High Profile Implants can be made to look soft, natural, or very projected
High Profile (HP) implants is a poorly chosen name for an impact that can be used to achieve subtle nuances in breast shape across the entire spectrum of requests. HP implants do not all look fake. This is ridiculous. Surgeons that simplify the complex discussion to this type of summary judgment are ignorant of the number of choices available from the three different manufacturers and have so little experience with HP implants that they have no business pushing you to make a choice based on this incredibly limited information.
Roundness of the upper pole is certainly contributed to by profile. However, if you use a saline HP implant filled to the low end of the range, it will not give you the upper pole fullness. If you want upper pole fullness, first you must use saline HP implants. Second you need to be in the upper end of the fill volume range for whatever implant you choose. Third, the larger the implant, the larger the diameter, the higher the projection, and the larger the surface area. All of these things contribute to upper pole fullness. Lastly, you need to pick a surgeon who has experience in this area.
Now if you look at the silicone implants, even the ultra high profile devices, they don't have nearly the projection as the equivalent volume saline implants. The Sientra HP implants have only 60% of the projection of equivalent HP saline implants. Also, saline implants come in larger sizes. You need to have a complex discussion with your surgeon about the available width, volume and projection of every implant that all of the manufacturers have to find the right one to achieve your goals. You might end up choosing a Mentor, Allergan, or Sientra implant in silicone or saline.
HP implants, which are a more modern shape than moderate profile implants, fit most women better. They have a more appropriate base diameter and can be made to look very natural or very augmented, depending on where in the range the implants are filled to achieve a particular volume. High profile implants are the first choice in my opinion. I rarely find an indication to use moderate or moderate plus implants. The subtlety in the final outcome is not achieved by which profile implant is used, it is determined by the skill in the creation of the pocket, the choice of volume, and where in the range the implant is filled.