When football players collide in the air, the costs are not always limited to concussion, torn ligaments, or sprained ankles.

Sometimes the injury is a broken nose - blood flow, a few minutes of treatment on the sidelines, and perhaps a protective mask and a quick return to play - that turns into a permanent injury causing the player to suffer breathing difficulties 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 football.

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

He added: 'The nose may look slightly swollen or a little crooked, but the inside actually has a zigzag pattern or an S-shaped deformity that truly 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 Zidan have 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 Josko Gvardiol's protective mask at the 2022 World Cup.

For 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 from trauma like an elbow strike or from surgery. We want to protect the bones.'

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

He added: 'People don't think of football as a combat sport. But you see 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 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 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 visible nasal deformity, or require reconstructive surgery months later if not properly assessed. 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 only to improve the aesthetic appearance of the nose but also to ensure they breathe as well as possible.'

In the moments after taking a hard hit, 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 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 emphasized that if the injury seems more than a bruise, X-rays are needed to check for fractures of the eye socket, cheekbone, or jaw, as well as concussion.

In the case of an isolated nasal fracture, the doctor may wait one to two weeks for swelling to subside before resetting the bones. More precise surgery, including rhinoplasty or septoplasty, 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 create a personalized plan for each case.'

Algerian goalkeeper Luka Zidan 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 may be hit by elbows, heads, or knees. They are at higher risk of direct impact to the face.'

However, he does not expect mandatory face 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 reasonable option.

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