When soccer players collide in the air, the damage is not always limited to concussions, torn ligaments, or ankle sprains.

Sometimes an injury that appears to be just a broken nose—flowing blood, a few minutes of treatment on the sidelines, and perhaps a protective mask and a quick return to play—turns into a permanent issue that leaves the player struggling to breathe long after the match ends.

Dr. Farhad Ardesh, a facial plastic and reconstructive surgeon in Beverly Hills, says this risk remains one of the most underappreciated in soccer.

Ardesh, who has treated professional athletes including soccer players, said: 'Sometimes a minor external injury can cause serious internal damage.'

He added: 'The nose may look slightly swollen or a bit twisted, but the inside actually has a zigzag pattern or an S-shaped deformity that really affects that player's breathing.'

With many players set to wear protective face masks at the 2026 World Cup after suffering jaw or facial injuries, hidden injuries in soccer are becoming increasingly apparent.

England's Jed Spence, Austria's Stefan Posch, and Algeria goalkeeper Luka Zidane have all played with protective face masks. Other notable recent cases include France's Kylian Mbappé wearing a mask to protect his broken nose at Euro 2024, and Croatia's Joško Gvardiol's protective mask at the 2022 World Cup.

To viewers, a mask might seem like a sign of toughness. But to surgeons like Ardesh, it often indicates the aftermath of trauma.

Ardesh said: 'The face is very fragile after an injury, whether from trauma like an elbow strike or from surgery. We want to protect the bones.'

Ardesh said facial injuries sustained during soccer can resemble those in boxing or mixed martial arts.

He added: 'People don't think of soccer as a combat sport. But you watch professional athletes running at top speed and jumping very high. When you talk about an elbow or shoulder hitting the nose directly, it's somewhat like taking a strong punch to the face.'

He noted that the ball itself is rarely the main cause; injuries often come from heads, shoulders, elbows, knees, feet, or falls.

The nose is particularly vulnerable due to its position and structure.

Ardesh said: 'The nose is the prominent part of our face. It's the first thing likely to receive any kind of impact.'

A broken nose can lead to chronic obstruction, deviated septum, long-term breathing problems, or a clearly twisted nose, and may require reconstructive surgery months later if not properly evaluated. For elite athletes, Ardesh said airflow can affect performance.

He added: 'If patients don't have good airflow through their noses, they won't perform at their best.'

He continued: 'The goal of rhinoplasty and septoplasty is not just to improve the nose's aesthetic appearance but also to ensure they breathe as well as possible.'

In the moments immediately after a hard blow, the first steps are to control bleeding, rule out a more serious injury, and lean forward to prevent blood from flowing down the throat.

Once the athlete reaches a specialist, a septal hematoma—bleeding inside the wall that divides the nose—is one of the urgent concerns.

If left untreated, it can cut off blood flow to the cartilage and cause a saddle-nose deformity.

Swelling can make it difficult to evaluate fractures in the first hours after injury, and Ardesh emphasized that if the injury appears to be more than a bruise, X-rays or scans will be needed to check for fractures of the eye socket, cheekbone, or jaw, as well as a concussion.

In the case of an isolated nasal fracture, the doctor may wait one to two weeks for swelling to subside before realigning the bones. More precise surgery, including rhinoplasty or septoplasty, may be performed three to six months later, depending on breathing, appearance, and function.

He said: 'The goal for these players is to return to the field. But we need to evaluate all injuries and create a customized plan for each case.'

Algeria goalkeeper Luka Zidane played a World Cup match with a mask (Reuters)

Goalkeepers are particularly at risk because they are constantly colliding with players while trying to save the ball.

Ardesh said: 'They can get hit by an elbow, head, or knee. They are at higher risk of direct impact to the face.'

However, he does not expect mandatory facial protection to gain widespread acceptance in a sport that relies on speed, wide vision, and comfort. He stressed that players recovering from injury wearing a protective mask is the most sensible option.

He added about professional players: 'These are fighters. They don't want to leave the field.'