Do high profile implants have more potential to sag? (Photo)

I do not think HP's cause any changes different than other shapes.  I think if you choose a very large volume implant, no matter what shape, they can cause problems because of the overall weight.

High profile implants apply more stress to your breast tissue and give more atrophy over time. Your initial heavy implants settled down, or bottomed out, because of too much weight on your tissue. Going smaller will decrease the amount of stress on your now thinned tissue. Alloderm will help give more tissue and support to that weak area. Your surgeon who has examined you will be the best one to discuss what size and profile implant might work best for you.

I am doing a revision for lateral drift, rippling, and bottoming out. I have 600 cc hp silicone unders. 
I have to assume that you have thin skin.  Where is the rippling? Is it at the bottom of the implant? Alloderm will definitely help mask the rippling.
I am going to 485 cc silicone unders. We are also doing a capsulorrhaphy and using Alloderm.
Is this all on the left side?  It appears that you may be lengthening on the right also (greater than 7 cm from nipple to infrmammary fold). Talk with your doctor and see what he/she thinks.
I am leaning towards inspira hp. My doc thinks we should drop down to moderate. And I am wondering what benefit that would have. 
The natrelle implants will be off the market in the future.  Allergan is finding more success with higher volume cohesive gels.  This means that if you have a sac and you are filling it with silicone.  Not only are they filling it with more silicone, they are making the silicone more and more like a semi solid rather than a liquid.
Is there a higher risk of displacement or sagging with high profile? 
No
Is there worry about tissue atrophy bc I have little breast tissue? 
If it is under the muscle, I have not seen tissue atrophy in my practice.
I'd like to stick to hp if I can.
Have the discussion with your Plastic surgeon and come up with a mutual plan.
I hope this helps

High profile breast implants have more volume per breast implant unit than do the moderate-plus and moderate profile implants. Thus more stress is placed on the patient's natural breast tissues to support the larger volume implant (high profile).  This will sometimes lead to implant malpositions. I have not, however, experienced more sagging with high profile versus moderate plus profile breast implants.
Every case and every patient is different in their revision surgery needs,  This is why a formal exam is needed to specifically answer your question.  I strongly recommend you listen to your plastic surgeon's recommendations.  They sound very appropriate to your situation you describe here. Wishing you a very successful final outcome.

I would say that the extra implant volume (and weight) going to HP with the same base diameter as a smaller volume mid profile implant would put more stress on your tissues (at least theoretically).  Whether this has a profound clinical effect or not is unclear in my mind but I often advise patients to consider the more natural proportioning of a mid or mid-plus profile implant in making their choice.  Larger implants do result in lower pole and general breast tissue thinning over time, especially with capsular contracture present or a history of multiple pregnancies and tissue stretching and thinning.  Therefor the advice to consider smaller rather than larger implants in the setting that you're describing.  
Please view the attached video for additional information and my perspective on large implants.
Best wishes,
Jon A Perlman MD FACS 

Certified, American Board of Plastic Surgery 

Member, ASAPS, ASPS

Extreme Makeover Surgeon, ABC TV

Best of Los Angeles Award 2015, 2016 

Beverly Hills, Ca