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

Sometimes an injury like a broken nose - blood flow, a few minutes of treatment on the sideline, and perhaps a protective mask and a quick return to play - can turn into a permanent injury that leaves the player struggling to breathe 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 inside.'

He added: 'The nose might look a little swollen or slightly bent, but the inside actually has a zigzag pattern or an S-shaped deformity that really affects the 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 France's Kylian Mbappé wearing a mask to protect his broken nose at Euro 2024, and Croatia's Josko 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 an injury, whether from trauma like an elbow strike or from surgery. We want to protect the bones.'

Ardesh said 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 see professional athletes running at top speed and jumping very high. And 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 location 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 visibly crooked nose or the need for 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 in the best possible way.'

In the moments after 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—bleeding inside the wall that divides the nose—is an urgent concern.

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 appears more than a bruise, X-rays or scans are needed to check for fractures in 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 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 customized plan for each case.'

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

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

Ardesh said: 'They can get 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 wide acceptance in a sport that depends on speed, wide vision, and comfort. He stressed that players recovering from an injury wearing a protective mask is the most logical option.

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