

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

To prepare for her appearance on the Fox TV show “Glee” this fall, Ms. Pempengco, who is 18, got Botox injections . “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, childrearing experts and others lamented the regrettable message sent to young fans of “Glee,” a show with a theme of self-acceptance. But like it or not, Ms. Pempengco has plenty of company. According to the American Society of Plastic Surgeons, botulinum toxin, which is sold under the brand names Botox and Dysport, was injected last year into Americans ages 13 to 19 nearly 12,000 times, including some teenagers who got multiple doses.

Doctors are injecting teenagers for a variety of perceived imperfections, from a too-gummy smile to a toosquare jaw.

In February, Phu Pham, who is 19 and lives in San Antonio, Texas, 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.”

After the treatment, Mr. Pham said, his parents asked whether he’d lost weight. He had not. “I told them I didn’t go under the knife,” he said. “I didn’t do anything drastic. I just got Botox injected into my chewing muscles,” or masseter muscles. After their initial surprise, Mr. Pham said, his parents did not object.

His doctor, Samuel M. Lam, is a facial plastic surgeon in Dallas who said he has seen more than 100 patients for jaw reduction via Botox. About 90 percent of them sought treatment for cosmetic reasons, he said, but even the 10 percent who had medical problems wanted it for aesthetic purposes, too.

Dr. Lam said he had injected many people in their late teens and 20s, but no minors. But he said he is not opposed to treating children this way, depending on their maturity and motivation. “A lot of teenagers tease each other about things that as adults we may not consider as important,” Dr. Lam said, adding that he has performed cosmetic surgery on teenagers, including nose jobs and an operation to create creases in the eyelids of minors of Asian descent.

The fact that 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.

“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.”

But in a culture in which teenagers have long been given nose jobs as birthday presents, some doctors question why a temporary injection of botulinum toxin should cause any more of a stir than a permanent surgery. Dr. Lisa M. Donofrio, a dermatologist with four offices, has performed liposuction on the jaw lines of normalweight minors with a family history of double chins. She has also injected Botox in a few teenagers who were self-conscious about their gums. The Botox was injected in the muscles that elevate the upper lip to relax them, so that the lip stays lower when a teenager smiles, for up to four months. Dr. Donofrio’s reasoning? “A smile is so important,” she said, adding that the treatment is about $100.

Interestingly, her gummy-smile patients all “outgrow” their desire to get Botox, she said. “They get busy, and it’s just not as important,” Dr. Donofrio said.

She isn’t surprised by the outrage over Ms. Pempengco. There is a “very extreme distaste about doing anything cosmetic on minors,” said Dr. Donofrio, who has been a paid consultant for the makers of Botox and Dysport.

At the heart of Ms. Pempengco’s “Botox apocalypse,” as one headline from the Philippines dubbed it, is “a collision of cultural norms,” said Dr. Richard G. Glogau, a clinical professor of dermatology at the University of California at San Francisco. Reshaping the lower face with Botox is “not an uncommon goal if you happen to live in Southeast Asia or China,” he said.

Yet, this kind of facial reshaping with Botox is not that common in the United States, which may be why a baby-faced star like Ms. Pempengco wanting to alter her jaw line still puzzles - or offends - many Americans.

“A 16-year-old in New York getting a rhinoplasty, it’s a birthday present,” said Dr. Glogau, a paid researcher for the makers of Botox and Dysport. “If you told teenagers in Southeast Asia that, they’d probably be aghast. It would never occur to them.”