Perhaps the most haunting design, Big Brain featured a massive, hydrocephalic cranium. Nicotero’s team had to balance the sheer size of the prosthetic with the practical needs of the actor, ensuring the "weight" of the mutation was visible on screen.

Nicotero's involvement with began in the late 1970s, when he was working as a special effects artist for Craven's production company. At the time, Nicotero was just starting to make a name for himself in the industry, having worked on films like The Texas Chain Saw Massacre and The Hills Have Eyes ' predecessor, The Hills Have Eyes 2 .

Nicotero's most significant contribution to the film was the creation of the mutant family, known as the Papa Jupiter and his clan. The creatures were designed to be both terrifying and pitiful, evoking a sense of unease and sympathy from the audience. The makeup designs were achieved using a combination of latex prosthetics, foam latex, and painted-on blood.

Nicotero's work on showcased his mastery of practical effects. Using techniques such as prosthetic makeup, animatronics, and pyrotechnics, Nicotero created a world that was both believable and terrifying.

Today, the 2006 remake remains a high-water mark for the genre, and Nicotero’s work is the primary reason the film continues to haunt the nightmares of viewers nearly two decades later.