I can only speak for Canada and for me, no, I have no extra cellular charge. It piggy-backs off of my iPhone. I am quite glad I bought the cellular version because it means I do not have to pack my iPhone, now an Xr, everywhere I go or dig it out of a pocket to use Apple Pay. Especially lately here where we had a cold streak of -40˚ Celsius and digging for deeply buried pockets was a challenge.
My first Apple Watch was a 44mm Series 4. I am a pretty big guy, 6’ 2" and about 230lbs on a good day so I needed the extra real estate the 44mm offered. I am senior and have had double cataract surgery so now have no ability to focus close up and the bigger watch face has proved the proper choice for me.
The fall detection feature in the S4 was a main motivation for me to buy the S4. After fighting a number of health issues I struggled with maintaining balance a lot so knowing if I fell and could not get up that I could get help called was enormously reassuring. I know this was discussed a lot last year on TidBITS and I can say that I too had a few false fall alerts early on in owning the S4. It is almost unfair to call them false alerts because the times it occurred were when I had slipped rather severely and then regained balance and one, which was rather odd, when I had to park sideways on a rather steep sloping parking area with the driver’s door on the down side. Regardless, after a few early on false alerts the S4 seems to have developed a basic threshold and I have had no false alerts for well over a year.
Being a Canadian the ECG feature was slow to gain approval here. I have to guess but think it would have been approved and available on the Apple Watch in April or May of 2019. While I have not had to put it to the test as far as using it to determine if I should get medical help it does appear to do the jobs it promised and gives me a certain level of comfort to see satisfactory results.
Apps were definitely not top of the list for my Apple Watch but I do use a few 3rd party Apps, mostly health and/or sleep related, along with 1Password, Tile, Overcast, IFTTT and a control access for my home alarm system.
I have stayed with silicone bands and have found them quite comfortable. I bought a few random, inexpensive bands on eBay to try some out without buying more expensive bands to only find I did not like them. I remain quite satisfied with my choice to buy that way.
Mine is an aluminum model and I have had no issues with scratches or any other blemishes so would find it hard to justify the extra cost to buy a stainless steel model. At the moment I have no reason to upgrade and really can’t imagine what new feature it would take for me to consider an upgrade. Maybe by Apple Watch 6 or 7 I will change my mind.
Another poster mentioned the Noise App. It is also available on the S4 and I do have it “on” and set to a 90 decibel threshold. I have never received a single Notification so may adjust the threshold.