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You can customize buttons in interactive studio, but you can also do so through code.
Here is an example of setting the background image of a button:
MixerInteractive.GetControl("myButtonControlID").SetProperty(InteractiveControlProperty.BackgroundImage, "https://www.website.com/image.png");
You can customize many more properties. The full list of properties can be found in the InteractiveControlProperty enumeration.