Over 2 million dermal filler procedures are performed each year in the USA alone, and this figure is only expected to increase as the aging population continues to grow. Dermal filler treatments can last from a few months to years depending on the type of filler and its placement. Although adverse reactions are rare, they can be quite severe due to ischemic events and filler migration. Previously, techniques such as ultrasound or magnetic resonance imaging have been used to evaluate the filler injections. However, these techniques are not practical for real-time filler injection guidance due to limitations such as the physical presence of the transducer. In this work, we propose the use of optical coherence tomography (OCT) for image-guided dermal filler injections due to the high spatial and temporal resolution of OCT. In addition, we utilize a noncontact optical coherence elastography (OCE) technique, to evaluate the efficacy of the dermal filler injection. A grid of air-pulse OCE measurements was taken, and the dynamic response of the skin to the air-pulse was translated to the Young’s modulus and shear viscosity. Our results show that OCT was able to visualize the dermal filler injection process, and that OCE was able to localize the dermal filler injection sites. Combined with functional techniques such as optical microangiography, and recent advanced in OCT hardware, OCT may be able to provide real-time injection guidance in 3D by visualizing blood vessels to prevent ischemic events.