At the end of the day nobody really knows what this guys doing. Pecs are not implants though.
However, for guys who are deep into bodybuilding (most of us are not and would never want to look like that) you can understand the cult following. The guy is old but he is freaking massive (he not aiming to get on the stage) and no matter what you say he does not look that bad walking around in normal gym attire.
As for pmma in arms and implants and all the other nonsense, who really cares. You guys act like using GH, Insulin, AAS, IGF etc.. is all normal yet synthol and PMMA is bad. Its such a ridiculous double standard.
The guy might look dumb and some of his decisions for his body might be dumb (which he has said many times - obviously their is an underlying psychological issue and insecurity) he is actually pretty smart with his marketing, targeting his audience and getting sales. The guy is doing the best in his world and just because we don't live in that world does not mean everything about it is shitty. He is making money and exposing the industry at the same time - he seems pretty honest in most of his videos unlike all the other bullshit we have read for decades.
Overall does not seem like that bad a guy and his physique for a 44 year old man looking for that particular look is decent. Guaranteed most of you guys on Getbig (included me) look like shit next to Piana (and that's not saying much).