Vascular malformations commonly occur in the facial region, and can be associated with significant stigma and embarrassment. Studies have shown that even recommended light-based treatments do not always result in complete clearance. This indicates the need for more accurate pre-treatment assessment of vessel morphology to optimize treatment settings and identify possible morphological predictors of the outcome. Fourteen patients (six males, eight females, and aged 37–66 years) with the diagnosis of telangiectasias were enrolled and were all scanned with OCT and digitally photographed before and minutes after IPL treatment. OCT images of the telangiectasias before treatment were displayed as hyporeflective/signal poor bands clearly demarcated from the surrounding tissue. Minutes after treatment, OCT images demonstrated two different reactions. (1) Narrow hyperreflective bands surrounding the vessels, which may indicate edema or insufficient coagulation. (2) Hyperreflective signals within the lumen of the vessels, compatible with the expected irreversible microthrombus formation in the vessels. OCT imaging is capable of real-time assessment of tissue damage during light and laser treatment, including visualization of the perivascular changes. This may offer a more dynamic, more complete understanding of the efficacy and potential outcome of the treatment process. It is hypothesized that these immediate changes may correlate to longer-term treatment outcome.