This was first time Gary Mosher and Costas Mandylor worked together, Gary worked with brother Louis Mandylor in Jack of Hearts
In the original screenplay, it was Becca's (Caylee Cowan) character that had the botched plastic surgery done to her and Alexa (Korrina Rico) was merely reactive to it. It was decided during filming that the surgery happen to Alexa due to it being her biggest fear. Some of Becca's lines still reflect her reaction to being scarred despite her not having the surgery in the final film, as well as lines indicating that Philip (John Wallbank) was obsessed with Becca, not Alexa. This also explains why Becca disappears for a large portion of the film.
Dr. Cunningham is a reference to writer Chris Kato's friendship with horror icon and Vendredi 13 (1980) director/producer Sean S. Cunningham.
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