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Make sure to cut the figure itself and not the cords that bind it to the surgical tray. The ensuing animation should be of the figure falling lifeless to the ground, as opposed to it being freed and subsequently melting into the tray. If you did exactly that and the achievement still wasn't unlocked, my advice is to exit the game and then try again — as trivial as it might seem, this method does occasionally work.
Hey, thank you for your comment. The testing I had done showed that one should be able to reach the ugly ending even when making a couple of choices that count towards the evil ending, and vice versa. I will look into Acephalus specifically, though.
As for having to restart the game, I can confirm that I also did encounter a bug where beginning a new run through the user interface on the end screen of the game would more often than not bring the evil ending about, regardless of the decisions made during that run. Considering someone else might experience the same issue, I have now included this information in the guide.