Marionette lines are caused by the breakdown and reduction of collagen. As collagen decreases as we age, our skins’ ability to bounce back also decreases. With marionette lines specifically, genes are also a major culprit. Although everyone gets wrinkles as they age, marionette lines generally run in the family. Lifestyle choices that impact skin health are also a factor. For instance, sun exposure, poor diet, excessive alcohol consumption, and smoking can all exacerbate the appearance of marionette lines as these all contribute to a decrease in collagen and skin elasticity.