Excess lipofuscin deposition in tissues is a phenomenon observed in normal aging. The amount of lipofuscin in myocardium, liver, skeletal muscle, and adnexal skin structures varies considerably with age and increases in older individuals. In addition, lipofuscin deposition occurs in association with specific, non-age-related processes; these include melanosis coli, the so-called brown bowel syndrome, and the black thyroid. Localized lipofuscinosis has also been described in the gallbladder, esophagus, and fallopian tubes. The present article adds lipofuscinosis vesicalis to the list of entities characterized by focal lipofuscin deposition. All cases have a characteristic gross appearance that is somewhat variable from entity to entity and in some cases may suggest clinically an ominous pathologic process.