- Cast the Expert: The actors playing Le Tenia and Mick (the guy Marcus mistakes for Le Tenia) are played by professional boxers-turned-actors so they would appear physically imposing but also have the body control to not hurt their co-stars. Joe Prestia (Le Tenia) was the world champion Thai boxer three years in a row and a one-time kick boxing champion in 1993. His appearance is the result of all the beatings he took during his 85 matches.
- Channel Hop: From Lions Gate Films to Altered Innocence.
- Completely Different Title: Released in Japan with Alex as the title.
- Enforced Method Acting: Monica Bellucci claims the easiest take of the rape was the first one to do, because she didn't know exactly what would happen.
- Follow the Leader: Meta: an integral part of Noé finding financing for the film while pitching it was its reverse chronological form, which he said would capitalize on the popularity of the similarly experimentally-structured Memento.
- Real-Life Relative: Monica Bellucci and Vincent Cassel, who played lovers, were married when they shot the movie.
- Referenced by...: The music video for Maroon 5's "Maps" is a direct homage to the film, according to the band's bassist. It uses the exact same story cuesnote and reverse narrative structure, alongside very similar camerawork and graphic violence (although the girl in question is hit by a car instead of assaulted).
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