Scaled rolling contact fatigue tests, used to practically simulate the wear of the wheel and rail material under laboratory conditions, are typically classified into two categories. Tests in the first category use twin-disc stands, while the second group of test rigs use two discs of different diameters considering the rail disc as the larger one. The latter setup is closer to the real situation, but problems can occur with high contact pressures and tractions. The focus of this paper is on two main contributions. Firstly, a case study based on finite element analysis is presented, allowing the optimization of the specimen geometry for high contact pressures. Accumulated plastic deformation caused by cycling is responsible for abrupt lateral deformation, which requires the use of an appropriate cyclic plasticity model in the finite element analysis. In the second part of the study, two laser profilers are used to measure the dimensions of the specimen in real time during the rolling contact fatigue test. The proposed technique allows the changes in the specimen dimensions to be characterized during the test itself, and therefore does not require the test to be interrupted. By using real-time values of the specimen’s dimensional contours, it is possible to calculate an instantaneous value of the slip ratio or the contact path width.