Six was an original director of Dutch reality TV series Big Brother,[1] which has since become an international franchise.

The first film's success gave Six the flexibility he needed to work on a sequel, The Human Centipede 2 (Full Sequence), eventually leading to a trilogy.

In the United Kingdom, the BBFC declined to issue an 18 certificate for The Human Centipede 2 (Full Sequence), highlighting the antagonist's "total degradation, humiliation, mutilation, torture, and murder of his naked victims".

Tom Six's idea was that each of the three sequences of The Human Centipede can stand on their own as a self-contained film, or they can be connected into a single 4.5 hour-long movie.

[10][11][12] For several years, Six has been attempting to distribute the satirical psychological horror film The Onania Club, originally due in 2017, later delayed to 2019, and with no updated release date.