To enjoy this movie, you need to view it as humorous. I kept thinking about how Tom Six is sitting there in front of me laughing as he's implementing every possible gory and sick idea he has to make me squirm. So, I constantly chuckled at his attempts - which are so apparent. He uses a disgusting looking actor (who did a great job at being disgusting) and a deplorable set to highlight his attempts. It's funny to think that the main character (Martin) loved Six's first MOVIE so much, that he was going to top it - IN REAL LIFE. And, I laughed how Six worked into this movie the actual actress from his first - playing the part of being an actress! Brilliant! Six leaves out so much detail, well he has to, in order to get to the main gore fest, that it's laughable. Martin has no knowledge of medicine or surgery, so he has to use a staple gun and duct tape - really?? Even then, the people had use of their arms and would've (if it were somewhat real) easily broken lose from their "attachments." Yes, of course the idea is super disgusting, and murder and torture is horrible - you just have to realize that this is a movie simply aimed at making you squirm - it's Six's little joke, and it's funny. When I watched it the first time (10 years ago), I thought it was totally foul, and it disturbed me. But, I guess now knowing all the actors were using prosthetic butts, I just saw Tom Six sitting over there getting a kick at trying to disturb me. Well, nice try Tom - it didn't work this time. But, you did get me on the your first move!! That one was truly awful and disturbing (probably because it was more plausible because the main character was a demented surgeon)!