When football players collide in the air, the losses are not always limited to concussion, torn ligaments, or a sprained ankle.

Sometimes an injury is a broken nose — a flow of blood, a few minutes of treatment on the touchline, and perhaps a protective mask and a quick return to play — that turns into a permanent injury causing the player difficulty breathing long after the match ends.

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

Ardesh, who has treated professional athletes including football players, said: 'Sometimes a minor injury from the outside can cause serious damage on the inside.'

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

With many players participating in the 2026 World Cup wearing protective face masks after sustaining jaw or facial injuries, hidden injuries in football are becoming increasingly evident.

Englishman Jed Spence, Austrian Stefan Posch, and Algerian goalkeeper Luka Zaidan all played with protective face masks. Other notable cases recently include Frenchman Kylian Mbappé wearing a mask to protect his broken nose at Euro 2024, and Croatian Joško Gvardiol's protective mask at the 2022 World Cup.

To viewers, the mask may seem like a sign of toughness. But for surgeons like Ardesh, it is often an indicator of the effects of trauma.

Ardesh said: 'The face is very fragile after injury, whether caused by trauma such as receiving an elbow strike or by surgery. We want to protect the bones.'

Ardesh said that facial injuries that occur while playing football can resemble those in boxing or mixed martial arts.

He added: 'People don't think of football as a combat sport. But you watch professional athletes running at full speed and jumping very high. And when you talk about an elbow or shoulder hitting directly on the nose, it is somewhat like receiving a strong punch to the face.'

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

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

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

A broken nose can lead to chronic blockage, deviated septum, long-term breathing problems, or a clearly twisted nose or the need for reconstructive surgery months later if not assessed correctly. For elite athletes, Ardesh said airflow can affect performance.

He added: 'If patients do not have good airflow through their noses, they will not perform at their best.'

He continued: 'The goal of rhinoplasties and septoplasties is not only to improve the aesthetic appearance of the nose but also to ensure they breathe in the best possible way.'

In the moments following a heavy blow, the first steps are to control bleeding and rule out a more serious injury, and to 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 immediate 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 assess fractures in the first hours after injury, and Ardesh stressed that if the injury seems more than a bruise, X-rays 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 broken nose, the doctor may wait one to two weeks for the swelling to subside before realigning the bones. More precise surgery, including rhinoplasty or septal surgery, may be performed after three to six months depending on breathing, appearance, and function.

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

Algerian goalkeeper Luka Zaidan played a World Cup match with a mask (Reuters)

Goalkeepers are particularly vulnerable because they are always colliding with players while trying to save the ball.

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

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

He continued about professional players: 'These are fighters. They do not want to leave the field.'