# Capturing Optimal Mobile 2D Facial Images in Remote Aesthetics Medicine Clinical Trials: Technical Considerations for Facial Severity Analysis

## TL;DR

A mobile app was developed to help patients capture high-quality facial images for aesthetic clinical trials, reducing clinic burden and improving data quality.

## Contribution

The study introduces a mobile app for self-captured facial images with objective quality assessment and clinical validation in aesthetic trials.

## Key findings

- The app performed best under natural light and captured larger facial structures effectively.
- App images had better quality than other methods, with BRISQUE scores significantly lower.
- Clinician ratings of facial severity from app images showed substantial to almost perfect agreement with in-person evaluations.

## Abstract

In aesthetic clinical trials, image self-capture using mobile devices may help reduce burden on clinic resources, increase data quality, and lower barriers to study participation.

This study aimed to develop a mobile device app to help participants self-capture clinically usable images.

The Allergan Aesthetic (an AbbVie Company) mobile image app was designed to auto-capture images while directing study participants on distance, head position, and expression to capture a high-quality clinical image. To assess resolution and optimal lighting conditions, images captured using the app in office, at home, and in outdoor settings were compared with those from a Canfield VISIA-CR system (Canfield Scientific). Objective image quality assessment of facial images captured using the app with an iPhone XR (Apple Inc) and iPhone 12 (Apple Inc), compared with images captured using the Canfield VISIA-CR with a digital single-lens reflex camera and the Canfield mobile image capture app with a variety of Android (Google) and iOS (Apple Inc) devices, was conducted using the Blind/Referenceless Image Spatial Quality Evaluator (BRISQUE). Clinical utility was assessed by calculating inter- and intrarater variability for severity ratings of participants’ lateral canthal lines (LCL) or forehead lines (FHL) obtained from app-captured images compared with ratings based on in-person evaluations performed by a physician. Usability was assessed according to the ISO (International Organization for Standardization)/IEC (International Electrotechnical Commission) 250101 standard.

The Allergan Aesthetic mobile image app was found to perform best under natural light and had image resolution insufficient for assessing minor facial structures, but appropriate for larger structures (eg, FHL). A total of 3968 images were assessed using BRISQUE. Images captured with the Allergan Aesthetic mobile image app had better image quality than those captured using other modalities, as indicated by lower mean BRISQUE scores of 14.05‐19.81 compared with Canfield VISIA-CR with a DSLR (34.47) and the Canfield mobile image capture app (23.43). LCL and FHL were rated both in person and digitally in 68 and 71 participants, respectively (median age 52‐56 y; 48% to 52% female; 75% to 78% White). Interrater reliability between clinician live evaluations and independent photo review of self-captured photos based on intraclass correlation coefficients (ICCs) was substantial (0.61‐0.80) to almost perfect (0.81‐1.00) for all raters (LCL: ICC 0.75‐0.91 at rest and 0.79‐0.89 at maximum contraction; FHL: ICC 0.77‐0.93 at rest and 0.70‐0.89 at maximum contraction). After 2 iterations of improvements, mean usability ratings of the app experience (out of 5) were as follows: easy to complete=3.2, enjoyable=3.1, satisfied with the level of guidance provided=3.2, and likely to complete a full session without exiting=4.1.

The Allergan Aesthetic mobile image app delivers consistent, high-quality images that allow for assessment of LCL and FHL in good agreement with in-person evaluation. Image self-capture using mobile devices may help reduce clinic costs and remove barriers to participation in aesthetic clinical trials.