‘The Pitt’ Makeup Head Unpacks the Show’s Goriest Moments, From a Bloody Head Flap to Tongue Lacerations

“The Pitt’s” department head makeup artist Myriam Arougheti knew that after the success of the show’s first season, she would have to step things up a notch for season 2.

The first season featured heart attacks, third-degree burns and an emergency thoracotomy. For Season 2, the challenge was to push boundaries and elevate the drama for the doctors at Pittsburgh Trauma Medical Hospital.

Arougheti worked on another thoracotomy procedure, a scalp laceration following a firework injury, margarita burns and much more. In episode 2, a patient’s cast is cracked open to reveal a maggot infestation. “The maggots were gross,” she chuckles.

Arougheti told Variety, “It’s always the excitement of blowing people’s minds in a different way.” Here she breaks down the makeup secrets behind some of the season’s goriest moments.

A clamshell thoracotomy – Episode 1

There was no holding back when the new shift started. A patient is wheeled into the trauma center after being stabbed in the chest with a kitchen knife. When his heart stops, it’s Dr. Garcia (Alexandra Metz) who has to perform the thoracotomy.

“We open everything up,” Arougheti says. The challenge, however, was to make it look realistic in terms of skin quality. “There are a lot of adjustments in the design, and making sure the silicone has the right amount of flexibility,” she explains. Arougheti notes the torso is fake, but where possible, she wanted to use as many real body parts as possible. “We’ve got the head and the arms. But it’s all angles. The actor is hidden in this fake gurney.”

Margarita burns – episode 8

In episode 8, a patient is brought in suffering from “margarita burns.” “I didn’t know that could happen, and that’s a scary thing,” Arougheti jokes.

But it’s very real. Margarita burns occur when parts of the skin that have been exposed to both citrus fruit and sunlight develop an extreme form of sunburn.

Arougheti admits this was the one that grossed her out as she spent time looking at pictures while she thought about what the design would be like. “There was nothing practical. It was just makeup, and that takes hours to apply,” she says.

The blisters were made from silicone by Autonomous Effects. “We wanted different sizes and in different shades of opaque, and then it’s a paint job. There’s some airbrushing and hand-painting. We’ll use little things like Vaseline or KY jelly for a little shine, to give different dimensions and texture,” she says.

The challenge was walking a fine line of making it look realistic without it appearing comical. “We do lots of tests. On this particular makeup, we added something at the end, a little element that the doctor wanted to see, and it got to set, and I was like, ‘Nope, it doesn’t work. It doesn’t look right.’ I said I needed 10 minutes, and we were able to make the adjustment, and it was great.”

The head flap – episode 12

Arougheti asks, “Do you remember our head flap? That was pretty gnarly.”

She’s not wrong. In episode 12, Dante (Shane Nelson) suffers a head trauma after a fireworks explosion in a storage unit goes wrong. “He has a whole laceration, and we reveal this big head flap,” Arougheti says.

The makeup required arteries gushing blood onto the doctor’s face, hair shaving, and sutures. Arougheti says it was a bit challenging. “We had that [flap] piece on the actor. We wanted to suture on camera, so you had to have enough protection not to poke him. Again, it was lots of tests and brainstorming to achieve that build so we could do that gag on camera.”

How long did something like that take to build? A whopping six weeks.

“You do a cast of the head, and so it has to fit. Then you have to punch hair, and it has to match his real hair in areas. It’s a long process and it takes time. There’s no hiding.”

Brandon’s knee – episode 6

On episode 6, Brandon (John Squires) is brought in with a knee laceration. The idea was to create a blended piece on the actor’s knee.

“This was the gag where they check if the damage was in the nerves and they put this liquid that glows in the dark, and if it comes out of the wound, then it’s bad, and he has to have surgery, and if it doesn’t, then he’s fine. We can just sew it up, and it’s all good.”

Arougheti explains that the one thing that people get really freaked out about is when a needle penetrates the skin. But Noah Wyle decided to switch things up a little. “He wanted to see that giant syringe going in. Well, can’t do that, obviously, so we had to quickly build a leg and rerun the appliance and lay that on the fake leg.”

The challenge however was that because the fake leg was made from foam, Arougheti had to “build a channel inside that follows the injection point where the liquid would just go in that channel, otherwise this real fluorescent liquid would go everywhere in the foam leg, and the whole leg would glow on in the dark.” She goes on to explain, “We created this channel, and the actor had to poke in that exact spot, so that it would go into that liquid.”

The suturing was also challenging because it needed to be an eight shape. The silicone needed to be hard enough to hold everything that was an open wound and “soft enough that it pushes in the middle and it creates this eight.” She adds, “It’s all about the flexibility of the silicone.”

Tongue laceration – episode 8

A retainer was the key to this makeup. “We built multiple tongue sizes that were sewn onto a retainer,” she says. Because the tongue was applied to a retainer, it allowed the actor to move and react. When the doctor cut into her,  it was a case of having a longer tongue. “They were able to stitch it.” Arougheti says with confidence, “Nothing’s hurting her.”

A gory birth – Episode 15

What better way to end the season than with a wild pregnancy? Nicole is wheeled in with swollen ankles and high blood pressure. When she starts having seizures, the doctors decide to give her an emergency C-section.

The makeup required multiple elements. “We had a blended prosthetic belly on her that was glued down for all the scenes up until the actual cut.” But because the patient was constantly rolling on her side, Arougheti says, “We had to be strategic in where we put the edges so that it wouldn’t be obvious.”

In addition to the belly, there were swollen ankles. “She was in the makeup chair for multiple days; five hours for the belly and the swollen ankles.”

When it came to the stomach cut and liquid oozing out, Arougheti said it took multiple tests to figure out what to do. The baby also needed to be covered in the goopy white substance known as vernix — for which cream cheese made a perfect dupe. But the challenge was that with every take, the whole pregnancy needed to be reset. “There were six or seven of us, and every person had one specific job: fill the uterus, goop up the baby, close the uterus.” She adds, “It was crazy.”