The rise of anti-ageing medicine is emblematic of the current conditions of American biomedicine. Through in-depth interviews with 31 anti-ageing practitioners, we examine how practitioners strive for—and justify—a model of care that runs counter to what they see as the ‘assembly line’ insurance-managed industry of healthcare. Their motivation, however, is not merely a reaction to conventional medicine. It is derived from what they see as a set of core beliefs about the role of the physician, the nature of the physician-patient relationship, and the function of biomedicine. We analyse this ideology to underscore how anti-ageing medicine is built on a ‘technology of the self’, a self in need of constant surveillance, intervention, and maintenance. The ultimate goal is to create an optimal self, not just a self free of illness. A fundamental irony is that, despite their self-presentation and the perception of the public, anti-ageing providers do not use practices that are especially ‘high-tech’ or unconventional. Instead, the management of ageing bodies rests on providers’ perceived knowledge of their patients, tailored treatments, and a collaborative pact between the provider and patient.