Why I Stopped Offering LipiFlow (and What I Use Instead)
I used to offer LipiFlow in my practice. I don't anymore.
If you've been researching treatments for meibomian gland dysfunction, you've probably seen LipiFlow come up. It's one of the best-known in-office dry eye treatments, and it's heavily marketed. So I want to explain, as a dry eye specialist, why I stopped offering it and what I use instead.
What both treatments do
Most dry eye isn't really about a lack of tears. It's about the oil layer that keeps tears from evaporating. That oil comes from tiny meibomian glands in your eyelids. When those glands get clogged, the oil thickens, your tears evaporate too fast, and your eyes burn, sting, feel gritty or get blurry by the end of the day. If you spend hours on screens, you blink less, and the problem gets worse.
LipiFlow and radiofrequency (RF) share the same basic goal: warm the eyelids enough to melt that thickened oil so the glands can drain and work again.
Both are thermal treatments: they use heat to do the work. The big difference is flexibility. LipiFlow pairs heat with pulsing pressure on the eyelids (what its maker calls thermal pulsation), and it runs the same preset cycle for every patient. With RF, I can customize the treatment, adjusting the temperature, how long I treat and which parts of the eyelids get the most attention, based on your glands and how you respond.
They also differ in how well the results hold up and what they cost.
Why I stopped offering LipiFlow
The results didn't last the way the marketing says. LipiFlow is advertised as a single treatment with results that last about a year. That was not what I saw in my own patients, or in my own eyes. I have dry eye myself, and I've had LipiFlow. It did not last a year for me either.
The evidence behind the one-year claim is thin. When I looked closely at the study the one-year claim is based on, I found it much weaker than the marketing suggests. I don't think it's a strong enough basis for patients to plan around.
The cost is hard to justify for a chronic condition. LipiFlow typically runs $800 to $1,000 per treatment, usually out of pocket. Meibomian gland dysfunction is chronic. Most people need ongoing maintenance, not a one-time fix. If the results fade in months rather than a year, that price adds up quickly, and many patients simply can't keep up with it.
What I use instead: radiofrequency (RF)
Radiofrequency is a well-established treatment for meibomian gland dysfunction. It uses controlled radiofrequency energy to gently heat the eyelids from the outside, warming the glands and the tissue around them so the thickened oil can melt and flow.
Here's how I do it:
• I treat directly over the oil glands in the eyelids, with a protective shield in place to keep the eye itself safe. Because the heat goes right where the glands are, I can express them while they're warm: heating and clearing them at the same time. Many providers apply RF periorbitally, around the eyes rather than over the glands, which in my experience is much less effective.
• I tailor the temperature, treatment time and focus areas to each patient, and adjust from session to session based on how your glands respond.
• Most patients describe it as a warm, comfortable sensation, like a heated mask that actually reaches the glands.
• Expressing glands while they're heated clears thickened oil far more easily than pressing on cool glands.
• Treatment takes about 3 minutes per eye and is followed by manual expression, with no downtime. You can go right back to work.
In my experience, the results with RF have been better than what I saw with LipiFlow.
What it costs
A single RF session in my office is $325. Like every dry eye treatment, how many sessions you need and how well it works depend on how severe your disease is. We'll map that out together at your evaluation.
| Lipiflow | RF in my office |
Cost | $800–$1,000 per treatment | $325 per session |
Typical plan | Single treatment, often repeated | Number of sessions based on severity |
Downtime | None | None |
The lower per-session cost means you can treat on the schedule your glands actually need, instead of rationing an expensive treatment.
Why so many people "fail" LipiFlow
Here's something that rarely gets explained: heat-and-express treatments like LipiFlow and RF only work for obstructive MGD, where the oil glands are clogged and the oil can't get out. Heat melts the blockage, and expression clears it.
But not all MGD is obstructive. In non-obstructive MGD, the glands aren't blocked. The problem is the oil itself, or inflammation around the glands. There's nothing for heat and pressure to clear, so these treatments won't help much.
I see many patients who "failed" LipiFlow, and many of them turn out to have non-obstructive MGD. LipiFlow didn't fail them so much as it was the wrong tool. For non-obstructive MGD, I use IPL, which targets the inflammation driving the problem.
This is why an accurate diagnosis matters before choosing any in-office treatment. Knowing which type of MGD you have tells us whether RF, IPL or a combination is right for you.
Is RF right for you?
RF tends to be a good fit if:
• You have obstructive MGD, meaning your oil glands are clogged
• Drops, warm compresses and lid hygiene haven't been enough
• You want an in-office option you can repeat without a huge bill each time
It's not the answer for everyone. Dry eye has many causes, including inflammation, Demodex mites and autoimmune conditions, and the right treatment depends on what's actually driving yours. Sometimes RF works best combined with other treatments, like IPL. That's why every plan in my office starts with a thorough evaluation.
The bottom line
I stopped offering LipiFlow because, in my patients, the results didn't last as advertised, the evidence for the one-year claim was weak, and the cost was hard to justify for a condition that needs ongoing care. RF has given my patients better results at a price they can sustain.
If you're in the Denver area and you've been told LipiFlow is your next step, or you've tried it and your symptoms came back, I'd be glad to see you. Book a dry eye evaluation and we'll figure out what your glands actually need.
