When football players collide in the air, the casualties are not always limited to concussions, ligament tears, or ankle sprains.

Sometimes the injury is a broken nose - a flow of blood, a few minutes of treatment on the sideline, and perhaps a protective mask and a quick return to play - turning into a permanent injury that causes the player to suffer from breathing difficulties 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 dangers in football.

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

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

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

Englishman Jed Spence, Austrian Stefan Posch, and Algerian goalkeeper Luka Zidane 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 Joško Gvardiol's protective mask at the 2022 World Cup.

To viewers, the mask may seem like a mark 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 that facial injuries occurring 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 watch professional athletes running at maximum speed and jumping very high. And when you talk about an elbow or shoulder hitting the nose directly, it's 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 prominent part of our face. It is 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 noticeable twisting of the nose or the need for reconstructive surgery months later if not properly evaluated. For elite athletes, Ardesh said airflow can affect performance.

He added: 'If patients don't get 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 following a strong 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, which is 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 deformity.

Swelling can make it difficult to assess fractures in the first hours after injury, and Ardesh stressed that if the injury appears 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 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 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 make a customized plan for each case.'

Algerian goalkeeper Luka Zidane 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 be hit by elbows, heads, or knees. 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 affirmed that players recovering from injury wearing a protective mask is the most logical choice.

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