Their job is *not* mechanical filtration. A UGF should always be accompanied by another filter employed for this purpose.
Their job *is* to perform biological filtration....and they do this very well. I can clean every part of my aquarium, from the uplift tubes to decor to the casing on my power filter, replace all media, and still have no worries of ammonia spike. Obviously this kind of cleaning isn't required (or recommended!!), but I'm secure that w/ a UGF my bio-filter is always intact.
To those that do run UGF's, do be sure that your air pump is in working order...this is the fuel to your filter.
Airstones may need replacing on occasion...but often they just need a cleaning...blowing them out in a glass of water works.
My pleco has lived w/ UG filtration for many years.
Downside: apparently requires more work. Not lived 'on the other side', but as I understand, they require more cleaning. I *think* in tanks w/out UGF's you only need gravel-vac maybe the top inch or so of gravel...while w/ UGF you need to be a little more thorough. Some claim you need to clean beneath the plate, say every 5yrs or so. (I'm personally not convinced of this.)
And you do lose a little bit of room. Couple inches off the bottom, and on occasion I've eyed them tubes bein' in the way of my desired decor
....but then I've a small tank to begin with (2ft).
While I'll agree a tank w/ sand substrate looks nice to be sure (and most seem pleased w/ the switch), I don't find a tank w/ gravel bed to be particularly ugly. But, true...sand & UGF's don't mix. By the same token, if it's plants you desire, UGF not the way to go...tho apparently possible w/ some plants.